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34 Cards in this Set
- Front
- Back
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traits of normal synovial fluid?
color clarity viscosity WBC PMN culture |
clarity-transparent
color-clear viscosity -very high WBC-less than 200 pmn %- 25 culture- neg |
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traits of nonimflammatory group 1synovial fluid?
color clarity viscosity WBC PMN culture |
clarity-translucent
color-yellow viscosity- high wbc-200-2000 pmn%-25 culture-neg |
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traits of inflammatory group 2 synovial fluid?
color clarity viscosity WBC PMN culture |
color-yellow to opal
clarity-translucent to opaque viscosity-low WBC-2000-100k PMN-50% culture-neg |
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traits of septic group 3synovial fluid?
color clarity viscosity WBC PMN culture |
color-yellow to green
clarity-opaque viscosity-variable WBC->100k PMN-75 culture-positive |
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what markers are used in rheumatoid arthritis?
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Rheumatoid factor(RF)-positive at a titer of greater than 1:80
HLA-DR4-positive elvated ESR-not specific C-reactive protien(CRP)-nonspecific measure of inflammation ANTI-CCP-fairly specific new test becoming more popular. |
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what is RF?
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Rheumatoid factor (RF) is an autoantibody (usually IgM) against the Fc portion of autologous IgG. About 80% or individuals with rheumatoid arthritis have elevated serum RF.
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can someone have rheumatoid arthritis and be negative for RF?
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yes about 80% have elevated RF though
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what is Anti-CCP?
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antibodies to cirtulline modified peptides
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what is the cause of rhematoid arthritis?
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autoimmune reaction stimulated by TNF and IL-1
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what is borrelia burgdorfer associated with?
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found in in synovial infection with lyme disease
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what is HLA-B27 associated with?
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seronegative ankylosing spondylopathies
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what is gummatous necrosis suggestive of?
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tertiary syphillis
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what is urate crystals in the joints indicate?
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gouty arthiritis
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what are the requirements to diagnose RA?
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Four of the following are needed to diagnose RA:
Morning stiffness √ Arthritis in three or more joint areas √ Arthritis of hand joints √ Symmetric arthritis √ Rheumatoid nodules √ Serum rheumatoid factor √ Typical radiographic changes (erosive synovitis) |
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what is definition of arthritis/
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Arthritis is the inflammation of any joint. Acute inflammation is defined with rubor (redness), tumor (swelling), dolor (pain), calor (heat), and functio laesa (loss of function).
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what is needed before diagnosis of gouty arthritis can be made?
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gout may be suspected but cannot be proved without uric acid crystals in the synovial fluid or phagocytized by WBCs
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are urate crystals always present in synovial fluid in gout?
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Examination of the synovial fluid under polarized light may not always reveal uric acid crystals in gout. The crystals may be sparse, or they may be deposited in soft tissue, and not present in the fluid at time of examination.
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what can be done if there is suspician of gout but no crystals seen in fluid?
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Examination of stained sediment in which white blood cells are concentrated, under polarized light can increase the sensitivity of the test.
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what is a possible kidney issue that can result of gout?
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uric acid kidney stones. Urine is normally slightly acidic; possibly slightly more acidic in this diabetic patient increasing the chances of uric acid stone formation.
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what increases risk of a patient getting uric acid kidney stones from grout?
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diabetes
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how is a diagnosis of gout made?
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Serum uric acid is the classical test for gout, but it has poor specificity and sensitivity.
90% with hyper-UA do not have gout (PV+ = 10%) Serum UA may be normal at the time of an acute attack Identification of monosodium urate crystals in the synovial fluid, especially if present within phagocytes, has the highest probability for the diagnosis of gout. Gout may mimic septic arthritis & vice versa. Arthrocentesis with adequate fluid for crystal analysis and culture is crucial to the diagnosis. |
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what is metabolized to form uric acid?
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purines
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what can raise uric acid levels other than gout?
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tumor lysis
kidney failure ingestion of high protein diet |
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what are the normal serum values for uric acid?
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6 mg/dL in women & 7 mg/dL in men.
As levels increase over 8 mg/dL monosodium urate is more likely to precipitate in tissues. |
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what protects women from gout?
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Men have higher serum uric acid levels than women and estrogen protects women (until menopause)
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what are the primary causes of overproduction of uric acid?
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Hypoxanthine-guanine phosphoribosyl-transferase deficiency
Primary idiopathic hyperuricemia (increased production & decreased excretion) |
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what are the causes of secondary hyperuricemia by over production?
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Proliferative disease; incr. tissue turnover; rhabdomyolysis, tumor lysis
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what are the causes of secondary hyperuricemia by decreased excretion?
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Renal insufficiency
Diabetes mellitus (ketoacidosis) Lactic acidosis Lead intoxication Drugs - salicylates, diuretics, alcohol Many more |
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what are the two major conditions causes by hyperuricemia?
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acute gouty arthirtis
gouty nephropathy |
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What is the significance of finding inflammatory cells in the joint fluid?
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Quantitation of white blood cells is an important part of synovial fluid analysis, especially because it is the major basis for classification of an effusion as septic, inflammatory, or noninflammatory
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Does the history of diabetes and hypertension in this obese patient help in the diagnostic work-up?
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Obesity, diabetes, and hypertension increase the risk factors for many disease.
Increased weight can contribute to arthritis Acidosis and progressive renal disease in diabetics can contribute to under excretion of uric acid. Hyperuricemia is also associated with the use of diuretics, especially thiazides, which are commonly used in the treatment of hypertension. |
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Catabolism of Adenine & Guanine is important to study of synovial fluid why?
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Uric acid is the end product of purine (adenine and guanine) metabolism
Humans don't have uricase which converts uric acid to soluble allantoin |
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at what pH level are uric acid stones more likey to form?
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less than 7
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can uric acid stones be visualized on xray?
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unlike many of the calcium-containing stones, are radiolucent.
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