calcium pyrophosphate microcrystal arthritis

The formation and deposition of monosodium urate (MSU) microcrystals in articular and periarticular tissues is the causative agent of acute or chronic inflammatory responses known as gouty arthritis. Mononuclear phagocyte activation is involved in early triggering events of gout attacks. Because stimulated mononuclear phagocytes can constitute an important source of the inducible isoform of cyclooxygenase (COX-2), we evaluated the effects that proinflammatory microcrystals might have on COX-2 protein expression in crystal-stimulated monocytes...

No abstract text is available yet for this article.

Although not strictly of crystalline nature, various formations can be observed in joint fluids and be responsible for "microcrystalline" arthritis. They can consist of lipidic structures (cholesterol crystals, fatty lobules, liposomes) or calcium crystalline structures such as calcium oxalate crystals detected in fluids of dialyzed chronic renal failure patients, reflecting primary or secondary oxalosis. Other phosphate calcium crystals have been identified, associated to apatite or pyrophosphate crystals, but their pathogenic role is uncertain...

Articular chondrocalcinosis is identified by radiological opacity of articular cartilage and fibrocartilage with calcium intensity. This disease is often asymptomatic. The most significant clinical pattern is an acute arthritis, caused by microcrystals of calcium pyrophosphate dihydrate, the so-called pseudo-gout syndrome. Chronic pyrophosphate arthropathy can blend mechanical illness and inflammatory flares. When the X-rays are normal or display ordinary osteoarthritis, arthrocentesis makes the diagnosis thanks to the identification of calcium pyrophosphate crystals by polarizing microscope...

In a preceding article, we described "pseudogout" which is the expression of an episode of acute synovitis related to microcrystals of dehydrated calcium pyrophosphate invading the joint. This brutal episode of inflammation, predominantly occurring in the knee joint, is the most spectacular, most frequent and most characteristic manifestation of articular chondrocalcinosis. We attempted to demonstrate the important role of radiographs in the diagnosis, discovering in many cases the microcrystal impregnation of cartilage and fibrocartilage...

Rice bodies are often found in inflammatory joint fluid specimens, especially from rheumatoid arthritis patients, but have rarely been reported in osteoarthritis. We found rice bodies in knee joint fluid specimens from four of 88 patients with osteoarthritis. There were three males and one female. Age ranged from 61 to 86 years. Three patients had slowly progressive knee osteoarthritis and one had rapidly destructive disease. Abundant, recurrent effusions occurred in all four patients despite one to five local corticosteroid injections per patient and radiation synovectomy in two patients...

Synovial fluid from 33 patients with inflammatory arthritis was examined with a polarized light microscope (PLM) and an atomic force microscope (AFM). Two samples were imaged with a transmission electron microscope (TEM) to determine calcium/phosphate ratios and identify microcrystals of calcium pyrophosphate dihydrate and octacalcium phosphate. Additional correlative x-ray diffraction studies were performed on several samples including purified hydroxyapatite and sodium chloride crystals. Monosodium urate, calcium pyrophosphate dihydrate, hydroxyapatite, octacalcium phosphate, and cholesterol crystals were identified with AFM...

Articular chondrocalcinosis (ACC), which is due to the precipitation of calcium pyrophosphate microcrystals, is known to produce symptom of acute arthritis or chronic degenerative polyarticular lesions. It is more rarely responsible for rapidly destructive lesions of the joints suggesting a metabolic or neurological process. The case reported here of a 66 year old woman with major lesions of the L1-L2 intervertebral space, together with other cases already published, shows that the destructive spinal forms of ACC may also present as subacute spondylodiscitis...

Chondrocalcinosis is an arthropathy caused by deposits of calcium pyrophosphate-dihydrate microcrystals (CPPD) in the joints and occasionally in the tendons and ligaments. In our region it is almost always seen in its sporadic form in elderly subjects. The patients can be without symptoms or present four different clinical entities: an acute arthritis which can resemble and even be mistaken for an attack of gout or a septic arthritis; an inflammatory polyarthritis suggesting a rheumatoid arthritis; most frequently it appears as a benign polyarthrosis; sometimes it runs a destructive course capable of seriously damaging one or several joints...

Scanning electron microscopy has been used in conjunction with wavelength dispersive X-Ray spectroscopy and in correlation with X-Ray diffraction to define the populations of crystals present in rheumatic diseases. Microcrystals of monosodium urate, triclinic and monoclinic calcium pyrophosphate dihydrate, apatite, calcium hydrogen phosphate dihydrate and corticosteroids, among others, have been found in synovial fluid, in the intraarticular tissues (fibrocartilage, cartilage, and synovial membrane), and in the periarticular tissues (tendons and ectopic calcifications)...

High-angle x-ray diffraction was applied to the study of four meniscal fibrocartilages and 11 articular cartilages from patients suffering from various articular disorders. In eight samples microcrystals were seen, apatite most frequently, CaHPO4 in two instances, calcium pyrophosphate dihydrate (CPPD) in one. These results confirm the association of various crystals in a single joint, and favour their heterogenous partition on collagen fibres.

Microcrystals of sodium urate, calcium pyrophosphate, hydroxyapatite and corticosteroids may induce acute arthritis by similar mechanisms in which neutrophils play the most important role. Interactions between neutrophils and microcrystals result in the release of several phlogogenic substances, e.g. lysosomal enzymes, chemotactic factor (CCF) or leukotrienes. Various proteins may be adsorbed to the surface of microcrystals, and this protein coating seems to be instrumental in modulating the neutrophil-microcrystal interaction...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

Coloration of articular fluids with alizarin S red has been proposed as a method of sensitive detection of calcium microcrystals, especially apatite crystals. We are reporting the results of a study of 230 non-selected fluids. The results of the coloration were quantified into negative, slightly positive, moderately positive and strongly positive. Study of X-Rays of the tapped joint and of the hospital file was done in 199 patients. Electron microscope study, of 44 fluid samples, shows that the coloration with alizarin red permits a reliable detection of calcium microcrystals in the articular fluid, only if the strongly positive results are taken into account...

Normal human blood neutrophils were studied for their capacity to synthesize and release interleukin-1 (IL-1) species after phagocytosis of triclinic monosodium urate (MSU) and calcium pyrophosphate dihydrate crystals (CPPD). MSU crystals were more potent inducers of IL-1 generation than CPPD or unopsonized zymosan. Microcrystal-stimulated neutrophils characteristically secreted most of the newly synthesized IL-1. Colchicine partly inhibited the secretion of IL-1 by neutrophils during phagocytosis of solid particles...

Articular chondrocalcinosis results from the deposits of calcium pyrophosphate microcrystals in the articular hyalin and fibrocartilages, the synovium and at times the tendons. In our area it is seen most frequently as isolated cases in the elderly and may be asymptomatic. When the affected joints present clinical manifestations, they vary from acute to subacute or chronic recurrent arthritis. A marked articular destruction can be observed in some cases. There is a classical radiological picture: linear opacities are most frequently seen localized in the mid-zone layer of the hyalin cartilage running parallel to but at a certain distance from the bone cortex...

Recent studies have shown elevated inorganic pyrophosphate (PPi) levels in most knee joint fluid supernates from patients with pseudogout (PG) or osteoarthritis (OA) and more modestly elevated levels in some supernates from patients with gout or rheumatoid arthritis (RA) relative to PPi levels found in the venous blood plasma of normal or arthritic subjects. We measured the intraarticular PPi pool and its rate of turnover to better understand the significance of the joint fluid-plasma PPi gradient. Preliminary studies in rabbits showed that (32-P)PPi passed from joint space to blood and vice versa without detectable hydrolysis...