Synovial tissue

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Biopsy of joint tissue.

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Synovial Tissue Test - Comprehensive Medical Guide

Why is it done?
- Diagnostic evaluation of unexplained joint inflammation or arthritis to identify underlying pathology
- Detection of infectious agents in joint fluid including bacteria, viruses, fungi, and mycobacteria
- Identification of crystal-induced arthropathies such as gout and pseudogout
- Differentiation between inflammatory, non-inflammatory, and degenerative joint diseases
- Diagnosis of systemic rheumatologic conditions including rheumatoid arthritis and systemic lupus erythematosus
- Assessment of unexplained joint effusions or swelling that is unresponsive to conservative treatment
- Monitoring and evaluation of prosthetic joint infections or complications
Normal Range
- Appearance: Clear to pale yellow, transparent
- White Blood Cell Count: Less than 200 cells/μL (normal synovial fluid)
- Red Blood Cell Count: 0 cells/μL (no blood present)
- Glucose: 40-60 mg/dL or approximately 50-80% of serum glucose
- Protein: Less than 2.5 g/dL
- Crystals: None present (negative)
- Cultures (Bacteria, Fungi, TB): No growth (negative)
- Gram Stain: No organisms seen (negative)
- Cell Differential: Predominantly monocytes and lymphocytes; less than 25% neutrophils
Interpretation
- Normal/Non-inflammatory Results:
  - Clear appearance with WBC <200 cells/μL suggests non-inflammatory conditions such as osteoarthritis or mechanical joint dysfunction
  - Absence of crystals, organisms, and normal cell counts indicate healthy joint tissue
- Inflammatory Results (WBC 200-2000 cells/μL):
  - Suggests rheumatoid arthritis, lupus arthritis, or other autoimmune joint diseases
  - Presence of lymphocytes and monocytes indicates chronic inflammation
- Septic/Infectious Results (WBC >50,000 cells/μL, predominantly neutrophils):
  - Positive Gram stain or positive cultures indicate bacterial, fungal, or mycobacterial joint infection (septic arthritis)
  - Urgent medical intervention is required to prevent joint damage and systemic infection
- Crystal-Induced Results (Positive crystals):
  - Monosodium urate crystals (needle-shaped, negatively birefringent) = gout
  - Calcium pyrophosphate dihydrate crystals (rhomboid, positively birefringent) = pseudogout
- Low Glucose Levels:
  - Particularly significant (<30 mg/dL) with elevated protein suggests serious infection or severe rheumatoid arthritis
Associated Organs
- Primary System Involved: Musculoskeletal system (joints, synovial membranes, cartilage, and surrounding tissues)
- Conditions Associated with Abnormal Results:
  - Septic arthritis (bacterial, fungal, tuberculous, or viral joint infections)
  - Rheumatoid arthritis (RA) - chronic inflammatory autoimmune disease
  - Gout - monosodium urate crystal deposition disease
  - Pseudogout - calcium pyrophosphate dihydrate deposition disease
  - Systemic lupus erythematosus (SLE) affecting joints
  - Reactive arthritis and post-infectious arthropathy
  - Osteoarthritis (degenerative joint disease)
  - Ankylosing spondylitis and other spondyloarthropathies
  - Prosthetic joint infections and complications
  - Hemophilic arthropathy (bleeding into joints)
- Potential Complications from Abnormal Results:
  - Progressive joint destruction and permanent disability if infection or inflammation remains untreated
  - Sepsis and systemic infection spreading from joint infections
  - Loss of joint mobility and function requiring surgical intervention
  - Chronic pain and systemic complications from untreated inflammatory arthropathies
Follow-up Tests
- Based on Suspected Infection:
  - Blood cultures and antibody testing for specific pathogens
  - PCR testing for viral, fungal, or mycobacterial agents
  - Repeat synovial fluid aspiration and analysis after antibiotic therapy initiation
- Based on Suspected Autoimmune Disease:
  - Serum rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies
  - Antinuclear antibodies (ANA) and anti-double stranded DNA (anti-dsDNA) for SLE
  - Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)
  - Complete blood count (CBC) and serum complement levels
- Based on Suspected Crystal-Induced Disease:
  - Serum uric acid level for gout assessment
  - Alkaline phosphatase and calcium levels for pseudogout
  - 24-hour urine uric acid measurement
- Imaging Studies:
  - X-rays to assess joint damage and structural changes
  - Ultrasound for effusion assessment and guidance of repeat aspiration
  - MRI for soft tissue and early cartilage damage visualization
- Recommended Monitoring Frequency:
  - For septic arthritis: Repeat aspiration within 24-48 hours to confirm sterilization
  - For chronic inflammatory arthritis: Every 6-12 months or as clinically indicated
  - For crystal-induced disease: Repeated aspiration during acute flares if clinical diagnosis is uncertain
Fasting Required?
- Fasting: No
- Synovial tissue aspiration does not require fasting as it is a local procedure performed on the affected joint only
- Pre-procedure Preparation:
  - Wear loose, comfortable clothing that allows easy access to the affected joint
  - Bathe or shower before the procedure to reduce skin bacteria
  - Avoid applying lotions, oils, or other substances to the joint area
  - Take pain relief medication (acetaminophen or ibuprofen) 30-60 minutes prior if not contraindicated
- Medications to Avoid/Discuss:
  - Anticoagulants (warfarin, DOACs): May increase bleeding risk; discuss with provider
  - Aspirin: Typically held 3-5 days prior to procedure due to antiplatelet effects
  - NSAIDs: May be resumed after the procedure; discuss timing with provider
  - Immunosuppressive medications: Continue unless specifically instructed otherwise by provider
- Post-procedure Instructions:
  - Rest the joint for 24-48 hours; avoid strenuous activity
  - Apply ice packs to the joint for 15-20 minutes several times daily to reduce swelling
  - Keep the puncture site clean and dry; cover with a bandage for 24 hours
  - Monitor for signs of infection (fever, increased pain, redness, warmth, or drainage)

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