A Comparative Study of Different Types of Joint Effusions in a Tertiary Care Hospital of Northern India

Introduction: Arthritis is the initial manifestation of many joint disorders. Synovial fluid analysis helps in this aspect. An analysis of synovial fluid has long been recommended as a routine procedure to assist in the diagnosis of arthritis. Synovial fluid fills the spaces in the joint cavities and its function is to moisturize and lubricate the joints.

Objective: To analyse the gross, microscopic and biochemical variations in the synovial fluid in various causes of joint effusions and to assess the synovial fluid cytology with biochemical parameters in various types of arthritis to increase the accuracy of diagnosis.

Materials and Methods: In the present cross sectional study, the synovial fluid of 477 cases was analysed in the Department of Biochemistry in collaboration with the Department of Pathology at SKIMS Medical College & Hospital, Bemina, Srinagar, India. Gross examination was done to find total volume, clarity, viscosity of the synovial fluid and it was equally divided into two halves. One half of synovial fluid was sent for biochemical analysis and the other half for microscopic examination.

Results: Out of 477 synovial fluid samples analysed, joint involvement was seen in patients between the age of 16 and 75 years which included 182 males and 295females.Total leucocyte count was found to be highest in septic arthritis and lowest in osteoarthritis. Neutrophils were highest in septic arthritis (95%) and lowest in osteoarthritis (24%). Sugar level in synovial fluid was highest in osteoarthritis and gouty arthritis (70-90 mg/dL each) and lowest in septic arthritis. Proteins were highest in rheumatoid arthritis and traumatic arthritis (4.1-6.5 gm/dL and 4.2-6.4 gm/dL respectively) and lowest in osteoarthritis (1.2-2.4 gm/dL). Out of 290 positive cases in synovial C-reactive protein levels, the highest were found in rheumatoid arthritis (130), rheumatoid factor was found positive in 143 cases while it was negative in 127 cases of osteoarthritis.

Conclusion: Biochemical analysis of synovial fluid for proteins and sugar contributes in diagnosis of different types of arthritis. RF in synovial fluid proves to be of value in diagnosis of monoarticular arthritis. C-reactive protein levels in synovial fluid were elevated in rheumatoid arthritis and can be used for the diagnosis of this disease in addition to other tests available. Using synovial fluid analysis frequently in hospital services will help doctors in early management, offering particular advantages in diagnosis, following up of patients with joint disease.