Unusual Synovial Fluid Findings in Reiter's Syndrome

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Abstract
Synovial fluid was obtained from 11 patients with Reiter''s syndrome within 2 wks. of the onset of the arthritis. Synovial fluid examination included cell count, search for crystals, test for rheumatoid factor, measurement of synovial fluid complement activity (C''), and study of the synovial fluid cytology on stained slides. Synovial fluid cell count was elevated in all subjects, with an average value of 28,000 WBC/mm3. Two features distinguished Reiter''s synovial fluid from other kinds of inflammatory joint effusions: elevated synovial fluid C levels (>140 CH50 units/ml) and the presence of macrophages containing leucocytes. Over 200 synovial fluids from other kinds of inflammatory joint diseases were examined similarly. Rarely does the synovial fluid C activity from gouty arthritis and chondrocalcinosis exceed 140 CH50 units; the values are lower in other types of arthritis. Synovial fluid C determination allows rapid differentiation of Reiter''s syndrome from rheumatoid arthritis and SLE [Systemic lupus erythematous]. Macrophages containing leucocytes were seen in all Reiter''s fluids; were seen in only 2 of the 200 non-Reiter''s fluids, both cases of infectious arthritis due to gram-negative agents. Elevated C'' activity and macrophages containing leucocytes have been consistently found in synovial fluid from Reiter''s syndrome and may be a function of the duration of the arthritis and/or, the agent responsible for Reiter''s syndrome.

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