Synovial Fluid pH:
Why Synovial Fluid pH Test?
CLINICAL INFORMATION
pH is defined as the negative logarithm of hydrogen ion concentration. pH indicates the concentration of hydrogen ions in a solution. Hence pH is a figure expressing the acidity or alkalinity of a solution on a logarithmic scale on which 7 is neutral. Values lower than 7 are acidic and the values higher than 7 are basic or alkaline in nature. The significance of body fluid pH is intended to assess the pH in the body fluids. Since pH indicates if the body/Biofluid is acidic, alkaline or neutral, it helps to distinguish between an infection and inflammation. The sample specimen is usually Intra-Vascular Fluid i.e Blood (serum/plasma) and/or body fluids. Body/Bio-Fluid Tests: Body Fluids include Peritoneal/Ascitic fluid (Ascites) – in peritonitis (inflammation of the lining of the inner abdominal wall etc), Pericardial fluid, infected pleural fluid causing pleural effusion, Bronchial Wash, Drain or aspiration Fluids - Paracentesis, Thoracocentesis, aspiration of bone marrow, aspiration of amniotic fluid, JP Drain and /or blood, urine, saliva, sweat, bile fluid, seminal fluid, vaginal fluid, synovial fluid, nasal fluid, CSF, lymph, endolymph etc can provide a vital clue in the biochemical investigation of pathologies in certain disorders or disease conditions in certain differential diagnosis to arrive at a conclusive definitive diagnosis and also for prognosis. Hence these altered pH in body fluids certainly helps in screening for the diagnosis of certain pathological states of the body. Synovial fluid analysis is also known as joint fluid analysis may be ordered to help diagnose the cause of joint inflammation, pain, swelling and fluid accumulation. The function of the synovial fluid is to supply nutrition and disposal of metabolic end products, to lubricate the joints and absorbs shock. Diseases associated with synovial fluid are of two types - Inflammatory type and Non-Inflammatory type. Some of the diseases are the auto-immune disease that leads to chronic synovitis (inflammation of synovial membrane), degenerative osteoarthritis (synovial fluid becomes less viscous and inflammatory substances come into direct contact with sensory nerve cells in the joints producing pain), rheumatoid arthritis, gout, tubercular arthritis (mycobacterium tuberculi – acid-fast bacilli), pyogenic arthritis or septic arthritis (increased amount of lactate accumulation), systemic lupus erythematosus, psoriatic arthritis, ankylosing spondylitis etc. The test analysis checks for changes in the physical properties like colour, and viscosity and screens for changes in the fluid’s biochemical composition. Determination of inflammatory infilterate is detected by adding acetic acid to the synovial fluid specimen. If mucin clot is formed it shows the presence of inflammatory cells. Estimation of lactate levels in septic arthritis. Symptoms includes pain, stiffness, swelling, cracking sound (since synovial fluid level reduces to fill the expanding volume of the joints negative pressure is formed and carbon-di-oxide gets filled up in the space and this bubble formation is called as cavitation leading to crackling sound) etc. Gram Stain Test: This test checks for the presence of harmful pathogenic microbes in suspected infection, for example in the throat, lungs, skin wounds, genitals etc and moreover in body fluids such as blood, urine etc. The two main categories of bacterial infections are gram positive and gram negative. This screening for diagnosis is done by the differentiation made, based on how the bacteria reacts to the gram stain. A gram stain is colored purple and if the bacteria remains in purple color it is gram positive bacteria and incase the bacteria turns red or pink they are gram negative bacteria. Examples of gram positive bacteria include nosocomial infection caused by Methicillin Resistant Streptococcus aureus (MRSA), Strep infections, toxic shock etc. Examples of gram negative infections include Salmonella, pneumonia, gonorrhea, UTI etc. The significance of differentiating the nature of bacteria as gram positive or gram negative helps the physician to begin the most effective antibiotic therapy for treating it. If the test result shows the presence of more than (≥15) colonies along with the same organism isolated from peripheral blood along with clinical signs and symptoms, then the case is said to be an infected positive case. Other gram stain test include Acid Fast Test (eg. For mycobacterium causing TB etc). Clinical manifestations include chills, fever, fatigue, nausea, confusion, increased heart rate, nasal flare due to increased breathing -which may or may not be associated with shortness of breath on physical exertion, inflammation (presenting with cardinal signs of inflammation like – rubor, tumor, calor, dolor and loss of function), blood clots, drop in blood pressure, organ failure, elevated WBCs etc. Once tested positive, then the additional supportive tests are ordered for - Evidence Based Therapy (EBT) such as CBC, test for presence of bacterial toxins (release of toxic by-products) eg staphylococcal infection, in case of foodborne-illness/food poison (or their toxins), different sample specimen collected for tests eg. blood, stool, urine culture, sputum test, CSF sampling, ascetic fluid, pleural fluid, pericardial fluid, synovial fluid, complement test (to check for increased levels of C3) etc. Moreover, sensitivity test (also known as susceptibility testing) are also performed in addition, to appropriate antibiotic treatment & for better prognosis eg. MRSA – Methicillin-Resistant Staphylococcus aureus, VMSA – Vancomycin-Resistant Staphylococcus aureus etc. Other tests other than culture and sensitivity of semen for the source of infection include microscopic examination and evaluation of semen analysis, blood tests like CBC, differential WBC count (in case of infection), Prostate-Specific Antigen test, testosterone, FSH, ELISA test for Mumps antibodies etc, other hormonal assays eg. pituitary hormones (in case of tumours etc), urinalysis to check for UTI, digital rectal examination to confirm pain and swelling of the prostate, CT Scan, ultrasound (vericocele), genetic tests like DNA, ABG, electrolytes etc.
General Instructions:
Sample Requirement: Specimen –Synovial Fluid. Test Preparation: None.
NOTE - Sample for specimen collections may vary based on the patient’s condition/cases according to the patient’s presenting complaints/signs or symptoms:
SPECIMEN REQUIREMENT (Special or Rare Cases) - As instructed and guided by Physician / Clinician / Pathologist / as per Laboratory’s requirements, according to procedures and protocols.
This Multi-Specialty Clinical Referral Laboratory RT DIAGNOSTICS provides precise and accurate tests with an extensive range of testing services to the medical centres to help in the diagnosis and identification of pathology in the test specimens for infectious diseases and also to evaluate the function of organ systems of the patient. It prevents further complications and helps to stabilize and restore health to near normalcy at the earliest without delay.
