Role of Synovial Fluid Examination in Diagnosis of Joint Diseases EC06-EC09
Dr. Vibhuti Goyal,
E-22, Faculty Residence, Rohilkhand Medical College and Hospitals, Bareilly-243006, Uttar Pradesh, India.
E-mail : email@example.com
Introduction: Joint effusion is a common clinical problem resulting from various inflammatory and non-inflammatory conditions. Synovial fluid analysis is one of the most important diagnostic tests to classify the type of effusion.
Aim: To assess the role of synovial fluid analysis in the diagnosis of joint diseases and also to assess the pattern of arthritis in tertiary care centre.
Materials and Methods: A total of 100 samples of synovial fluid were examined. Synovial fluids were subjected to gross examination for colour, viscosity, appearance, wet mount preparation, total and differential leukocyte count, microbiologic assays and crystal analysis by polarised microscopy.
Results: Out of 100 samples analysed, Effusion was non-inflammatory in 32 (32%) cases, inflammatory in 46 (46%) cases, infective in 10 (10%) cases, traumatic in 3 (3%) cases, crystal induced in 3 (3%) cases, normal in 4 (4%) cases and non-diagnostic in 2 (2%) cases. The majority of cases were of osteoarthritis 22 (22%), then rheumatoid arthritis 16 (16%), tuberculous arthritis in 6 (6%) cases, septic arthritis in 4 (4%) cases, gout in 3 (3%) cases and traumatic arthritis in 3 (3%) cases. 10 (10%) cases were of non-inflammatory arthritis-not otherwise specified and 30 (30%) cases were of inflammatory arthritis-not otherwise specified. A total of 4 (4%) cases were normal and 2 (2%) cases were non-diagnostic. Total leukocyte count was found to be highest in septic arthtritis (60,000-78,000 cells/mm3) and lowest in osteoarthritis (120-23,00 cells/mm3). Polymorphs were highest in septic arthtritis (95%) and lowest in non-inflammatory conditions like osteoarthritis (23%). Sensitivity and specificity for gross examination to differentiate between inflammatory and non-inflammatory conditions was 0.91 and 0.70 respectively while it was 0.94 and 0.86 respectively for white blood cell count.
Conclusion:Synovial fluid analysis is a simple procedure. The study of synovial fluid is a tool that allows the establishment of diagnosis and treatment of patient with joint diseases. Gross examination, total leukocyte count and differential leukocyte count accomplish well to differentiate between various inflammatory and non-inflammatory arthritis and also to diagnose septic arthritis.