Identification of Pathologic Synovial Fluid Crystals on Gram Stains

Petrocelli, Alfred; Wong, Andrew L.; Swezey, Robert L.

doi:10.1097/00124743-199804000-00015

Cited by 24 publications

(16 citation statements)

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“…Our observations correspond well with previous studies on the identification of crystals in slides stained with the DiffQuik method [6] and Gram stain [7]. In these trials, crystals were identifiable at least 12 months after the end of the studies [6,7].…”

Section: Discussionsupporting

confidence: 91%

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Dried cytospin preparations of synovial fluid are a stable material for long-time storage and delayed crystal analysis

Robier¹,

Neubauer²,

Stettin³

et al. 2012

Clin Rheumatol

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The aim of this study was to evaluate dried SF cytospin preparations as a suitable medium for long-time storage and delayed crystal analysis. For this purpose, we analyzed ten MSU-positive, ten CPPD-positive and 20 crystal-negative SF at baseline (wet preparation), after 24 h, 1 week, 4 weeks, 6 months and 12 months for the occurrence of crystals. After cytocentrifugation for 10 min at 700 rpm in a Shandon Cytospin 4 cytocentrifuge (Thermo Fisher Scientific, Waltham, USA), the sediments were dried on the slides and examined in blinded fashion at any time point by an experienced analyst using polarized microscopy. The crystal content of the initially MSU- and CPPD-positive samples was positively confirmed at any time point of the study, whereas the controls remained crystal-negative during the whole study period. Thus, compared to the examined wet preparations at baseline, there were no false positive or false negative results observed. In conclusion, dried cytospin preparations were confirmed as a suitable material for long-time storage and delayed crystal identification.

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Section: Discussionsupporting

confidence: 91%

“…In these trials, crystals were identifiable at least 12 months after the end of the studies [6,7]. An advantage of unstained slides is that staining can still be performed after examination of the undyed slides by polarized microscopy [8].…”

Section: Discussionmentioning

confidence: 99%

Dried cytospin preparations of synovial fluid are a stable material for long-time storage and delayed crystal analysis

Robier¹,

Neubauer²,

Stettin³

et al. 2012

Clin Rheumatol

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“…24 Equally good results for MSUM identification were obtained from both Gram stained and wet preparations of SF. 29 However, some laboratories did very badly, particularly in the McGill and Schumacher studies. 25 27 In general, results for CPPD crystals were a lot worse than for MSUM (table 5); for example, in the Hasselbacher study CPPD crystals were correctly identified in only six of a possible 50 slides.…”

Section: Urate and Pyrophosphate Crystal Identificationmentioning

confidence: 99%

The value of synovial fluid assays in the diagnosis of joint disease: a literature survey

Swan

Amer²,

Dieppe³

2002

Annals of the Rheumatic Diseases

268

160

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Objective: To carry out a critical appraisal of the literature in an attempt to assess the current value of synovial fluid (SF) analysis in the diagnosis of joint disease. Methods: A literature search was undertaken using the Medline, Biomed, Bids, Pubmed, and Embase electronic databases using the keywords: synovial fluid (SF) analysis, SF crystals, joint sepsis, acute arthritis, and SF cell counts, cytology, biomarkers, and microbiology. Results: Publications fell into three main categories. Firstly, reports assessing the value of the three traditional assays (microbiology, white blood cell counts, and microscopy for pathogenic crystals). For these quality control evidence was found to be sparse, and tests for sensitivity, specificity, and reliability showed worrying variations. These poor standards in SF analysis may be due to lack of inclusion of some tests within routine pathology services. Secondly, claims for the usefulness of "new" assays (cytology and biochemical markers). For cytology, the supporting evidence was mainly anecdotal and there were no reports on specificity, sensitivity, and reliability. Interpretation difficulties are a major hindrance to the clinical use of biochemical assays, which remain primarily research tools. Finally, work on the diagnostic value of SF analysis in general. The appraisal confirmed that SF analysis remains of major diagnostic value in acute arthritis, where septic arthritis or crystal arthropathy is suspected, and in intercritical gout. Conclusions: Given the importance of SF tests, rationalisation of their use, together with improved quality control, should be immediate priorities. Further investigation is recommended into the contribution of SF inspection and white cell counts to diagnosis, as well as of the specificity and sensitivity of SF microbiological assays, crystal identification, and cytology.

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“…Исследуя синовиальную жидкость па-циента с острым септическим артритом голеностопного сустава, кроме повышенного содержания глюкозы и лей-коцитов, авторы при окрашивании по методу Грама обна-ружили ромбовидные кристаллы, которые при ПМК бы-ли идентифицированы как ДПФК. Интересно, что кри-сталлы обнаруживались даже после 2 лет хранения образ-ца [27].…”

Section: методы окрашиванияunclassified

“…К сожалению, метод окрашивания образцов синови-альной жидкости по Граму крайне плохо изучен с точки зрения воспроизводимости и специфичности, что не поз-воляет рекомендовать его как рутинный для идентифика-ции кристаллов [27]. Вероятно, дальнейшие исследования в этой области позволят расширить возможности примене-ния окраски по Граму.…”

Section: методы окрашиванияunclassified