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Quality and use of synovial fluid tests open to question

The use of synovial fluid tests gives cause for concern, despite their obvious diagnostic value in certain joint diseases, suggests a comprehensive literature review of their applications from the University of Bristol.

The review, based on 300 papers out of an initial trawl of 6556, published between 1980 and 2001, confirms that synovial fluid analysis can be of major diagnostic value. It is especially useful in acute arthritis, when a crystal arthropathy or septic arthritis is suspected, and in intercritical gout.

But standards fall well short of optimal for the traditional assays of microbiology, white blood cell counts, and microscopy for pathogenic crystals. And there are "worrying variations" in reported sensitivity, specificity, and reliability, and scant evidence of quality control, it finds.

Furthermore, the use of the newer cytological and biochemical marker assays is based primarily on anecdotal evidence, with no research into their sensitivity, specificity, and reliability, it says. . . . [Full text of this article]