Toggle Main Menu Toggle Search

Open Access padlockePrints

Gross synovial fluid analysis in the differential diagnosis of joint effusion

Lookup NU author(s): Dr Steven Young-Min, Dr Susan Hudson, Dr Clive Kelly



Aims: To develop an objective and easy to complete standardised questionnaire for documentation of synovial fluid ( SF) gross appearance and use it in the assessment of patients presenting to the rheumatology service with a joint effusion. Methods: A standardised questionnaire to record the gross appearance of SF was developed. Interobserver error in recorded observations and direct gross analysis of synovial fluid between four observers was calculated in a pilot study. In a prospective study over 8 months, SF gross analysis and cell count were documented in all patients presenting with a joint effusion. Fusch Rosenthal manual counting chamber was used for calculating SF cell counts. Results: There was good interobserver agreement on direct gross analysis and between questionnaire assessors (mean kappa 0.889). 80 SF samples were collected. Gross analysis was performed in all samples and cell count in 72. Of the specimens thought to be inflammatory on gross analysis, 31% were found to be noninflammatory based on cell count; however, 12 of these patients had an established inflammatory arthritis. Gross analysis had a sensitivity of 94% and specificity of 58% when used to determine whether SF is inflammatory or non-inflammatory. The positive and negative predictive values were 0.69 and 0.91 respectively. Conclusions: SF cell count did not add any information when SF gross analysis suggested a non-inflammatory process. Gross analysis was better than cell count to determine a potentially septic joint fluid. Further work needs to be done on the value of SF cell counts if gross analysis suggests the fluid to be inflammatory.

Publication metadata

Author(s): Abdullah S, Young-Min SA, Hudson SJ, Kelly CA, Heycock CR, Hamilton JD

Publication type: Article

Publication status: Published

Journal: Journal of Clinical Pathology

Year: 2007

Volume: 60

Issue: 10

Pages: 1144-1147

Date deposited: 21/06/2010

ISSN (print): 0021-9746

ISSN (electronic): 1472-4146

Publisher: BMJ Group


DOI: 10.1136/jcp.2006.043950


Altmetrics provided by Altmetric