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Rationale:
- Arthrocentesis is generally performed in a manner that minimizes the probability of invading a vessel or nerve and avoids
areas of cellulitis that may overly the joint.
- Experienced observers must be available for optimal synovial fluid analysis because an inexperienced observer may miss monosodium
urate crystals (although they are generally easy to see).
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Evidence:
- Rheumatologists are significantly more likely than other practitioners to study synovial fluid and establish a definite diagnosis
(25).
- Skill at interpreting synovial fluid findings varies greatly among laboratories. In one study, 39 of 50 fluid samples with
monosodium urate crystals were correctly identified by routine laboratory analyses (24).
- A misdiagnosis of gout is common. In one study, half of the patients seen in consultation had an incorrect diagnosis, most
commonly those with psoriatic arthritis or pseudogout (35). Most of these patients had been given uric acid-lowering therapies.
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Comments:
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Grace P. Teal, MD (deceased) has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Howard A. Fuchs, MD, is a consultant for TAP Pharmaceuticals.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott.
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The information included herein should never be used as a substitute
for clinical judgment and does not represent an official position of
ACP. Because all PIER modules are updated regularly, printed web pages
or PDFs may rapidly become obsolete. Therefore, PIER users should
compare the date of the last update on the website with any printout
to ensure that the information being referred to is the most current
available.
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PIER is copyrighted (c) 2009 by the American College of Physicians,
190 N. Independence Mall West, Philadelphia, PA 19106-1572, USA.
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Gout
> Consultation for Diagnosis
