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1438
QUESTION OF THE
WEEK
Good Morning
BACKGROUND
A
BACKGROUND
On
BACKGROUND
Plain
BACKGROUND
Arthrocentesis
is performed, and
a synovial-fluid sample is clear
yellow with a leukocyte count of
900 per mm3(reference range,
450011,000) and a differential
of 92% lymphocytes and 8%
neutrophils.
QUESTION
What
ANSWER
Osteoarthritis
noninflammatory effusion
associated with a leukocyte
count in the range of 200 to
2000 per mm3 is most consistent
with a diagnosis of
osteoarthritis.
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The
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The
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There
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The
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Similarly,
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Rheumatoid
arthritis is unlikely
in the absence of inflammatory
synovial fluid. Rheumatoid
arthritis also usually features
morning stiffness lasting >30
minutes and does not involve
the distal interphalageal joints;
it typically involves variable
combinations of other small and
medium-sized joints of the
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A
The
characteristics of normal
synovial fluid are as follows:
Appearance: Clear
White blood cell (WBC) count: Less
than 200 cells/L
Polymorphonuclear neutrophils
(PMNs): Less than 25%
Viscosity: High
Glucose level: Similar to that of the
patients serum glucose level
Clear, yellow
WBC count: Less than 2000
cells/L
PMNs: Less than 25%
Viscosity: High
Glucose level: Similar to that of
the patients serum glucose
level
Non-Inflammatory fluid:
200 - 2000 WBC/mm3
Osteoarthritis
Trauma
Osteochondritis
Dissecans
Rheumatic Fever
Chronic gout
ChronicPseudogout
ProgressiveSystemic Sclerosis (Scleroderma )
Polymyositis
Systemic Lupus Erythematosus (SLE)
NeuropathicArthropathy Hemorrhage may be
present)
Erythema Nodosum
Pigmented villonodular synovitis
Hypertrophic Osteoarthropathy
Inflammatory fluid:
2000 - 50,000 WBC/mm3 (mild < 20,000)
Rheumatoid
Arthritis
Psoriatic Arthritis
Ankylosing Spondylitis
Acute Rheumatic Fever
Acute gout
AcutePseudogout
ProgressiveSystemic Sclerosis (Scleroderma )
Polymyositis
Systemic Lupus Erythematosus (SLE)
Reiter's Syndrome
Inflammatory Bowel Disease Arthritis
Fungal Infections
Viral Infections
Bacterial Infections (partially treated)
Septic fluid:
Over 50,000 WBC/mm3
(especially
>100,000)
Septic Arthritis until proven
otherwise
REFERENCE
NEJM
, November 1, 2016
Citations
Felson
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