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Rheumatic Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Synovial fluid is commonly examined for: Infection: Gram stain acid-fast methods and culture for bacteriaCrystal identification: to detect urate (needle-shaped negatively birefringent crystals) and calcium pyrophosphate (rectangular-shaped positively birefringent crystals)
Selected topics
Published in Henry J. Woodford, Essential Geriatrics, 2022
Clinical examination or blood tests (e.g. WCC, CRP or ESR) are not very helpful for distinguishing septic arthritis from acute gout or pseudogout. Examination of the synovial fluid is often required. Septic arthritis is more likely if there is a history of RA, prosthetic joint, diabetes, age over 80 or skin infection.29 In people aged over 80, the knee and shoulder joints are most often affected, around 25% occur in prosthetic joints and around 10% involves more than one joint.32 Elevations in serum CRP and ESR are very likely, 30–50% of people can have a normal temperature and/or serum WCC. The commonest causative organisms are staphylococci or streptococci species. Mortality is around 10% in people aged over 80.
Introduction and Review of Biological Background
Published in Luke R. Bucci, Nutrition Applied to Injury Rehabilitation and Sports Medicine, 2020
Synovial fluid is produced by synoviocytes and consists mainly of a plasma filtrate with few or no proteins above 150,000 Da and a protein content (mostly albumin) of 1.5 to 2 g/dl. In addition to lubricin, a glycoprotein that helps lubricate joint surfaces, the major feature of synovial fluid is hyaluronate. Synovial fluid is viscous and slimy from an approximately 0.2% solution of hyaluronate, a long, nonsulfated glycosaminoglycan. Hyaluronate helps to reduce friction in joints, allowing easy movement of joints without excessive wear. The friction coefficient of synovial joints is 0.003 to 0.015, compared to 0.02 for an ice skate on ice, and 1 for automobile tires on the road. Synovial fluid is probably the major route for nutritional supply to cartilage and chondrocytes. As such, the gel-like properties of hyaluronate solutions influence the passage of large molecules and proteins. Small molecules and ions, such as oxygen, glucose, and calcium, are free to diffuse through the hyaluronate gel.
A fluid-structure interaction investigation of intra-articular pressure and ligament in wrist joint
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2023
Joachim Ee En Ong, Shi Lei Teng, Duncan Angus McGrouther, Hwa Liang Leo, Yoke Rung Wong
The synovial fluid geometry was constructed as an arbitrary sphere of fluid volume 1.5 ml, in the middle of the carpal bones and SLIL in order to match with the volume of synovial fluid injected into the cadaveric wrist. Synovial fluid is known to exhibit non-Newtonian behaviour due to the presence of hyaluronic acid (HA) (Petrtyl et al. 2011) and computationally modelled as viscoelastic with varying shear rate response dependent on HA concentration (Hron et al. 2010). Due to the lack of pre-defined fluid properties in the ANSYSTM software as well as the complexity of implementing a robust custom model, synovial fluid was defined as a homogenous, incompressible fluid with a density of 1010 kg/m3 and constant viscosity of 0.008 kg/(m.s.) (TMJ) (Xu et al. 2013).
Intra-articular drug delivery systems for osteoarthritis therapy: shifting from sustained release to enhancing penetration into cartilage
Published in Drug Delivery, 2022
Huirong Huang, Zijian Lou, Shimin Zheng, Jianing Wu, Qing Yao, Ruijie Chen, Longfa Kou, Daosen Chen
The articular cavity is a closed space enclosed by the synovial layer of the articular capsule and articular cartilage, which contains a small amount of transparent viscous fluid called synovial fluid. The main ingredient of synovial fluid in the articular cavity is including water, hyaluronic acid, mucopolysaccharide, and electrolytes. When OA occurs, the synovial fluid is filled with pro-inflammatory factors (Mathiessen & Conaghan, 2017). The infiltration of inflammatory factors promotes catabolism of chondrocytes and degradation of cartilage. Deterioration of OA affects the entire joint, including subchondral bone, ligaments, synovium, and peri-articular muscles. Further, more severe symptoms appear around the articular cavity: fibrocartilage degeneration, chondro-osteophytes, protrusions, subsynovial inflammatory, and joint effusion (Pereira et al., 2015). Due to the damage of the joint function, it may also cause the atrophy of thigh and calf muscles, whereby the first atrophied part is the skeletal muscle in the inner thigh. Subsequently, it causes an imbalance of force on the limbs, increases the burden on the lumbar spine, and causes some diseases related to the spine.
Novel strategies to diagnose prosthetic or native bone and joint infections
Published in Expert Review of Anti-infective Therapy, 2022
Alex Van Belkum, Marie-Francoise Gros, Tristan Ferry, Sebastien Lustig, Frédéric Laurent, Geraldine Durand, Corinne Jay, Olivier Rochas, Christine C. Ginocchio
Septic arthritis is an inflammation of a joint that is caused by infection. Typically, septic arthritis affects one large joint in the body, such as the knee or hip. Risk factors for septic arthritis include hematogenous spread of pathogens (due to skin infection, cutaneous ulcers, or adjacent osteomyelitis), direct inoculation of pathogens (penetrating trauma, intrauricular injection, recent joint surgery) and higher age. Early stages of the disease include soft tissue swelling, purulence, and widening of joint space. If the disease is untreated it can progress to cartilage destruction, narrowing and irregularity of the joint space, bone destruction, and growth disturbances. Symptoms include pain, fever, restricted movement, swelling, effusion, and erythema. This category of infections is frequently culture negative (between 4.5% and 64%) [13]. Microorganisms involved most commonly are Staphylococcus aureus, coagulase-negative staphylococci, streptococci, enterococci, and several species of gram-negative bacteria and anaerobes. Acute arthritis in children less than 4 years old is frequently due to Kingella kingae and requires rapid antibiotic administration [14]. Neisseria gonorrhoeae, Neisseria meningitidis, or Mycobacterium spp. are less frequently isolated from arthritic patients [15]. Diagnosis mostly relies on arthrocentesis, i.e. joint fluid punctate analysis [16]. Synovial fluid examination includes microbiological, histological, and biochemical analyses. Time to result is key to rapidly initiating targeted antibiotic therapy.