J Korean Orthop Assoc.  1970 Mar;5(1):7-16. 10.4055/jkoa.1970.5.1.7.

Synovial Fluid Analysis as a Diagnostic Aid in Arthritis

Abstract

Extensive knowlege of the characteristics of synovial fluid has been available for at least the past 30 years, when a Monograph on the subject by Kling first appeared in 1938. Since that time, Ropes, Bauer(1953) and Hollander (1960, 1961, 1965) have published classic. Monographs on their extensive studies and findings of synovial fluid. Specific laboratory tests for diagnosis of various forms of arthritis are usually lacking. For example, the test for the rheumatoid factor in serum may be helpful in establishing the diagnosis of rheumatoid arthritis, but these are often negative in early cases and L. E. phenomenon is often negative in the early stage or between severe exacerbations of the Systemic lupus erythematosus. It has become increasingly clear during the past 10 years that synovial fluid analysis is both the most valuable and yet the most neglected differential diagnostic test for arthritis. Studies of synovial fluid have presented a virtually unexplored frontier in the investigation of arthritis. So, we studied the synovial fluid from 100 cases of various forms of arthritis in the Department of Orthopedic Surgery, Severance Hospital from May, 1968 to May, 1969. 100 cases of arthritis are; 30 cases of Osteoarthritis, 20 cases of Traumatic athritis, 25 cases of Rheumatoid arthritis, 10 cases of Septic arthritis, 5 cases of Tuberculous arthritis, and 10 cases of Non-specific bursitis. The synovial fluid were aspirated from the involved joints in aseptic conditions and follwing studies were done. 1) General appearance. 2) Mucin content by Acetic acid PPT. or Ropes test. 3) Viscosity by Drop test. 4) Cell count by Wright s stain. WBC: Total and differential count. RBC count. 5) Synovial sugar by Folin Wu method. 6) Fasting blood sugar by Folin Wu method. 7) Sugar difference between synovial sugar and Fasting blood sugar. 8) Total protein by Kingsley s Biuret method. 9) Bacterial culture in Septic arthritis. 10) Microscopic examination. RA cells by Sternheimer-Malbin stain in Rheumatoid arthritis. Cartilage fragments with simple wet preparations in Osteoarthritis. 6 kinds of arthritides were grouped into 3 categories based on the degree of inflammation of the synovial membrane as reflected by synovial fluid changes according to Ropes and Bauer s classification(1953). The first group, consisting of Osteoarthritis and Traumatic arthritis, was associated with mild inflammatory reactions and increased amount of fluid, but no significant changes in the number of WBC, sugar concentration, or quality of mucin. The second group was characterized by more sever inflammation of the synovial membrane and included Rheumatoid arthritis, Septic arthritis and Tuberculous arthritis. The second group was associated with decreased mucin content, increased WBC, polymorphonuclear leucocytes, RBC and protein and decreased amount of synovial sugar. RA cells were found in all cases of Rheumatoid arthritis and cartilage fragments in Osteoarthritis under the light microscope. The third group, an intermediate group-Non specific bursitis might have some distinguishing characteristics of synovial fluid but these were not usually diagnostic.

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