Gout is joint inflammation caused by deposition of uric acid crystals. Septic arthritis is caused by bacterial infection of the joint, The most commonly implicated organism in sexually active persons is Neisseria gonorrhoeae. The most common cause of inflammatory arthritis is rheumatoid arthritis. Inflammatory arthritis results from damage to the joint caused by immune complexes that deposit in the joint or autoantibodies that attach to and destroy the synovial membrane. Noninflammatory or osteoarthritis is the most common form and results from loss of cartilage covering the bone. Causes of arthritisĪrthritis can be classified by cause into five categories. Therefore, a blood sample should be collected at the same time. Some tests, such as glucose and total hemolytic complement must be evaluated with respect to blood levels. Only a drop of fluid is needed for culture and microscopic examination and these two procedures are given top priority because of their diagnostic importance. The physician may need to prioritize the tests that he or she orders since fluid yields from this procedure may be very small. The sample is transferred to one or more tubes containing liquid heparin or liquid EDTA anticoagulant. The needle is then withdrawn and an adhesive bandage is placed over the puncture site. The syringe may contain a small amount of sodium heparin. At this point, the clinician slowly drains some of the fluid into the syringe. Correct placement of the needle in the joint space is normally painless. As the needle enters the joint, a "pop" may be felt or heard this is normal. A local anesthetic, typically a sub-cutaneous injection of lidocaine, xylocaine, or ethyl chloride, is then administered. The patient is asked to lie on their back and remain relaxed. The size of the needle and volume of fluid withdrawn depends on the size of the joint. The joint must be cleaned thoroughly with iodine before inserting the needle to prevent any infection. The procedure is done by passing a needle into a joint space and aspirating synovial fluid using aseptic technique. The removal of synovial fluid, arthrocentesis, is also called a joint tap, or closed joint aspiration. Therefore, a poorly accessible joint space, such as in hip aspiration in an obese patient, should not be subjected to this procedure. Sampling of a joint may be contraindicated when there is evidence of infection in overlying skin or tissue. Arthrocentesis should not be performed on a patient who is uncooperative, especially if the patient cannot or will not keep the joint immobile throughout the procedure. Universal precautions for the prevention of transmission of bloodborne pathogens should be observed when collecting synovial fluid. Diseases which may cause joint swelling include rheumatoid arthritis, systemic lupus erythematosus, gout, gonococcal arthritis (caused by the bacteria that causes gonorrhea), other types of bacterial arthritis, and viral inflammation of the synovial lining. In addition, removal of the fluid can decrease pain in the joint. The purpose of joint fluid analysis is to diagnose arthritis, an inflammation of the joint, and identify its cause. The fluid lubricates the bone and cartilage tissues of the joint. Synovial or joint fluid is an ultrafiltrate of plasma formed in the synovial membrane of movable joints. Joint fluid analysis, also called synovial fluid analysis, or arthrocentesis, is a procedure used to assess joint-related abnormalities, such as occur in the knee or elbow.
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