Arthritis, which is one of the most common chronic conditions, affects nearly 70 million Americans. The term arthritis is derived from the Greek words “arthron” which means joint and “itis”, which means inflammation. It can be used to describe more than 100 conditions. A physician must determine whether the patient’s symptoms are within a joint or due to disorders in the area around the joint. This is known as “periarticular pain”. These problems include tendonitis and bursitis as well as ligament injuries and skin infections.
Joints
Once you have resolved the situation, it is time to determine if there are multiple joints involved. These clues will all lead to the diagnosis. The ability to examine the fluid in the joints (synovial) is an important tool. Sometimes, fluid can be found in joints that are accessible via needle. It is important to check for synovial fluid in order to establish a diagnosis. Different stains and other examinations may help the doctor diagnose. It is not necessary to use a lot fluid. A few cc’s are usually enough.
The procedure is performed using sterile techniques. To make fluid aspiration less painful, local anesthetic may be used. To aid in needle localization, diagnostic ultrasound is required. Normal synovial fluid has fewer than 200 white cells per cubic ml. An infection should be suspected if there are higher counts. Almost always, an infection is responsible for a high number of white blood cells per cubic milliliter.
Take Into Account
This can sometimes be caused by “pseudoseptic” reactions to injections of lubricants. Synovial fluids can also have significantly elevated white blood cells due to crystal-induced arthritis, such as pseudogout or gout. All synovial fluid needs to be cultured. This was something I learned from my chief. He said, “Everytime you get joint fluid it must be cultured.” This was done at the National Institutes of Health (the world’s foremost biomedical research centre).
Crystal-induced arthritis, such as pseudogout or gout, can lead to high white blood cell counts. Polarized microscopy can be used to examine the fluid and determine if crystals exist. Infection can be ruled out by the presence of crystals. Gout can sometimes make you more susceptible to infection. All synovial fluid needs to be cultured! A high level of fat in the joint fluid should be cause for concern. Why is the importance of the joint fluid? Once the diagnosis has been made, the treatment can be started.