FREE SHIPPING over $40
OVER 10000 FIVE-STAR REVIEWS
5% OFF ALL SUBSCRIPTIONS
100% HAPPINESS GUARANTEE
Analyze Diet
0
Frontiers in veterinary science2019; 6; 325; doi: 10.3389/fvets.2019.00325

Comparison of Serum Amyloid A Measurements in Equine Synovial Fluid With Routine Diagnostic Methods to Detect Synovial Infection in a Clinical Environment.

Abstract: Synovial fluid analysis is utilized to diagnose septic synovitis. However, not all cases are clearly and rapidly discernible with the diagnostic tools available in the laboratory. Serum amyloid A (SAA), an acute phase protein, has been shown to be elevated in synovial fluid from inflamed synovial structures. The goal of this study is to describe the correlation between two diagnostic tests measuring equine SAA levels in septic and non-septic synovial structures and to understand the correlation between an elevated SAA result and synovial sepsis. Prospective estimation of sensitivity (Se) and specificity (Sp) of two tests, handheld and ELISA, measuring SAA in synovial fluid was completed in 62 horses presented with injured synovial structures. The comparison was made to a reference diagnosis based on white cell count, percentage of neutrophils, intracellular bacteria and bacterial culture on synovial fluid. Handheld test levels were classified as: 4 lines visible-SAA level negative; 3 lines visible-SAA level mild; 2 lines visible-SAA level moderate; and 1 line visible-SAA level severe and compared to the numerical value obtained with ELISA test. The ELISA SAA test had an area under the curve of 0.88 (0.78-0.98). An ELISA cut-off of 23.95 μg/mL maximized Se and Sp. This cutoff gave a Se of 0.93 (0.66-1.00) and Sp of 0.77 (0.63-0.88). The handheld test was highly correlated with the ELISA SAA test (Spearman rank correlation 0.96) and at a cutoff of moderate or higher for positive results gave identical Se and Sp. Se and Sp of synovial fluid SAA are very reliable when clinical signs of synovitis are present for >6 h. This test, in conjunction with traditional methods, can assist practitioners to rapidly diagnose and expedite appropriate intervention of synovial sepsis.
Copyright © 2019 Stack, Cousty, Steele, Handel, Lechartier, Vinardell and David.
Get Full Text
Publication Date: 2019-10-01 PubMed ID: 31632987PubMed Central: PMC6779708DOI: 10.3389/fvets.2019.00325Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
LinkedInCopy
  • Journal Article

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This study explores the potential of using Serum Amyloid A (SAA) measurements to diagnose septic synovitis in horses, comparing it with routine diagnostic methods. The study found that using SAA could help in the quick diagnosis and treatment of synovial sepsis, particularly when traditional materials do not provide clear results.

Objective and Research Methodology

  • The study aims to understand the correlation between septic and non-septic synovial structures in horses using two types of diagnostic tests that measure SAA levels.
  • These two tests, the handheld and ELISA tests, were applied on 62 horses with injured synovial structures.
  • The collected data was then compared to reference data that was based on white cell count, neutrophils percentage, presence of intracellular bacteria, and bacterial culture in synovial fluid.

Diagnostic Tests

  • For the handheld test, levels were classified into four categories based on the visibility of lines, which indicate SAA levels. These categories are negative, mild, moderate, and severe.
  • The results of the handheld test were then compared to the numerical results obtained from the ELISA test.

Findings and Conclusions

  • The ELISA test yielded an area under the curve of 0.88, indicating a high level of accuracy in the test.
  • At an optimal cut-off of 23.95 μg/mL, the ELISA test delivers a sensitivity i.e., true positive rate of 0.93 and a specificity i.e., true negative rate of 0.77.
  • The handheld test showed a high correlation with the ELISA test (0.96), and positive results above the moderate level yielded identical specificity and sensitivity rates.
  • These results suggest that SAA measurements in synovial fluid are reliable for diagnosing synovitis with over 6 hours of clinical signs.
  • Notably, using this alongside traditional methods can assist clinical practitioners to diagnose synovial sepsis promptly and advance appropriate interventions swiftly.

Cite This Article

APA
Stack JD, Cousty M, Steele E, Handel I, Lechartier A, Vinardell T, David F. (2019). Comparison of Serum Amyloid A Measurements in Equine Synovial Fluid With Routine Diagnostic Methods to Detect Synovial Infection in a Clinical Environment. Front Vet Sci, 6, 325. https://doi.org/10.3389/fvets.2019.00325

Publication

Frontiers in veterinary science
ISSN: 2297-1769
NlmUniqueID: 101666658
Country: Switzerland
Language: English
Volume: 6
Pages: 325
PII: 325

Researcher Affiliations

Stack, John David
  • Institute of Veterinary Science, University of Liverpool, Neston, United Kingdom.
Cousty, Matthieu
  • Centre Hospitalier Vétérinaire Equin de Livet, Saint-Michel-de-Livet, France.
Steele, Emma
  • Clinique Vétérinaire de la Côte Fleurie, Bonneville-sur-Touques, France.
Handel, Ian
  • The Royal (Dick) School of Veterinary Studies, The Roslin Institute, The University of Edinburgh, Midlothian, United Kingdom.
Lechartier, Antoine
  • Clinique Vétérinaire Equine de Meheudin, Écouché, France.
Vinardell, Tatiana
  • Equine Veterinary Medical Center, Member of Qatar Foundation, Doha, Qatar.
  • College of Health and Life Sciences, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar.
David, Florent
  • Equine Veterinary Medical Center, Member of Qatar Foundation, Doha, Qatar.
  • College of Health and Life Sciences, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar.

References

This article includes 37 references
  1. Richardson DW, Ahern BJ. Synovial and osseous infections. Equine Surgery 4th ed. St. Louis, MO: Elsevier; (2012). p. 1189–90.
    doi: 10.1016/B978-1-4377-0867-7.00085-5google scholar: lookup
  2. Fraser BS, Bladon BM. Tenoscopic surgery for treatment of lacerations of the digital flexor tendon sheath.. Equine Vet J 2004 Sep;36(6):528-31.
    doi: 10.2746/0425164044877396pubmed: 15460078google scholar: lookup
  3. Palmer JL, Bertone AL. Experimentally-induced synovitis as a model for acute synovitis in the horse.. Equine Vet J 1994 Nov;26(6):492-5.
    doi: 10.1111/j.2042-3306.1994.tb04056.xpubmed: 7889925google scholar: lookup
  4. Schneider RK, Bramlage LR, Moore RM, Mecklenburg LM, Kohn CW, Gabel AA. A retrospective study of 192 horses affected with septic arthritis/tenosynovitis.. Equine Vet J 1992 Nov;24(6):436-42.
    doi: 10.1111/j.2042-3306.1992.tb02873.xpubmed: 1459056google scholar: lookup
  5. Taylor AH, Mair TS, Smith LJ, Perkins JD. Bacterial culture of septic synovial structures of horses: does a positive bacterial culture influence prognosis?. Equine Vet J 2010 Apr;42(3):213-8.
    doi: 10.2746/042516409X480403pubmed: 20486977google scholar: lookup
  6. Walmsley EA, Anderson GA, Muurlink MA, Whitton RC. Retrospective investigation of prognostic indicators for adult horses with infection of a synovial structure.. Aust Vet J 2011 Jun;89(6):226-31.
    doi: 10.1111/j.1751-0813.2011.00720.xpubmed: 21595644google scholar: lookup
  7. Wereszka MM, White NA 2nd, Furr MO. Factors associated with outcome following treatment of horses with septic tenosynovitis: 51 cases (1986-2003).. J Am Vet Med Assoc 2007 Apr 15;230(8):1195-200.
    doi: 10.2460/javma.230.8.1195pubmed: 17501662google scholar: lookup
  8. Wright IM, Smith MR, Humphrey DJ, Eaton-Evans TC, Hillyer MH. Endoscopic surgery in the treatment of contaminated and infected synovial cavities.. Equine Vet J 2003 Sep;35(6):613-9.
    doi: 10.2746/042516403775467225pubmed: 14515964google scholar: lookup
  9. Bertone AL. Infectious arthritis. Joint Disease of the Horse Philadelphia, PA: Saunders; (1996). p. 397–409.
  10. Tulamo RM, Bramlage LR, Gabel AA. Sequential clinical and synovial fluid changes associated with acute infectious arthritis in the horse.. Equine Vet J 1989 Sep;21(5):325-31.
    doi: 10.1111/j.2042-3306.1989.tb02681.xpubmed: 2776718google scholar: lookup
  11. Baxter GM. Instrumentation and techniques for treating orthopedic infections in horses.. Vet Clin North Am Equine Pract 1996 Aug;12(2):303-35.
    doi: 10.1016/S0749-0739(17)30284-5pubmed: 8856879google scholar: lookup
  12. Owens JG, Kamerling SG, Stanton SR, Keowen ML, Prescott-Mathews JS. Effects of pretreatment with ketoprofen and phenylbutazone on experimentally induced synovitis in horses.. Am J Vet Res 1996 Jun;57(6):866-74.
    pubmed: 8725815
  13. Tulamo RM, Bramlage LR, Gabel AA. The influence of corticosteroids on sequential clinical and synovial fluid parameters in joints with acute infectious arthritis in the horse.. Equine Vet J 1989 Sep;21(5):332-7.
    doi: 10.1111/j.2042-3306.1989.tb02682.xpubmed: 2776719google scholar: lookup
  14. McIlwraith CW. Treatment of infectious arthritis.. Vet Clin North Am Large Anim Pract 1983 Jul;5(2):363-79.
    doi: 10.1016/S0196-9846(17)30083-6pubmed: 6356569google scholar: lookup
  15. Milner PI, Bardell DA, Warner L, Packer MJ, Senior JM, Singer ER, Archer DC. Factors associated with survival to hospital discharge following endoscopic treatment for synovial sepsis in 214 horses.. Equine Vet J 2014 Nov;46(6):701-5.
    doi: 10.1111/evj.12212pubmed: 24417437google scholar: lookup
  16. Bertone A. Infectious arthritis. Diagnosis and Management of Lameness in the Horse Philadelphia, PA, Saunders: (2003). p. 598–9.
    doi: 10.1016/B978-0-7216-8342-3.50073-5google scholar: lookup
  17. Dumoulin M, Pille F, van den Abeele AM, Boyen F, Boussauw B, Oosterlinck M, Pasmans F, Gasthuys F, Martens A. Use of blood culture medium enrichment for synovial fluid culture in horses: a comparison of different culture methods.. Equine Vet J 2010 Sep;42(6):541-6.
    doi: 10.1111/j.2042-3306.2010.00091.xpubmed: 20716195google scholar: lookup
  18. Pille F, Martens A, Schouls LM, Dewulf J, Decostere A, Vogelaers D, Gasthuys F. Broad range 16S rRNA gene PCR compared to bacterial culture to confirm presumed synovial infection in horses.. Vet J 2007 Jan;173(1):73-8.
    doi: 10.1016/j.tvjl.2005.07.019pubmed: 16146700google scholar: lookup
  19. Uhlar CM, Whitehead AS. Serum amyloid A, the major vertebrate acute-phase reactant.. Eur J Biochem 1999 Oct;265(2):501-23.
    doi: 10.1046/j.1432-1327.1999.00657.xpubmed: 10504381google scholar: lookup
  20. Hultén C, Grönlund U, Hirvonen J, Tulamo RM, Suominen MM, Marhaug G, Forsberg M. Dynamics in serum of the inflammatory markers serum amyloid A (SAA), haptoglobin, fibrinogen and alpha2-globulins during induced noninfectious arthritis in the horse.. Equine Vet J 2002 Nov;34(7):699-704.
    doi: 10.2746/042516402776250405pubmed: 12455841google scholar: lookup
  21. Jacobsen S, Thomsen MH, Nanni S. Concentrations of serum amyloid A in serum and synovial fluid from healthy horses and horses with joint disease.. Am J Vet Res 2006 Oct;67(10):1738-42.
    doi: 10.2460/ajvr.67.10.1738pubmed: 17014325google scholar: lookup
  22. Jacobsen S, Niewold TA, Halling-Thomsen M, Nanni S, Olsen E, Lindegaard C, Andersen PH. Serum amyloid A isoforms in serum and synovial fluid in horses with lipopolysaccharide-induced arthritis.. Vet Immunol Immunopathol 2006 Apr 15;110(3-4):325-30.
    doi: 10.1016/j.vetimm.2005.10.012pubmed: 16337010google scholar: lookup
  23. Jacobsen S, Nielsen JV, Kjelgaard-Hansen M, Toelboell T, Fjeldborg J, Halling-Thomsen M, Martinussen T, Thoefner MB. Acute phase response to surgery of varying intensity in horses: a preliminary study.. Vet Surg 2009 Aug;38(6):762-9.
    doi: 10.1111/j.1532-950X.2009.00564.xpubmed: 19674420google scholar: lookup
  24. Vandenplas ML, Moore JN, Barton MH, Roussel AJ, Cohen ND. Concentrations of serum amyloid A and lipopolysaccharide-binding protein in horses with colic.. Am J Vet Res 2005 Sep;66(9):1509-16.
    doi: 10.2460/ajvr.2005.66.1509pubmed: 16261823google scholar: lookup
  25. Ludwig EK, Brandon Wiese R, Graham MR, Tyler AJ, Settlage JM, Werre SR, Petersson-Wolfe CS, Kanevsky-Mullarky I, Dahlgren LA. Serum and Synovial Fluid Serum Amyloid A Response in Equine Models of Synovitis and Septic Arthritis.. Vet Surg 2016 Oct;45(7):859-867.
    doi: 10.1111/vsu.12531pubmed: 27580707google scholar: lookup
  26. Robinson CS, Singer ER, Piviani M, Rubio-Martinez LM. Are serum amyloid A or D-lactate useful to diagnose synovial contamination or sepsis in horses?. Vet Rec 2017 Oct 21;181(16):425.
    doi: 10.1136/vr.104386pmc: PMC5738594pubmed: 28765498google scholar: lookup
  27. Robin X, Turck N, Hainard A, Tiberti N, Lisacek F, Sanchez JC, Müller M. pROC: an open-source package for R and S+ to analyze and compare ROC curves.. BMC Bioinformatics 2011 Mar 17;12:77.
    doi: 10.1186/1471-2105-12-77pmc: PMC3068975pubmed: 21414208google scholar: lookup
  28. R Core Team. R: A Language and Environment for Statistical Computing. Vienna: R Foundation for Statistical Computing; (2014).
  29. Busk P, Jacobsen S, Martinussen T. Administration of perioperative penicillin reduces postoperative serum amyloid A response in horses being castrated standing.. Vet Surg 2010 Jul;39(5):638-43.
    doi: 10.1111/j.1532-950X.2010.00704.xpubmed: 20459482google scholar: lookup
  30. Greiner M, Pfeiffer D, Smith RD. Principles and practical application of the receiver-operating characteristic analysis for diagnostic tests.. Prev Vet Med 2000 May 30;45(1-2):23-41.
    doi: 10.1016/S0167-5877(00)00115-Xpubmed: 10802332google scholar: lookup
  31. Stoilova T, Colombo L, Forloni G, Tagliavini F, Salmona M. A new face for old antibiotics: tetracyclines in treatment of amyloidoses.. J Med Chem 2013 Aug 8;56(15):5987-6006.
    doi: 10.1021/jm400161ppubmed: 23611039google scholar: lookup
  32. Goodrich LR, Nixon AJ. Medical treatment of osteoarthritis in the horse - a review.. Vet J 2006 Jan;171(1):51-69.
    doi: 10.1016/j.tvjl.2004.07.008pubmed: 16427582google scholar: lookup
  33. Hultén C, Sletten K, Foyn Bruun C, Marhaug G. The acute phase serum amyloid A protein (SAA) in the horse: isolation and characterization of three isoforms.. Vet Immunol Immunopathol 1997 Jul;57(3-4):215-27.
    doi: 10.1016/S0165-2427(97)00021-4pubmed: 9261960google scholar: lookup
  34. Firth EC. Diagnosis of metaphysitis in foals.. N Z Vet J 1990 Jun;38(2):66-8.
    doi: 10.1080/00480169.1990.35619pubmed: 16031579google scholar: lookup
  35. Stoneham SJ, Palmer L, Cash R, Rossdale PD. Measurement of serum amyloid A in the neonatal foal using a latex agglutination immunoturbidimetric assay: determination of the normal range, variation with age and response to disease.. Equine Vet J 2001 Nov;33(6):599-603.
    doi: 10.2746/042516401776563472pubmed: 11720032google scholar: lookup
  36. Hultén C, Demmers S. Serum amyloid A (SAA) as an aid in the management of infectious disease in the foal: comparison with total leucocyte count, neutrophil count and fibrinogen.. Equine Vet J 2002 Nov;34(7):693-8.
    doi: 10.2746/042516402776250360pubmed: 12455840google scholar: lookup
  37. Šimundić AM. Measures of Diagnostic Accuracy: Basic Definitions.. EJIFCC 2009 Jan;19(4):203-11.
    pmc: PMC4975285pubmed: 27683318

Citations

This article has been cited 9 times.
  1. Jacobsen S, Mortensen CD, Høj EA, Vinther AM, Berg LC, Adler DMT, Verwilghen D, van Galen G. Neutrophil Gelatinase-Associated Lipocalin in Synovial Fluid from Horses with and without Septic Arthritis. Animals (Basel) 2022 Dec 21;13(1).
    doi: 10.3390/ani13010029pubmed: 36611638google scholar: lookup
  2. Thurston CC, Stefanovski D, MacKinnon MC, Chapman HS, Richardson DW, Levine DG. Serum amyloid A and fibrinogen as markers for early detection of surgical site infection associated with internal fixation in the horse. Front Vet Sci 2022;9:960865.
    doi: 10.3389/fvets.2022.960865pubmed: 36299628google scholar: lookup
  3. Hussein K, Abdelbaset AE, Sadek AA, Noreldin A. In vitro and in vivo Effects of a Single Dose of Bupivacaine 5% on Donkey Chondrocytes. Front Vet Sci 2021;8:661426.
    doi: 10.3389/fvets.2021.661426pubmed: 34888370google scholar: lookup
  4. Kiemle J, Hindenberg S, Bauer N, Roecken M. Comparison of a point-of-care serum amyloid A analyzer frequently used in equine practice with 2 turbidimetric immunoassays used in human and veterinary medicine. J Vet Diagn Invest 2022 Jan;34(1):42-53.
    doi: 10.1177/10406387211056029pubmed: 34763564google scholar: lookup
  5. Haralambus R, Florczyk A, Sigl E, Gültekin S, Vogl C, Brandt S, Schnierer M, Gamerith C, Jenner F. Detection of synovial sepsis in horses using enzymes as biomarkers. Equine Vet J 2022 May;54(3):513-522.
    doi: 10.1111/evj.13459pubmed: 33977535google scholar: lookup
  6. Souto PC, Santos MR, Orozco AMO, Bento LD, Ramirez-Lopez CJ, Girardi FM, Machado JCA, de Oliveira LL, da Fonseca LA. Enzyme-Linked Immunosorbent Assay (ELISA) Development for Equine Serum Amyloid A (SAA) Determination Using Recombinant Proteins. Methods Protoc 2025 Apr 7;8(2).
    doi: 10.3390/mps8020037pubmed: 40278511google scholar: lookup
  7. Koziy RV, Katselis GS, Yoshimura S, Simko E, Bracamonte JL. Temporal kinetics of serum amyloid A (SAA) concentration and identification of SAA isoforms in blood and synovial fluid of horses with experimentally induced septic arthritis, non-septic synovitis, and systemic inflammation. J Vet Diagn Invest 2025 Jan;37(1):42-54.
    doi: 10.1177/10406387241299873pubmed: 39688235google scholar: lookup
  8. Arifianto D, Esfandiari A, Wibawan IWT, Amrozi A, Maharani M, Darsono D, Setiadi H, Setiyono A. Assessment of health impacts in retired antisera-producing horses: Blood biochemistry and serum amyloid A analysis. Vet World 2024 Sep;17(9):2136-2143.
    doi: 10.14202/vetworld.2024.2136-2143pubmed: 39507779google scholar: lookup
  9. Birckhead EM, Das S, Tidd N, Raidal SL, Raidal SR. Visualizing neutrophil extracellular traps in septic equine synovial and peritoneal fluid samples using immunofluorescence microscopy. J Vet Diagn Invest 2023 Nov;35(6):751-760.
    doi: 10.1177/10406387231196552pubmed: 37661696google scholar: lookup
Subscribe to our newsletter
Join 99,780 horse owners like you who receive our email updates on horse health and nutrition.