Joints are made up of two opposing cartilage surfaces surrounded and supported by a multilayer capsule and bathed in synovial fluid. To understand the formation of joint effusions, knowledge of the anatomy and physiology of healthy joints is important. Arthrocentesis and examination of the synovial fluid can confirm the presence of arthritis, characterize the response as inflammatory or noninflammatory, and, in some circumstances, reveal the etiologic agent. All cases of lingering lameness and those unresponsive to nonsteroidal anti-inflammatory drugs should have synovial fluid analyzed to rule out a chronic infectious process. In general, joints that contain excessive fluid should be sampled however, if none exist, at least two to three joints should be sampled, especially the carpal and tarsal joints. Synovial fluid analysis is also recommended in disorders characterized by persistent or fluctuating fever of unknown origin, shifting leg lameness, or generalized malaise in which arthralgia is suspected. The technique of arthrocentesis to acquire synovial fluid for analysis is no more difficult or imbued with risk than pleurocentesis or abdominocentesis. Arthrocentesis and joint fluid analysis are integral to the clinical evaluation of not only primary joint disorders but systemic diseases in which joint effusion is part of the clinical picture.
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