Quality Improvement in the Identification of Crystals from Synovial Fluid

It has been well studied and accepted that the best method for evaluating joint disease is examination of synovial fluid. Synovial fluid analysis is critical to establish a definite diagnosis, whether the patient has a septic joint or a crystal arthropathy. Our study aims at studying the consistency of crystal identification between the Rheumatology department and the hospital laboratories as well as identifying the factors contributing to the misidentification of crystals.

The sensitivity for the detection of any crystals by the faculty was found to be 0.92, while for the laboratory it was 0.66. The sensitivity of MSU crystal detection by the faculty was 0.89 and by the laboratory, 0.74. Similar results were seen for the detection of CPP crystals by the Rheumatologists with the sensitivity being 0.90, while the laboratory’s sensitivity was much less, only at 0.57.

The results of our study are consistent with previous studies showing that there are still discrepancies in synovial fluid analysis. Many factors may be contributing to these variations including observer error, differences in time spent examining the fluid, technician training and crystal concentration. When analyzed separately, not all of our findings reached statistical significance, but when examined together, statistical significance was met. We believe that this study has profound clinical significance. Errors in crystal detection can have serious impacts on disease management and patient care.

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Quality Improvement in the Identification of Crystals from Synovial Fluid: Hospital Laboratory Versus Rheumatology Department Evaluation

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Source: : ACR Meeting Abstracts