synovial fluid

synovivla fluid is

an ultra filtrate of plasma- Meaning no high MW molecules

therfore G and uric acid levels are equal to that of plasma, while protein is still < that of plasma

From blank, synovial membrane cellls secrete blank, making the fluid blank

From synonviocytes, they secrete hyaluronic acid, making the fluid thick and stringy

Functions of synovial fluid

Lubricates the joints

lessens shock

transport medium for delivery of O2 and nutrients and removal of CO2 and cellular waste

What are the categoried of joint effusion

Non-inflammatory

inflammatory

septic

hemorrhagic

Non-inflammatory artirtis pathologic significance

Degenerative joint dz

Inflammatory arthritis pathologic significance

• Crystal-induced arthritis (gout & pseudogout

• Rheumatoid arthritis (RA), reactive arthritis,
  psoriatic arthritis, Lyme arthritis

• Lupus erythematosus (SLE),

septic arthiritis pathologic significance

microbial infection

joint effusion is collected into 3 different tubes via

arthrocentesis

must collect in liquid additive bc it would interfere with crystal studies

What is the order of the tubes for synovial fluid

CHem and sero

Hemat and cyto

Microbio

what si the RR for synovial fluid volume

<3.5

>3.5 = effusion

what does the synovial fluid color say about the condition

non-inflammatory- yellow, clear

inflammatory- cloudy, turbid

crystals- milky, cloudy

sepsis- yellow- green, cloudy

hemorrhagic or traumatic tap - pinl-red brown, cloudy

where does the viscosity of synvoial fluid come from

due to the polymerization of hyaluronic acid

string test- 4-6 cm long

low visc- indicates inflammatory or septic process

what are the three different inclusions

lipid droplete- crush injuries

ochronotic shards- black debris from joint prosthesis- pigmented cartilage from alkaptonuria

Rice bodies- collagen and fibrin- RA

Hematology in synovial fluid

most common test

may need to thin w/ hyaluronidase

wbc differential- from smear prepared by cytocentrifuge

An increase in neutrophils indicates

bacterial septic

An increase in lymphocytes indicates

non-septic inflammatory and viral

An increase in eosinophils indicate

allergies, lyme dz, parasitic infection

what are LE cells

neutrophils or macrophages w/phagocytosed nucleus of another cell, indicates lupus

What are Tart cells

monocytes or macrophages that have engulfed some nuclear material, not significant

what are ragocytes

Neutrophils w/ precipiated RF, indicates RA

What are reiter cells/neutrophages

vacuolated macrophages w/ ingested neutrophils, indicates autoimmine DZ

1st birefringent crystals are screens w

polarized light microscopy

if positive- they use red compensator filter

if a crystal appears yellow when parallel to this arrow

it is negatively birefrigence

if blue, its positive

what is monosodium urate

needle shaped and yellow when parallel to arrow- strong( - ) BR

indicates gout

What is calcium pyrophosphate

rhombic shaped and blue when parallel to arrow- weak ( + ) BR

indicates pseudogout

total protein is increased in

inflammatory and hemorrhagic D/Os

a decrease in G levels indicate

septic (bacterial)artirtis

an increase in lactic acid indicates

septic

an increase in uric acid indicates

gout

RF indicates

RA`

What are the most common autoimmune cases of arthritis

RA and SLE

test for RF and ANA

Lyme disease

Arthritis is a frequent complication, test serum for borrelia burgdorferi antibodies