Synovial Fluid White Blood Cell Count as a Potential Biomarker for the Clinical Severity of Knee Osteoarthritis: A Prospective Study

Knee osteoarthritis is categorized classically as a non-inflammatory arthropathy. However, there has been increasing evidence regarding the supplementary role of inflammation in the pathogenesis and disease progression of knee osteoarthritis. This study aims to identify a potential correlation between synovial fluid white blood cell (SF WBC) count and the severity of knee osteoarthritis clinical presentation. 200 knees (200 patients) were assessed through SF aspiration and cytology analysis for WBC count. All patients have filled out the Knee Injury and Osteoarthritis Outcome Score for clinical correlation. For the 200 knees, there was a statistically significant positive correlation between the severity of osteoarthritis clinical presentation as expressed by the Knee Injury and Osteoarthritis Outcomes Score (KOOS) and the synovial white blood cell count among the studied cases (p-value < 0.001). There was no statistically significant correlation found between the patient's age, sex, or side and KOOS or SF white cell count. The clinical severity of knee osteoarthritis is directly correlated with increased SF white cell count, and hence, SF WBCs may play a role in identifying and grading osteoarthritis clinical severity. This may raise the interest in identifying the role of using specific disease-modifying drugs that deal with the WBC function in cases of osteoarthritis along with other modalities. Received: 30 April 2024 | Revised: 22 July 2024 | Accepted: 12 September 2024 Conflicts of Interest The authors declare that they have no conflicts of interest to this work. Data Availability Statement The data that support this work are available upon reasonable request to the corresponding author. Author Contribution Statement Hesham El-khodary: Conceptualization, Methodology, Software, Validation, Formal analysis, Investigation, Resources, Data curation. Ahmed Nageeb Mahmoud: Software, Writing - original draft, Writing - review & editing, Visualization. Daniel S. Horwitz: Writing - review & editing, Visualization. Elzaher Hassan Elzaher: Resources, Writing - review & editing, Visualization. Mostafa Aly Elabd: Software, Resources, Writing - review & editing. Mariia Sovalkina: Software, Formal analysis. Ahmed Samy Kamel: Conceptualization, Methodology, Investigation, Resources, Data curation, Supervision, Project administration. Ahmed Mohasseb: Conceptualization, Methodology, Validation, Formal analysis, Investigation, Resources, Data curation, Supervision, Project administration.