Synovial Fluid Analysis + Bloods in Rheumatology

Question 1

Synovial Fluid Analysis;

For diagnosis of acute bacterial ? or ? associated disease.
Often combined with ? injection.
If the joint is inflamed, the synovial fluid changes from clear (?-coloured) to ?, due to an increase in cell count (particularly ?)

Answer 1

sepsis
crystal
steroid
straw
turbid
neutrophils

Question 2

Synovial Fluid Analysis;

Turbid fluid should be analysed with an urgent ? ?, and then ?.
o ? takes 48h - so treat ? first.

Viscosity ? in inflammation despite the increase in inflammatory cells, as their degranulation ? the usual proteins.

Uniformly ? ? SF may be due to trauma, severe inflammation of
any kind, or ? tendencies.

Answer 2

gram stain
culture
culture
sepsis
decreases
digests
blood stained
bleeding

Question 3

Synovial Fluid Analysis;

Non-uniform blood-stained SF indicates a ? ?.
If suspected crystal arthropathy, send for ? ? microscopy;
o MSU crystals: ? shaped, ?biorefringent = gout.
o CPPD crystals: ? shaped, ? biorefringent =
pseudogout.

Answer 3

traumatic aspiration
compensated polarised
needle
negatively
rhomboid
positively

Question 4

FBC;

Thrombocytopenia: due to disease activity in ?/?, ?’s syndrome in RA or due to drugs such as ?.

Leukopenia: ? seen in lupus (or leucocytosis in ? of SLE).

Anaemia: can occur due to ? disease, ? deficiency (medication associated ulcers etc.), megaloblastic anaemia (due to ? or associated ? anaemia) or haemolysis (? / drugs).

Answer 4

sle/apl
felty
mtx
lymphopenia
flare
chronic
iron
mtx
pernicious
sle

Question 5

LFTs;

? often elevated in RA / polymyositis, as well as ?disease.

U+E

Can be abnormal due to ? in CTDs.
A ? ? is a much better indicator of pathology.

Answer 5

alp
bone
glomerulonephritis
urine dip

Question 6

Rheumatoid Factor (RF)

lgM antibody against lgG, forming immune complexes that contribute to the
disease process.
Positive in 70% of people with ?, 78% specific.
0 Also raised in SLE / ?
Indicates a ? prognosis (and extra-? manifestations) if +ve at diagnosis.
Can be transiently raised in ?.

Answer 6

RA
sjogrens
worse
articular
infections

Question 7

Anti-CCP

• 90-98% specific for ? - 60% sensitive
• +ve in around 40% of pts that are -ve for ??
• may precede onset of RA by 12 ?
• if raised at presx - indicates a ? prognosis

Answer 7

RA
RF
years
worse

Question 8

ANA

-titres >1 in ? positive, but generally >1 in 320 in ? disease
Useful to rule out ?, with has nearly 100% ANA positivity.
Also raised in RA, ?, ?, ?.

Answer 8

80
Autoimmune
lupus
polymyositis
sjogrens
scleroderma

Question 9

Anti ds-DNA· ,

Specific for ?, but often only present in ? disease.
Marker for ? prognosis (indicates ? involvement).
It changes with disease activity, so can be used as a ?.

Answer 9

lupus
severe
poor
renal
marker

Question 10

Extractable Nuclear Antigens;

Anti-Sm is specific to ?.
Anti-? & Anti-? (aka SSl & SS2) are often present in Sjogrens;
o 70% Anti-?, 30% Anti-? positive in primary Sjogren’s.

Answer 10

sle
ro
la
ro
la

Question 11

Extractable Nuclear Antigens

Can be used to indicate specific ? involved;
o Anti-? in ? indicates pulmonary fibrosis.
o Anti ? in ? indicates pulmonary/ cardiac
involvement.
Generally there is no use for ? ENA monitoring.

Answer 11

tissue
Jo1
myositis
topoisomerase
scleroderma
longitudinal