RT Journal Article
SR Electronic
T1 Persistence of Crystals in Stored Synovial Fluid Samples
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 1416
OP 1423
DO 10.3899/jrheum.190468
VO 47
IS 9
A1 Sonia Pastor
A1 José-Antonio Bernal
A1 Rocío Caño
A1 Silvia Gómez-Sabater
A1 Fernando Borras
A1 Mariano Andrés
YR 2020
UL http://www.jrheum.org/content/47/9/1416.abstract
AB Objective. Lack of access to polarized light microscopy is often cited as an argument to justify the clinical diagnosis of crystal-related arthritis. We assessed the influence of time since sampling and preservation methods on crystal identification in synovial fluid (SF) samples under polarized light microscopy.Methods. This was a prospective, longitudinal, observational factorial study, analyzing 30 SF samples: 12 with monosodium urate (MSU) crystals and 18 with calcium pyrophosphate (CPP) crystals. Each SF sample was divided into 4 subsamples (120 subsamples in total). Two were stored in each type of preserving agent, heparin or ethylenediamine tetraacetic acid (EDTA), at room temperature or at 4°C. Samples were analyzed the following day (T1), at 3 days (T2), and at 7 days (T3) by simple polarized light microscopy, and the presence of crystals was recorded.Results. The identification of crystals in the MSU group was similar between groups, with crystals observed in 11/12 (91.7%) room temperature samples and in 12/12 (100%) refrigerated samples at T3. Identification of CPP crystals tended to decrease in all conditions, especially when preserved with EDTA at room temperature [12/18 (66.7%) at T3], while less reduction was seen in refrigerated heparin-containing tubes.Conclusion. Preserving samples with heparin in refrigerated conditions allows delayed microscopic examination for crystals. Avoiding crystal-proven diagnosis because of the immediate unavailability of microscopy no longer appears justified.