Presence of Crystals in the Synovial Fluid of Patients With Psoriatic Arthritis

Abstract

Analyzing synovial fluid from joints affected by the pathological process of psoriatic arthritis is part of the overall patient examination, since it may have differential diagnostic significance. The purpose of this study was to assess the presence of crystals in the synovial fluid of psoriatic arthritis patients as biomarkers for disease activity. Materials and methods: The synovial fluid of 156 patients with proven PSA diagnosis (patients covered CASPAR criteria) was analyzed over 24 months and compared to 50 patients with activated gonarthrosis. The Leica DM4500P polarization microscope (Leica Microsystems, Germany) was used for crystal detection. Pain and disease activity measures were also evaluated (PSA VAS for pain, DAPSA, PASDAI, mCPDAI, and HAQ-DI). The statistical analysis was carried out using SPSS version 26 with a significance set at p < 0.05. Results: The macroscopic appearance of synovial fluid from patients with psoriatic arthritis was clear in 84.6% of the patients. Synovial fluid crystals were found in 23.71% of patients with psoriatic arthritis - predominantly monosodium urate (67.58%) but also calcium pyrophosphate (21.62%) and lipid drops (5.4%). The presence of monosodium urate crystals significantly correlates with all pain and disease activity measures – VAS for pain, DAPSA, PASDAI, mCPDAI, and HAQ-DI. In 67.56% of patients with established crystals treatment with an anti-TNF blocker was started at the discretion of the treating rheumatologist due to high levels of disease activity. Conclusion: Examining the synovial fluid in PSA patients is a necessary minimally invasive procedure in cases of joint effusion, since the presence of synovial fluid crystals is a significant indicator of disease severity. The current analyses demonstrate that the presence of synovial fluid crystals in PSA patients can be used as a biomarker for disease severity and the necessity to commence biological treatment (most often TNF-a-blocker).