{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T02:38:47Z","timestamp":1778899127205,"version":"3.51.4"},"reference-count":8,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T00:00:00Z","timestamp":1738627200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Gout and calcium pyrophosphate deposition (CPPD) disease are common crystalline arthropathies. Identification of crystals in synovial fluid using polarized light microscopy (PLM) aids diagnosis. In routine clinical practice, the volume of synovial fluid available for PLM is frequently insufficient, especially when fluid is also needed for other analyses, such as Gram stain and culture. Few studies have investigated the reliability of microscopic examination for crystals, with or without polarization, using Gram-stained synovial fluid specimens. This study estimated the sensitivity and specificity of microscopy with and without polarization on Gram-stained specimens for identification of crystals compared with standard PLM on unstained samples.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In total, 105 unstained synovial and bursal fluid samples were processed and examined by laboratory personnel using routine PLM procedures. Gram-stained samples of the same fluid were independently interpreted by microbiologists trained in examining fluid for crystals using standard light microscopy, followed by at least 2 pathologists using PLM.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Compared with standard PLM on unstained samples, the sensitivity and specificity of crystal examination by microbiologists on Gram-stained samples were 16% and 98%, respectively. Pathologists, using PLM on these Gram-stained samples, achieved slightly better sensitivity (24.5% and 96%, respectively). Concordance regarding crystal type was 100% and unaffected by Gram stain.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Crystal examination of Gram-stained synovial and bursal fluid by trained personnel has low sensitivity but high specificity compared with standard evaluation of unstained samples. Examination of Gram-stained samples with PLM may be helpful when sample volumes are limited and, when positive, has sufficient specificity to support crystalline arthropathy diagnoses.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jalm\/jfae162","type":"journal-article","created":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T17:39:51Z","timestamp":1738690791000},"page":"653-658","source":"Crossref","is-referenced-by-count":1,"title":["Detection of Crystals in Gram-Stained Synovial Fluid"],"prefix":"10.1093","volume":"10","author":[{"given":"Steven J","family":"Szlembarski","sequence":"first","affiliation":[{"name":"Department of Medical Education, Gundersen Medical Foundation , La Crosse, WI ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William A","family":"Agger","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Gundersen Health System , La Crosse, WI ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah R","family":"Pendley","sequence":"additional","affiliation":[{"name":"Department of Anatomic Pathology, Gundersen Health System , La Crosse, WI ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen J","family":"Bloechl","sequence":"additional","affiliation":[{"name":"Department of Anatomic Pathology, Gundersen Health System , La Crosse, WI ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher H","family":"Cogbill","sequence":"additional","affiliation":[{"name":"Department of Anatomic Pathology, Gundersen Health System , La Crosse, WI ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arick P","family":"Sabin","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Gundersen Health System , La Crosse, WI ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9268-8062","authenticated-orcid":false,"given":"Cathy Mikkelson","family":"Fischer","sequence":"additional","affiliation":[{"name":"Department of Research Navigation, Gundersen Medical Foundation , La Crosse, WI ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas W","family":"White","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Gundersen Health System , La Crosse, WI ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,2,4]]},"reference":[{"key":"2025050206370672000_jfae162-B1","doi-asserted-by":"crossref","first-page":"255","DOI":"10.2174\/1573397113666170329123308","article-title":"The limitations of Gram-stain microscopy of synovial fluid in concomitant septic and crystal arthritis","volume":"14","author":"Stirling","year":"2018","journal-title":"Curr Rheumatol Rev"},{"key":"2025050206370672000_jfae162-B2","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1097\/00124743-199804000-00015","article-title":"Identification of pathological synovial fluid crystals on Gram stain","volume":"4","author":"Petrocelli","year":"1998","journal-title":"J Clin Rheumatol"},{"key":"2025050206370672000_jfae162-B3","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.ejim.2024.02.024","article-title":"Gram staining of shoulder joint fluid","volume":"124","author":"Miyamatsu","year":"2024","journal-title":"Eur J Intern Med"},{"key":"2025050206370672000_jfae162-B4","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/j.berh.2005.01.004","article-title":"Synovial fluid analysis","volume":"19","author":"Pascual","year":"2005","journal-title":"Best Pract Res Clin Rheumatol"},{"key":"2025050206370672000_jfae162-B5","volume-title":"Clinical microbiology procedures handbook","author":"Leber","year":"2016","edition":"4th Ed"},{"key":"2025050206370672000_jfae162-B6","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1136\/ard.2004.027268","article-title":"Analysis for crystals in synovial fluid: training of the analysts results in high consistency","volume":"64","author":"Lumbreras","year":"2005","journal-title":"Ann Rheum Dis"},{"key":"2025050206370672000_jfae162-B7","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1097\/RHU.0b013e31829cde53","article-title":"A 3-day delay in synovial fluid crystal identification did not hinder the reliable detection of monosodium urate and calcium pyrophosphate crystals","volume":"19","author":"Tausche","year":"2013","journal-title":"J Clin Rheumatol"},{"key":"2025050206370672000_jfae162-B8","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1002\/anr.1780320308","article-title":"Is it mandatory to examine synovial fluids promptly after arthrocentesis?","volume":"32","author":"Kerolus","year":"1989","journal-title":"Arthritis Rheum"}],"container-title":["The Journal of Applied Laboratory 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