Amigo CMC, Canoso JJ

Language: Spanish
References: 11
Page: 173-176
PDF size: 215.70 Kb.

ABSTRACT

Introduction: New clinical criteria for classifying a patient as having gout are based on the presence of swelling in one or more joints or bursae, plus the finding of monosodium urate crystals in synovial fluid or tophus. In the absence of the latter, a criterion called «of sufficiency» and that is actually «of certainty», there are additional clinical or imaging data for confirming the diagnosis. Objectives: To determine, in the private medical environment of Mexico City, if there are barriers to a diagnosis of gout based on the identification of monosodium urate crystals in synovial fluid. Methods: Telephone survey: nine well-known clinical pathology laboratories in Mexico City were surveyed. They were asked if they studied synovial fluid, if they look specifically for crystals in synovial fluid samples, and what the smallest volume of synovial fluid that they accept for a study was. Patient identification: the clinical records of gout patients seen by the authors from 1995 to 2014, and among them, those who were diagnosed by finding monosodium urate crystals in synovial fluid, were reviewed. Results: All nine laboratories studied synovial fluid. In five laboratories, the crystal search was routine. The smallest volume accepted for analysis was two mL. During the study period, 7,200 individuals were seen by the authors. In 110 a diagnosis of gout was made by identification of monosodium urate crystals in synovial fluid. In 10 of these subjects, synovial fluid volume was not recorded. Of the remaining 100, synovial fluid volume was ≥ 2 mL in 28, and ‹ 2 mL in 72. Conclusions: The study shows that the majority of monosodium urate crystals-positive synovial fluid samples would have been rejected by clinical laboratories due to insufficient volume. Operational manuals should be modified to accept small samples that are earmarked for crystal search. Also, all laboratories should be encouraged to acquire expertise in the synovial fluid analysis

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