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{{Crystal arthritis}}
{{Crystal arthritis}}
{{CMG}} ; {{AE}} {{ADG}} {{Cherry}}
{{CMG}} ; {{AE}} {{ADG}}


==Overview==
==Overview==
Line 36: Line 36:
|Definition
|Definition
|
|
* Supersaturation of [[Extracellular fluid|extracellular fluids]] and [[Blood plasma|plasma]] with [[uric acid]] leading to monosodium urate (MSU) crystal deposition in the [[joint]] spaces is called gout.
* Supersaturation of extracellular fluids and plasma with uric acid leading to monosodium urate (MSU) crystal deposition in the joint spaces is called gout.
|
|Acute and chronic inflammatory joint disease leading to deposition of calcium pyrophosphate dihydrate (CPPD) deposition in the joints leads to pseudogout.  
* Acute and chronic inflammatory joint disease leading to deposition of [[Calcium pyrophosphate|calcium pyrophosphate dihydrate (CPPD)]] deposition in the joints leads to [[Chondrocalcinosis|pseudogout]].
|-
|-
|Pathogenesis
|Pathogenesis
|
|
* Increased production or decreased excretion of [[uric acid]] leads to hyperuricemia.
* Increased production or decreased excretion of uric acid leads to hyperuricemia.
|
|Shedding from articular cartilage into joint space where they are phagocytosed by neutrophils and incite an inflammatory response, leading to crystal formation.
* Shedding from [[Cartilage|articular cartilage]] into joint space where they are phagocytosed by [[Neutrophil|neutrophils]] and incite an inflammatory response, leading to [[Crystal|crystal formation]].
|-
|-
|Clinical Features
|Clinical Features
|
|
* [[Arthritis|Acute arthritis]]:  
* Acute arthritis:  
** [[Pain]]
** Pain  
** [[Swelling]] of the joint  
** Swelling of the joint  
** Warmth  
** Warmth  
** [[Tenderness]]
** Tenderness


* [[Arthritis|Chronic arthritis]]:  
* Chronic arthritis:  
** Chronic nonsymmetric [[synovitis]]
** Chronic nonsymmetric synovitis  
** Periarticular [[Tophus|tophi]] formation
** Periarticular tophi formation


* [[Kidney stone|Nephrolithiasis]]
* Nephrolithiasis  
** [[Renal colic]]
** Renal colic
|
|
* Acute CPPD arthritis:  
* Acute CPPD arthritis:  
** [[Pain]]
** Pain  
** [[Swelling]], frequently involving the knee  
** Swelling, frequently involving the knee  
** Redness
** Redness


Line 73: Line 71:
|Diagnosis
|Diagnosis
|
|
* [[Aspiration|Joint asp]]<nowiki/>creatnine
* Joint aspiration:
** [[Synovial fluid]] analysis shows both intracellular and extracellular needle-shaped negatively birefringent MSU crystals by polarizing microscopy
** Synovial fluid analysis shows both intracellular and extracellular needle-shaped negatively birefringent MSU crystals by polarizing microscopy


* [[Uric acid|Serum uric acid levels]]
* Serum uric acid levels


* Urine [[uric acid]]
* Urine uric acid


* [[Serum creatinine|Serum creatinine levels]]
* Serum creatnine levels
|
|
* [[Synovial fluid]] analysis:
* Synovial fluid analysis:
** Demonstration of CPPD crystals appearing as rhomboids with weak positive birefringece by polarizing microscopy
** Demonstration of CPPD crystals appearing as rhomboids with weak positive birefringece by polarizing microscopy
|-
|-
|Treatment
|Treatment
|
|
* [[Analgesia]]
* Analgesia
* [[Non-steroidal anti-inflammatory drug|NSAIDs]]
* NSAIDs
* [[Glucocorticoid|Intraarticular glucocorticoids]]
* Intraarticular glucocorticoids
* [[Glucocorticoid|Systemic glucocorticoids]]
* Systemic glucocorticoids
* [[Allopurinol]], [[Febuxostat]]
* Allopurinol, Febuxostat
* [[Probenecid]], [[Sulfinpyrazone]]
* Probenecid, Sulfinpyrazone
|
|
* NSAIDs
* NSAIDs

Revision as of 17:19, 23 April 2018

Crystal arthritis Main page

Patient Information

Gout (patient information)
Pseudogout (patient information)

Overview

Causes

Classification

Gout
Pseudogout

Differentiating Gout from Pseudogout

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Crystal induced arthritis is a relatively common condition that involves deposition of crystals in joints and soft tissues. A variety of crystals can deposit in and around joints and soft tissues, resulting in articular and periarticular inflammation. Monosodium urate (MSU) and calcium pyrophosphate dihydrate (CPPD) are the most commonly involved crystals in the pathogenesis of crystal induced arthropathies. Other rare types of crystal arthropathy include hydroxyapatite crystal deposition arthropathy. Gout and pseudo-gout manifest with similar symptoms, and cannot be distinguished clinically. Synovial fluid analysis the involved joint is essential to diagnose and differentiation of crystal induced arthropathies.

Causes

Classification

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Arthritis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Inflammatory
 
 
 
 
 
 
 
 
 
Non-Inflammatory
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Osteoarthritis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Rheumatoid factor
 
 
 
Infectious
 
 
 
Crystalloid
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Rheumatoid positive
 
 
 
 
 
Rheumatoid negative
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
RA
Lupus
Scleroderma
 
 
 
 
 
AKS
Psoriatic arthritis
Reactive arthritis
 
Gout
 
Pseudogout
 
Calcium hydroxapatite crystals
 
 

Differentiating Gout from Pseudogout

Gout can be differentiated from pseudogout based on the following characteristics:

Gout Pseudogout
Definition
  • Supersaturation of extracellular fluids and plasma with uric acid leading to monosodium urate (MSU) crystal deposition in the joint spaces is called gout.
 Acute and chronic inflammatory joint disease leading to deposition of calcium pyrophosphate dihydrate (CPPD) deposition in the joints leads to pseudogout.
Pathogenesis
  • Increased production or decreased excretion of uric acid leads to hyperuricemia.
 Shedding from articular cartilage into joint space where they are phagocytosed by neutrophils and incite an inflammatory response, leading to crystal formation.
Clinical Features
  • Acute arthritis:
    • Pain
    • Swelling of the joint
    • Warmth
    • Tenderness
  • Chronic arthritis:
    • Chronic nonsymmetric synovitis
    • Periarticular tophi formation
  • Nephrolithiasis
    • Renal colic
  • Acute CPPD arthritis:
    • Pain
    • Swelling, frequently involving the knee
    • Redness
  • Chronic arthropathy:
    • Progressive degeneration in multiple joints
  • Symmetric proliferative synovitis
Diagnosis
  • Joint aspiration:
    • Synovial fluid analysis shows both intracellular and extracellular needle-shaped negatively birefringent MSU crystals by polarizing microscopy
  • Serum uric acid levels
  • Urine uric acid
  • Serum creatnine levels
  • Synovial fluid analysis:
    • Demonstration of CPPD crystals appearing as rhomboids with weak positive birefringece by polarizing microscopy
Treatment
  • Analgesia
  • NSAIDs
  • Intraarticular glucocorticoids
  • Systemic glucocorticoids
  • Allopurinol, Febuxostat
  • Probenecid, Sulfinpyrazone
  • NSAIDs
  • Intraarticular injection of glucocorticoids
  • Colchicine
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