Synovial fluid

A typical joint

Synovial fluid is a viscous, non-Newtonian fluid found in the cavities of synovial joints. With its yolk-like consistency ("synovial" partially derives from ovum, Latin for egg), the principal role of synovial fluid is to reduce friction between the articular cartilage of synovial joints during movement.

Overview

The inner membrane of synovial joints is called the synovial membrane and secretes synovial fluid into the joint cavity. The fluid contains hyaluronic acid secreted by fibroblast-like cells in the synovial membrane and interstitial fluid filtered from the blood plasma. This fluid forms a thin layer (roughly 50 μm) at the surface of cartilage and also seeps into microcavities and irregularities in the articular cartilage surface, filling all empty space. The fluid in articular cartilage effectively serves as a synovial fluid reserve. During movement, the synovial fluid held in the cartilage is squeezed out mechanically to maintain a layer of fluid on the cartilage surface (so-called weeping lubrication). The functions of the synovial fluid include:

• reduction of friction - synovial fluid lubricates the articulating joints
• shock absorption - as a dilatant fluid, synovial fluid is characterized by the rare quality of becoming more viscous under applied pressure; the synovial fluid in diarthrotic joints becomes thick the moment shear is applied in order to protect the joint and subsequently thins to normal viscosity instantaneously to resume its lubricating function between shocks
• nutrient and waste transportation - the fluid supplies oxygen and nutrients and removes carbon dioxide and metabolic wastes from the chondrocytes within the surrounding cartilage

Composition

Synovial tissue is sterile and composed of vascularized connective tissue that lacks a basement membrane. Two cell types (type A and type B) are present: Type A is derived from blood monocytes, and it removes the wear-and-tear debris from the synovial fluid. Type B produces synovial fluid. Synovial fluid is made of hyaluronic acid and lubricin, proteinases, and collagenases. Synovial fluid exhibits non-Newtonian flow characteristics; the viscosity coefficient is not a constant and the fluid is not linearly viscous. Synovial fluid has thixotropic characteristics; viscosity decreases and the fluid thins over a period of continued stress.

Normal synovial fluid contains 3–4 mg/ml hyaluronan (hyaluronic acid), a polymer of disaccharides composed of D-glucuronic acid and D-N-acetylglucosamine joined by alternating beta-1,4 and beta-1,3 glycosidic bonds. Hyaluronan is synthesized by the synovial membrane and secreted into the joint cavity to increase the viscosity and elasticity of articular cartilages and to lubricate the surfaces between synovium and cartilage.

Synovial fluid contains lubricin secreted by synovial cells. Chiefly, it is responsible for so-called boundary-layer lubrication, which reduces friction between opposing surfaces of cartilage. There also is some evidence that it helps regulate synovial cell growth.

Its functions are:

reducing friction by lubricating the joint, absorbing shocks, and supplying oxygen and nutrients to and removing carbon dioxide and metabolic wastes from the chondrocytes within articular cartilage.

It also contains phagocytic cells that remove microbes and the debris that results from normal wear and tear in the joint.

Health and disease

Collection

Synovial fluid may be collected by syringe in a procedure termed arthrocentesis, also known as joint aspiration.

Classification

Synovial fluid may be classified into normal, noninflammatory, inflammatory, septic, and hemorrhagic:

Classification of synovial fluid in an adult knee joint

	Normal	Noninflammatory	Inflammatory	Septic	Hemorrhagic
Volume (ml)	<3.5	>3.5	>3.5	>3.5	>3.5
Viscosity	High	High	Low	Mixed	Low
Clarity	Clear	Clear	Cloudy	Opaque	Mixed
Color	Colorless/straw	Straw/yellow	Yellow	Mixed	Red
WBC/mm3	<200	<2,000	5,000-75,000	>50,000	Similar to blood level
Polys (%)	<25	<25	50-70	>70	Similar to blood level
Gram stain	Negative	Negative	Negative	Often positive	Negative

Pathology

Synovial joint

Many synovial fluid types are associated with specific diagnoses:

• Noninflammatory (Group I)
  • Osteoarthritis, degenerative joint disease
  • Trauma
  • Rheumatic fever
  • Chronic gout or pseudogout
  • Scleroderma
  • Polymyositis
  • Systemic lupus erythematosus
  • Erythema nodosum
  • Neuropathic arthropathy (with possible hemorrhage)
  • Sickle-cell disease
  • Hemochromatosis
  • Acromegaly
  • Amyloidosis
• Inflammatory (Group II)
  • Rheumatoid arthritis
  • Reactive arthritis
  • Psoriatic arthritis
  • Acute rheumatic fever
  • Acute gout or pseuodgout
  • Scleroderma
  • Polymyositis
  • Systemic lupus erythematosus
  • Ankylosing spondylitis
  • Inflammatory bowel disease arthritis
  • Infection (viral, fungal, bacterial) including Lyme disease
  • Acute crystal synovitis
• Septic (Group III)
  • Pyogenic bacterial infection
  • Septic arthritis
• Hemorrhagic
  • Trauma
  • Tumors
  • Hemophilia/coagulopathy
  • Scurvy
  • Ehlers-Danlos syndrome
  • Neuropathic arthropathy

Cracking joints

Main article: Cracking joints

When the two articulating surfaces of a synovial joint are separated from one other, the volume within the joint capsule increases and a negative pressure results. The volume of synovial fluid within the joint is insufficient to fill the expanding volume of the joint and gases dissolved in the synovial fluid (mostly carbon dioxide) are liberated and quickly fill the empty space, leading to the rapid formation of a bubble. This process is known as cavitation. Cavitation in synovial joints results in a high frequency 'cracking' sound.

Further reading

• Warman W. "Delineating biologic pathways involved in skeletal growth and homeostasis through the study of rare Mendelian diseases that affect bones and joints." Arthritis Res. Ther. 2003, 5(Suppl 3):5 [1]

External links

• Hyaluronan: structure and properties
• Normal joint structure from the University College London