Dieppe P, Amer H, Swan A; International Society of Technology Assessment in Health Care. Meeting.

Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 2000; 16: 112.

MRC HSRC Department of Social Medicine, University of Bristol, Bristol, UK

Introduction: Synovial fluid (SF) analysis is widely used to aid the diagnosis and management of both acute and chronic arthritis. Five different types of test on SF are used: microbiology, total and differential white cell counts, crystal identification by polarised light microscopy (PLM), cytology and biochemical assays. However, the sensitivity, specificity and validity of many of these tests has been questioned. Methods: A review of the literature was undertaken from electronic literature databases (MEDLINE, Embase, ISI). Results: The literature only provides support for the use of SF analysis to aid the diagnosis of acute arthritis (to differentiate crystal arthritis from septic arthritis), and in the diagnosis of both acute and chronic infectious arthritis. However, negative synovial fluid cultures are common in septic arthritis, and can result in serious delays in diagnosis. A very high cell count (>60,000/mm, with a predominance of polymorphonuclear cells (>75%) is suggestive of infection. PLM is the only reliable way of diagnosing acute gout or pseudogout, and the literature shows that reports of the positive identification of crystals changes patient management. However, four papers examining the reliability were identified, all of which suggest that there are high inter and intra-observer variations in crystal identification. Strong claims have been made that cytology may add diagnostic information, but these tests have not been validated. We found no evidence that any of the available investigations have been tested for their diagnostic sensitivity or specificity. Conclusions: SF analyses can change patient management, but the literature indicates that there is a need for caution in the interpretation of routine laboratory data, and for improved quality control work. None of the tests available have been properly validated.

Publication Types:

• Meeting Abstracts

Keywords:

• Arthritis
• Arthritis, Infectious
• Chondrocalcinosis
• Gout
• Hematologic Tests
• Humans
• Leukocyte Count
• Leukocytes
• Microscopy, Polarization
• Observer Variation
• Quality Control
• Sensitivity and Specificity
• Synovial Fluid
• United States
• diagnosis
• methods
• organization & administration
• hsrmtgs

Other ID:

• GWHSR0000091

UI: 102271765

From Meeting Abstracts