Why the study?
Does synovial fluid L-lactic acid concentration differentiate between culture-positive and culture-negative acute knee arthritis in adults?
Does synovial fluid L-lactic acid concentration differentiate between culture-positive and culture-negative acute knee arthritis in adults?
Synovial fluid L-lactic acid values > 9 mmol/l strongly support the occurrence of bacterial arthritis, challenging previous suggestions that it is an unspecific indicator.
Elevated synovial L-lactic acid may aid differentiation of bacterial arthritis; hypothesis-generating and requires prospective validation before practice change.
Determination of synovial fluid (SF) lactic acid has been suggested to be an unspecific indicator of SF leukocytosis, and it is not recommended for differential diagnosis of bacterial arthritis. We analyzed the L-lactic acid content by enzymatic UV-method in 65 SF samples obtained from adult patients with acute knee arthritides. The concentration of L-lactic acid was not high in any SFs with intensive leukocytosis. The mean concentration of L-lactic acid was 13.5 mmol/l (95% confidence intervals 9.4; 17.6 mmol/l) in the synovial-fluid samples from culture-positive arthritis and 5.5 mmol/l (4.9; 6.2 mmol/l) in the synovial-fluid samples from culture-negative arthritis. Determination of SF L-lactic acid is an important part of the diagnostic setup for acute arthritis. Values > 9 mmol/l strongly support occurrence of bacterial arthritis and indicates an immediate onset of the treatment.
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Kortekangas et al. (1995) studied this question.
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