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Synovial Fluid WCC Threshold — SCE Rheumatology MCQ

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HardRheumatology EmergenciesSynovial Fluid WCC ThresholdSCE Rheumatology

A 42-year-old woman with an acute hot swollen knee is sent for urgent joint aspiration. The aspirate is sent for Gram stain culture crystal analysis and cell count. What synovial fluid WCC level generally distinguishes inflammatory from non-inflammatory causes?

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Correct answer: D — 2000 cells/microL is the conventional threshold above which an inflammatory cause is likely

The best answer is “2000 cells/microL is the conventional threshold above which an inflammatory cause is likely”. 2000 cells/microL is the conventional threshold above which an inflammatory cause is likely is supported by the cited UK or directly applicable specialist authority and best matches the tested threshold, complication or monitoring principle. The remaining choices—“100000 cells/microL, after specialist assessment, after specialist assessment, with clinical reassessment”, “100 cells/microL, with clinical reassessment, with clinical reassessment, within a rheumatology pathway”, “50000 cells/microL, after safety review, within a rheumatology pathway, after safety review”, “10000 cells/microL, after specialist assessment, after safety review, after specialist assessment”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: NICE NG226 osteoarthritis: https://www.nice.org.uk/guidance/ng226/chapter/Recommendations