Synovial Fluid Leukocyte Count Research Articles

Occurrence of interleukin-1 in human synovial fluid: detection by RIA, bioassay and presence of bioassay-inhibiting factors.

Synovial fluid (SF) from patients with osteoarthritis (OA), rheumatoid arthritis (RA), and various other arthridites was analyzed to assess the prevalence of interleukin-1 (IL-1) using both radioimmunoassay competitive inhibition specific for the beta form of IL-1 and the D10.G4.1 cell line bioassay which measures both alpha and beta forms of IL-1. Using radioimmunoassay competitive inhibition, IL-1 beta was found in 45% and 60% of individual samples from patients with OA and RA respectively. When RA and OA SF were examined in sequentially obtained samples, IL-1 beta occurred in one or more samples from 8 of 10 patients studied, suggesting the probability that it can be produced at some time in SF by all patients with these conditions. No correlation between SF leukocyte counts and the occurrence of IL-1 beta was noted and no effect of antiinflammatory drug treatment on the prevalence of IL-1 beta was found. When tested for the presence of IL-1 by the D10.G4-1 cell line, 66% and 50% of RA and OA patients respectively were found to contain IL-1. These were not in total concordance with results obtained by RIA. Of all SF tested, seven were negative by RIA but positive by D10.G4.1 and these are considered to contain IL-1 alpha. Seven samples which were RIA positive and D10.G4.1 negative were tested for their ability to inhibit IL-1 responses in the bioassay. Five of these contained inhibitor and one markedly enhanced the proliferative response of D10.G4.1 to a known amount of IL-1.(ABSTRACT TRUNCATED AT 250 WORDS)

Carboxypeptidase N (Kininase I) activity in blood and synovial fluid from patients with arthritis

Carboxypeptidase N (CPN, kininase I) and kininase II (angiotensin converting enzyme) activities were measured simultaneously in blood plasma and synovial fluid in patients suffering from rheumatoid arthritis (RA), psoriatic arthritis (PA) and osteoarthritis (OA) and in the plasma of normal volunteers. CPN levels (defined as the rate of hydrolysis of furylacryloyl-Ala-Lys) in blood were modestly increased and correlated with erythrocyte sedimentation rate in RA and PA. Based on the hydrolysis of synthetic substrates, CPN activity was much higher than kininase II activity in synovial fluid (SF). SF kininase activities were always inferior to the blood levels in all patients and were correlated with the logarithm of SF leukocyte counts, an indicator of the intensity of inflammation. In addition, CPN and albumin levels in SF were highly correlated when expressed as a percent of the plasma concentrations. Biochemical properties of CPN in crude SF confirmed its similarity to blood CPN. Polymorphonuclear leukocytes derived from inflammatory SF did not release CPN. It is concluded that kininases diffuse from the blood into SF through increased vascular permeability and that CPN could be a major metabolic pathway for kinins in this form of exudate. CPN leads to the formation of des-Arg kinins, selective agonists of the B 1 receptors for kinins.

Synovial fluid crystals in osteoarthritis.

Apatite crystals, calcium pyrophosphate dihydrate crystals, or both were observed in knee joint effusions from 60% of 100 consecutive osteoarthritis (OA) patients. Crystals were mor common in patients with more severe OA and in joints that had received previous intraarticular steroid injections. Whether the latter was predominantly related to an effect of the steroid or to the fact that steroids were used in more severe cases was not clear. Crystals existed in many effusions without elevated synovial fluid leukocyte counts. A subgroup of 7 patients had both types of crystals, more crystal phagocytosis, and more severe OA.

The penetration of ceftriaxone into synovial fluid of the inflamed joint.

Fifteen patients with acute exacerbation of rheumatoid arthritis each received a 1 g bolus intravenous injection of ceftriaxone. Serum and synovial fluid was sampled at intervals between 1 h and 24 h later and assayed for ceftriaxone. Synovial fluid leucocyte counts and albumin content were measured concomitantly. Detectable levels of ceftriaxone were found in synovial fluid and serum 24 h after injection. Synovial fluid ceftriaxone concentration ranged between 66% and 100% of the concomitant serum levels. No correlation was observed between synovial fluid ceftriaxone concentration and synovial fluid leucocyte count and albumin concentration.

Effects of joint lavage on knee synovitis in rheumatoid arthritis.

Ten patients with rheumatoid arthritis and persistent knee synovitis had synovial fluid aspirated through a 14 gauge wide-bore needle followed by joint lavage and intra-articular triamcinolone. This resulted in the removal of variable quantities of intra-articular debris including rice bodies. When compared to a control group of patients, the addition of joint lavage to the standard procedure of aspiration and injection of corticosteroid resulted in more sustained resolution of synovitis after 12 weeks as judged by knee tenderness and circumference, recurrence of effusion, and synovial fluid leucocyte count. This study suggests that knee joint lavage may be a useful adjunct to therapy in rheumatoid arthritis patients having persistent knee synovitis.

Effect of intra-articular orgotein versus a corticosteroid on rheumatoid arthritis of the knees

The effects of intra-articular injections of orgotein (4 mg a week for six weeks) and of methylprednisolone acetate (4 mg a week for six weeks) on the knee joints were compared in a random long-term trial. Twenty-eight patients with active, definitive rheumatoid arthritis were studied by double-blind comparison. The first control examination made after six weeks of therapy showed no differences between the joints treated with orgotein or with steroid. However, at the final control examination after 24 weeks, a disparity between both drug regimens became apparent. Clinical response was evaluated in the knees in terms of cumulative rheumatoid activity index based on morning stiffness, range of flexion, pain scores, and 25-foot walking time. After 24 weeks, orgotein was found to be superior to steroid in the major points of the clinical assessment index but equipotent in marked improvement of the rheumatoid activity index after six weeks of treatment. After intrasynovial orgotein injections, synovial fluid enzyme activity fell significantly, concurrently with reduced prostaglandin E 2 formation. Synovial fluid leukocyte counts also decreased, but the percentage of polymorphonuclear cells increased simultaneously only in the orgotein-treated group. The results suggest that patients with rheumatoid arthritis of the knee joints who show good response to orgotein during a short course of treatment are likely to continue their positive response and possibly attain increased relief of symptoms over longer periods of treatment, in contrast to those patients receiving steroids.

Arthritis in Acute Leukemia

Eight patients had acute leukemia and arthritis. In five the arthritis had no evident cause other than the leukemia, and three had crystal-induced arthritis. Effusions from both groups of patients were often inflammatory. The average synovial fluid leukocyte count from the five effusions attributed to leukemia was 8,790/cu mm. A synovial needle biopsy specimen from one of these patients showed acute and chronic inflammation but no leukemic infiltration. Bone involvement was suggested by bone pain in only one patient. In no case did arthritis persist in the presence of a hematologic remission. In the three patients with crystal-induced arthritis, the average synovial fluid leukocyte count was 13,000/cu mm. There were crystals of monosodium urate in one and of calcium pyrophosphate dihydrate in two patients. Suspected blast forms were seen in the synovial fluid of only one patient, one of those with pseudogout. Electron microscopic studies of needle biopsy specimens of synovial membrane from leukemic patients with arthritis described herein for the first time showed no blast forms, virus-like particles, or electron-dense deposits in vessel walls to suggest specific mechanisms for the arthritis.

Survey of synovial fluid cryoprecipitates.

Synovial fluid cryoproteins from various inflammatory and noninflammatory arthritides were examined for the presence of immunoglobulin, fibrinogen, antiglobulin activity, and third component of complement and correlated with the synovial fluid leucocyte count. The majority of rheumatoid synovial fluid cryoproteins contained either IgG-IgM complexes or IgG alone. Contrary to previous reports, many synovial fluid cryoproteins from psoriasis, Reiter's syndrome, nonspecific acute polyarthritis, gout, and gonococcal arthritis also contained IgG and occasionally IgG-IgM complexes. Noninflammatory synovial fluids were less likely to contain any immunoglobulin. The highest concentration of cryoprotein was found in Reiter's syndrome. There was a significant (P < 0.05) correlation between the presence of immunoglobulin and the concentration of the synovial fluid cryoprotein with the synovial fluid leucocyte count. Since synovial fluid cryoproteins containing immunoglobulin are present in the synovial fluids of many diverse rheumatic diseases not postulated to be immune complex mediated, they may be a nonspecific phenomenon related to the degree of inflammation.

Acute gouty bursitis: report of 15 cases.

Fifteen cases of acute gouty bursitis were seen among 136 crystal-proved cases of gout. Bursal aspirate yielded yellow or pink fluid in 10, chalky white fluid in 1, and a small amount of bloody fluid in 4. Monosodium urate crystals were present in all. Bursal fluid leucocyte counts averaged 2.9 X 10(9)/1 compared with synovial fluid leucocyte counts that averaged 25.5 X 10(9)/1 in cases of articular gout (P less than 0.05). Gouty, septic, and idiopathic (traumatic) bursitis share clinical features, and detailed bursal fluid analysis is crucial for diagnosis.

Activation of complement components C3 and factor B in synovial fluids.

Synovial fluids from 106 patients with various types of arthritis were examined for the presence of conversion products of C3 by means of crossed antigen-antibody electrophoresis and for products of factor B by immunoelectrophoresis. C3 conversion was found in all 15 fluids from patients with seropositive rheumatoid arthritis, in 11 of 15 with seronegative rheumatoid arthritis, in the majority with probable and possible rheumatoid arthritis, juvenile rheumatoid arthritis, SLE, pseudogout, gout, Reiter's syndrome, and frequently in other arthritides studied, but in only one of 15 with degenerative arthritis. In 53 synovial fluids a single C3 conversion peak was seen in addition to the native protein and in 18 others two conversion peaks were present. In many synovial fluids showing conversion whole-complement titers and C3 protein concentrations were normal. In both rheumatoid arthritis and crystal synovitis the per cent of C3 conversion, as estimated by planimetry, correlated with synovial fluid leukocyte counts, Factor B conversion was found in 31 fluids and usually occurred in fluids also showing C3 conversion. The findings indicate that in vivo activation of components of the classical and alternative considered mediated by immune complexes. Activation is also commonly present in a wide variety of other inflammatory arthritides and ofter would not be recognized by measuring only concentrations of hemolytic whole complement or C3 by immunodiffusion. The positive association between C3 conversion and synovial fluid polymorphonuclear leukocytes suggests that chemotactic factors generated from complement may be responsible for the attraction of leukocytes into the synovial space in these diseases.

High Synovial Fluid White Blood Cell Counts in Pseudogout

During a 12-month period, we have treated five patients with acute inflammatory arthritis and synovial fluid leukocyte counts of 65,000 to 100,000/cu mm with 93% to 100% polymorphonuclear cells, calcium pyrophosphate dihydrate crystals in the synovial fluid, and negative cultures. Four of these five were originally treated for septic joints. We would like to emphasize this relatively uncommon, but important, manifestation of pseudogout.

High synovial fluid white blood cell counts in pseudogout; Possible confusion with septic arthritis

During a 12-month period, we have treated five patients with acute inflammatory arthritis and synovial fluid leukocyte counts of 65,000 to 100,00/cu mm with 93% to 100% polymorphonuclear cells, calcium pyrophosphate dihydrate crystals in the synovial fluid, and negative cultures. Four of these five were origingally treated for septic joints. We would like to emphasize this relatively uncommon, but important manifestation of pseudogout.

Effects of cold and heat on urate crystal-induced synovitis in the dog.

AbstractLocal cooling decreased, while heating increased, the acute inflammation produced by a single injection of urate crystals into dog knees. Synovial fluid leukocyte counts and volume, polymorphonuclear infiltration of synovial membrane, and 133Xe clearance were decreased by cold, and increased by heat. There was good correlation between altered inflammation and vascular changes, but not with enzyme levels, cell death, or leukocyte structural changes. Chronic synovitis from repeated crystal injections was not altered by cold or heat.

Synovitis of recent onset. A clinicopathologic study during the first month of disease.

AbstractNine of 24 patients studied during the first month of synovitis subsequently fulfilled diagnostic criteria for adult or juvenile rheumatoid arthritis. Most showed prominent synovial vascular lesions and inflammation that rarely included plasma cells. Rheumatoid factor titers were low, but gammaglobulin levels were often elevated. Synovial fluid leukocyte counts were generally lower than in chronic RA, and synovial membrane inflammation was seen even with noninflammatory effusions. Nine patients had a transient synovitis not fitting any known disease entity.