Clinical perception of arthrocentesis and the utility of synovial fluid analysis
Keywords:
Arthrocentesis, Clinical perception, Synovial fluid, Diagnosis, AnalysisAbstract
Introduction: Synovial fluid (SF) analysis provides useful information about the degree of inflammation, which is why it remains the gold standard for the diagnosis of crystal and septic arthritis; however, in some cases it can be problematic for health care professionals due to technical difficulties in correctly performing the analysis.
Objective: To investigate the perception of physicians and health care personnel regarding the usefulness of arthrocentesis and SF analysis in clinical practice.
Material and methods: A questionnaire with 22 questions was developed and applied after the course II Training for the correct identification and interpretation of crystals in the SF. A descriptive statistical analysis was carried out
Results: Ninety-six people were interviewed, with a mean age of 37.1 ± 9.32 years. This population consisted of men (45.8%) and women (54.2%), of whom 68.4% were specialists. By specialty, 66.7% were in rheumatology, 12.2% in internal medicine and 3.3% in orthopedics. Of the total number of physicians surveyed, 47.2% did not perform SF analysis due to lack of equipment and supplies in the practice or lack of experience and/or skill in performing the analysis; however, 52.8% reported always sending the sample to the laboratory, 21.3% often, 14.6% almost never, and 11.2% never. Twenty-seven point six % thought that SF analysis often changed their diagnosis and 17.2% always did.
Conclusions: SF analysis remains essential for a diagnostic approach. Encouraging the performance of SF analysis by rheumatologists and residents of rheumatology and orthopedic services deserves all possible efforts to provide a more accurate diagnosis.
References
Referencias
Martínez-Castillo A, Núñez C, Cabiedes J. Synovial fluid analysis. Reumatol Clin. 2010;6 (6):316-21. https://doi.org/10.1016/j.reuma.2009.12.010
Neogi T, Jansen TL, Dalbeth N, Fransen J, Schumacher HR, Berendsen D, et al. 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2015;74(10):1789-98. https://doi.org/10.1136/annrheumdis-2015-208237
Qaseem A, McLean RM, Starkey M, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Diagnosis of Acute Gout: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017, 3;166(1):52-57. https://doi.org/10.7326/M16-0569
Taylor WJ, Fransen J, Dalbeth N, Neogi T, Ralph Schumacher H, Brown M, et al. Diagnostic Arthrocentesis for Suspicion of Gout Is Safe and Well Tolerated. J Rheumatol. 2016 Jan;43(1):150-3. https://doi.org/10.3899/jrheum.150684
Amigo-Castañeda MC, Canoso JJ. Detección de cristales de urato monosódico en el líquido sinovial en la práctica clínica: barreras y oportunidades. Ann Med (Mex) 2016;61(3):173-176.
García-Méndez S, Arreguín-Reyes R, López-López O, Vázquez-Mellado J. Frecuencia de la gota según la percepción de los médicos en México. Reumatol Clin. 2014;10:197–198. https://doi.org/10.1016/j.reuma.2013.06.003
Swan A, Amer H, Dieppe P. The value of synovial fluid assays in the diagnosis of joint disease: a literature survey. Ann Rheum Dis. 2002;61(6):493-498. https://doi.org/10.1136/ard.61.6.493
Graf SW, Buchbinder R, Zochling J, Whittle SL. The accuracy of methods for urate crystal detection in synovial fluid and the effect of sample handling: a systematic review. Clin Rheumatol. 2013;32(2):225-32. https://doi.org/10.1007/s10067-012-2107-0
Lumbreras B, Pascual E, Frasquet J, González-Salinas J, Rodríguez E, Hernández-Aguado I. Analysis for crystals in synovial fluid: training of the analysis results in high consistency. Ann Rheum Dis. 2005;64(4):612-5. https://doi.org/10.1136/ard.2004.027268
Zamudio-Cuevas Y, Martínez-Nava GA, Martínez-Flores K, Ventura-Ríos L, Vazquez-Mellado J, Rodríguez-Enriquez P, et al. Synovial fluid analysis for the enhanced clinical diagnosis of crystal arthropathies in a tertiary care institution. Clin Rheumatol. 2021;40(8):3239-3246. https://doi.org/10.1007/s10067-021-05610-0
Huang Q, Huang Y, Guo X, Chen J, Zhong Z, Liu Y, et al. The Diagnostic Value of Synovial Fluid Lymphocytes in Gout Patients. Dis Markers. 2021;2021:4385611. https://doi.org/10.1155/2021/4385611
Liu D, Xiao WF, Li YS. The Diagnostic and Prognostic Value of Synovial Fluid Analysis in Joint Diseases. Methods Mol Biol. 2023;2695:295-308. https://doi.org/10.1007/978-1-0716-3346-5_20
Mandell, BF. The Impact of Synovial Fluid Analysis on Clinical Practice Introduction. In: Mandell, B.F. (eds) Synovial Fluid Analysis and The Evaluation of Patients with Arthritis. 2022, Springer, Cham. https://doi.org/10.1007/978-3-030-99612 3_1.
Oliviero F, Mandell BF. Synovial fluid analysis: Relevance for daily clinical practice. Best Pract Res Clin Rheumatol. 2023; 8:101848. https://doi.org/10.1016/j.berh.2023.101848
Punzi L, Oliviero F. Arthrocentesis and synovial fluid analysis in clinical practice: value of sonography in difficult cases. Ann N Y Acad Sci. 2009;1154:152-8. https://doi.org/10.1111/j.1749-6632.2009.04389.x
Berendsen D, Neogi T, Taylor WJ, Dalbeth N, Jansen TL. Crystal identification of synovial fluid aspiration by polarized light microscopy. An online test suggesting that our traditional rheumatologic competence needs renewed attention and training. Clin Rheumatol. 2017;36(3):641-647. https://doi.org/10.1007/s10067-016-3461-0
Punzi L, Ramonda R, Oliviero F. Why are rheumatologists still reluctant to perform joint-fluid analysis? Joint Bone Spine. 2015;82(3):139-40. https://doi.org/10.1016/j.jbspin.2015.01.001
Pollet S, Coiffier G, Albert JD, Chales G, Guggenbuhl P, Perdriger A. Concordance between fresh joint fluid analysis by the rheumatologist and joint fluid analysis at the laboratory: Prospective single-center study of 180 samples. Joint Bone Spine. 2015;82(3):161-5. https://doi.org/10.1016/j.jbspin.2014.11.005
Hasselbacher P. Variation in synovial fluid analysis by hospital laboratories. Arthritis Rheum. 1987;30(6):637-42. https://doi.org/10.1002/art.1780300606
Abdalla A. P004 Rheumatologist vs pathology department: correlation of crystal identification in synovial fluid analysis, Rheumatology. 2021;60(Supplement_1): keab247.003. https://doi.org/10.1093/rheumatology/keab247.003
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra
This work is licensed under a Creative Commons Attribution 4.0 International License.
© Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra under a Creative Commons Attribution 4.0 International (CC BY 4.0) license which allows to reproduce and modify the content if appropiate recognition to the original source is given.
