Colloid Osmotic Pressure of Rheumatoid Synovial Fluid

Journal/Book: Reprinted from Nature Vol. 183 p. 475 only Feb. 14 1959. 1959;

Abstract: Department of Medical Chemistry University of Turku Turku Finland. Dec. 5. THE colloid osmotic pressure of rheumatoid synovial fluid samples was measured before and after intra-articular hydrocortisone treatment using collodium membranes and a hydrostatic compensation system1. Previously it had been found that contents of vacuum-dried synovial fluid adsorbed decreased volumes of water after cortisone treatment2. The results are presented in Tables 1 and 2 (without Tables) but a detailed account an the material is given elsewhere3. The colloid osmotic pressure could be correlated with the total protein (r = 0 · 66 ; P < 0 · 001 ) and with the blood erythrocyte sedimentation rate (r = 0 · 70 P < 0 · 001 ) but not with the concentration of synovial fluid sodium potassium chloride or hyaluronate or with the intrinsic viscosity. With the size of effusion a relation could be established only in the cases of Stages I-II (roentgenologically nonadvanced). It is concluded that the changes in the protein concentration and consequently in the colloid osmotic pressure of the synovial fluid are of importance in the formation and disappearance of the effusion. It may be argued that if the protein actually passes into the synovial cavity its colloid osmotic pressure cannot have any significance. Admittedly in the genesis of traumatic effusions a permeability damage is more important and in the anatomically more advanced cases with stiff joints the colloid osmotic pressure is generally lower (P < 0 · 001 ) and seems immaterial. However submitting the observed clinical and chemical correlations as circumstantial evidence we suggest that the increased colloid osmotic pressure may prevent the normal resorption of fluid from the synovial cavity in rheumatoid arthritis. The polysaccharide does not seem important in the maintenance of the colloid osmotic pressure. The significance of the qualitative and quantitative changes in the hyaluronate should be sought from the analogies with the connective tissue response to inflammation. The financial support from the Sigrid Jusélius Foundation is gratefully acknowledged. ___MH

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