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Crystal arthropathy

Jeffrey R Claiborne, Leslie G Branch, Michael Reynolds, Anthony J Defranzo
An acutely painful, erythematous wrist can be due to a variety of pathologic processes, including crystalline arthropathy, infection, trauma, osteoarthritis, and systemic disease. The broad differential diagnosis of the inflamed wrist and nonspecific clinical findings make accurate diagnosis challenging. There is no published clinical or laboratory criterion that reliably differentiates septic wrist arthritis from a sterile inflammatory arthropathy. For septic joint patients, long-term results are notably poorer in patients with a delay in treatment, therefore establishing evidenced-based guidelines deserves attention...
February 10, 2017: Annals of Plastic Surgery
O Şahap Atik, Yılmaz Ergişi, Tacettin Ayanoğlu, Mehmet Ali Tokgöz, Erdem Aras Sezgin, Pınar Uyar Göçün
Acute monoarthritis is a common situation in orthopedic emergency where the patient presents with typical inflamed joint. It is hard to clinically distinguish inflammatory arthritis of bacterial origin from monoarthritis attacks of gout disease. If these two situations, which are the most common causes of acute monoarthritis, are misdiagnosed, outcomes might be catastrophic and costly. Synovial fluid analysis is the most reliable method for confirming the diagnosis although it might not always lead to definitive diagnosis...
December 2016: Eklem Hastalıkları Ve Cerrahisi, Joint Diseases & related Surgery
Wais Afzal, Omer M Wali, Kelly L Cervellione, Bhupinder B Singh, Farshad Bagheri
Pseudogout is a crystal-induced arthropathy characterized by the deposition of calcium pyrophosphate dihydrate (CPPD) crystals in synovial fluid, menisci, or articular cartilage. Although not very common, this entity can be seen in patients with chronic kidney disease (CKD). Septic arthritis due to Mycobacterium avium-intracellulare (MAI) is a rare entity that can affect immunocompromised patients such as those with acquired immunodeficiency syndrome (AIDS) or those who are on immunosuppressive drugs. Here, we describe a 51-year-old female who presented with fever, right knee pain, swelling, warmth, and decreased range of motion for several days...
2016: Case Reports in Rheumatology
Patrick Omoumi, Pascal Zufferey, Jacques Malghem, Alexander So
In this article, the authors consider the manifestations of intraarticular and periarticular crystal deposits. Most cases of crystal deposits are asymptomatic and represent incidental findings at imaging. In symptomatic arthropathies, imaging can play an important role in the diagnosis and assessment of disease progression and the extent of crystal deposits. Conventional radiography is the most common imaging modality. But ultrasound, conventional computerized tomography (CT), dual-energy CT, and MRI play an increasing role...
November 2016: Rheumatic Diseases Clinics of North America
H Bastian, M Worsch, A Huppertz, A Krause, W A Schmidt
Clinical manifestations of gouty arthropathy are usually acute inflammatory arthritis, bursitis and accumulation of urate crystals in the form of tophi. Manifestations on the axial skeleton are also known and have been described but occur infrequently and for this reason play a subordinate role in the awareness of rheumatologists. With dual energy computed tomography (CT) gout tophi can be detected even in unusual regions or regions that are difficult to access for puncturing. We describe two rare cases of gouty arthropathy of the axial skeleton in a 76-year-old male patient with spinal involvement and in a 53-year-old female patient with involvement of the sacroiliac joint...
February 2017: Der Internist
Matt Rheinboldt, Courtney Scher
Both gout and calcium pyrophosphate deposition disease are common metabolic arthopathies, presenting not only diagnostic but also management challenges. Though histological crystal aspiration is definitive, diagnosis is commonly established through a composite of clinical features and laboratory findings. Musculoskeletal ultrasound has a contributory and growing role not only in routine disease surveillance but also in helping render a timely and specific diagnosis for patients presenting with new-onset oligoarticular arthritis in the emergency setting...
December 2016: Emergency Radiology
Clare C Cunningham, Emma M Corr, Geraldine M McCarthy, Aisling Dunne
OBJECTIVE: Basic calcium phosphate (BCP) and monosodium urate (MSU) crystals are particulates with potent pro-inflammatory effects, associated with osteoarthritis (OA) and gout, respectively. Bone erosion, due to increased osteoclastogenesis, is a hallmark of both arthropathies and results in severe joint destruction. The aim of this study was to investigate the effect of these endogenous particulates on anti-osteoclastogenic cytokine signalling. METHODS: Human osteoclast precursors were treated with BCP and MSU crystals prior to stimulation with IL-6 or IFN-γ and the effect on STAT-3 and STAT-1 activation in addition to MAP kinase activation was examined by immunoblotting...
July 14, 2016: Osteoarthritis and Cartilage
Yibo Zhang, Seung Yoon Celine Lee, Yun Zhang, Daniel Furst, John Fitzgerald, Aydogan Ozcan
Gout is a form of crystal arthropathy where monosodium urate (MSU) crystals deposit and elicit inflammation in a joint. Diagnosis of gout relies on identification of MSU crystals under a compensated polarized light microscope (CPLM) in synovial fluid aspirated from the patient's joint. The detection of MSU crystals by optical microscopy is enhanced by their birefringent properties. However, CPLM partially suffers from the high-cost and bulkiness of conventional lens-based microscopy, and its relatively small field-of-view (FOV) limits the efficiency and accuracy of gout diagnosis...
2016: Scientific Reports
Victoria H Wilkinson, Emma L Rowbotham, Andrew J Grainger
The foot and ankle are commonly involved in a range of arthritides that affect the joints, bones, and soft tissues. Accurate plain film interpretation can often aid the diagnosis and monitor disease progression and treatment response. Ultrasound and MRI afford superior depiction of the soft tissues, and advances over recent years have centered on early detection of synovitis, enabling earlier diagnosis and treatment. Advantages and disadvantages of the imaging techniques of radiography, multidetector computed tomography, ultrasound, and MRI are discussed, as is optimization of these modalities for the assessment of the anatomically complex joints of the foot and ankle...
April 2016: Seminars in Musculoskeletal Radiology
Yessica Zamudio-Cuevas, Karina Martínez-Flores, Javier Fernández-Torres, Yahir A Loissell-Baltazar, Daniel Medina-Luna, Ambar López-Macay, Javier Camacho-Galindo, Cristina Hernández-Díaz, Mónica G Santamaría-Olmedo, Edgar Oliver López-Villegas, Francesca Oliviero, Anna Scanu, Jorge Francisco Cerna-Cortés, Marwin Gutierrez, Carlos Pineda, Alberto López-Reyes
BACKGROUND: Gout is the most common inflammatory arthropathy of metabolic origin and it is characterized by intense inflammation, the underlying mechanisms of which are unknown. The aim of this study was to evaluate the oxidative stress in human fibroblast-like synoviocytes (FLS) exposed to monosodium urate (MSU) crystals, which trigger an inflammatory process. METHODS: Human FLS isolated from synovial tissue explants were stimulated with MSU crystals (75 μg/mL) for 24 h...
2016: Arthritis Research & Therapy
Theodoros Soldatos, Parham Pezeshk, Fatemeh Ezzati, David R Karp, Joel D Taurog, Avneesh Chhabra
This article highlights the key aspects and current perspectives of the role of cross-sectional imaging in adult crystal and inflammatory arthropathies in adults, briefly discussing CT, and particularly focusing on MRI and US imaging as it supplements the conventional radiography. The role of conventional and advanced MR imaging techniques and imaging findings in this domain is discussed and illustrated with case examples. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards...
September 2016: Skeletal Radiology
A Scanu, F Oliviero, L Gruaz, P Galozzi, R Luisetto, R Ramonda, D Burger, L Punzi
OBJECTIVES: Monosodium urate (MSU) crystal deposition in gouty joints promotes the release of inflammatory mediators, in particular interleukin (IL)-1β. The induction of IL-1β production by MSU crystals requires a co-stimulus. The objective of this study was to determine which part of the synovial fluid (SF) provides co-stimulation to MSU crystals to induce IL-1β in macrophages. METHOD: The lipidic fraction (LF) and the protein fraction (PF) were isolated from the SF of patients with arthropathies...
October 2016: Scandinavian Journal of Rheumatology
Jan Fritz, Joerg C Henes, Matthew K Fuld, Elliot K Fishman, Marius S Horger
Gout is a true crystal deposition arthropathy caused by the precipitation of monosodium urate into joints and periarticular soft tissues. It is the most common inflammatory arthropathy in men and women of older age with a male-to-female ratio of 3 to 8:1. The disease may progress from asymptomatic hyperuricemia through symptomatic acute gout attacks with asymptomatic periods into chronic symptomatic tophaceous gout. Although invasive arthrocentesis and demonstration of monosodium urate crystals on polarized light microscopy is definitive for the diagnosis of gout, dual-energy computed tomography (CT) allows for noninvasive visualization and reproducible volume quantification of monosodium urate crystals...
February 2016: Seminars in Musculoskeletal Radiology
Emilia L Heselden, Antony J Freemont
OBJECTIVES: The aim of this study was to investigate the characteristics of arthritis in which monosodium urate (urate) and calcium pyrophosphate (CPP) crystals coexisted in synovial fluid (SF) to aid patient management and set a baseline from which to investigate the pathophysiological basis of an unusual coexistence of 2 disorders. METHODS: Synovial fluid analyses of 33,000 patients were reviewed, identifying those containing urate and/or CPP crystals. Synovial fluid cell count and differential cell count, together with patient age and gender, were retrieved from a computerized database spanning 22 years of SF analysis...
March 2016: Journal of Clinical Rheumatology: Practical Reports on Rheumatic & Musculoskeletal Diseases
Guang-Ming Han, Kaleb Michaud, Fang Yu, Shinobu Watanabe-Galloway, Ted R Mikuls
OBJECTIVE: To describe the burden and changing trends of arthritis and other rheumatic conditions (AORCs) on health care and public health by estimating annual rates of emergency department (ED) visits, hospitalizations, and mortality, in addition to medical charges related to AORCs and their comorbidities in Nebraska from 2007 to 2012. METHODS: Nebraska state ED discharge, hospital discharge, and death certificate data from 2007 to 2012 were used to estimate disease burden...
October 2016: Arthritis Care & Research
Mihra S Taljanovic, David M Melville, Lana H Gimber, Luke R Scalcione, Margaret D Miller, C Kent Kwoh, Andrea S Klauser
For the past 15 years, high-resolution ultrasonography (US) is being routinely and increasingly used for initial evaluation and treatment follow-up of rheumatologic diseases. This imaging technique is performed by using high-frequency linear transducers and has proved to be a powerful diagnostic tool in evaluation of articular erosions, simple and complex joint and bursal effusions, tendon sheath effusions, and synovitis, with results comparable to those of magnetic resonance imaging, excluding detection of bone marrow edema...
November 2015: Radiographics: a Review Publication of the Radiological Society of North America, Inc
F T Beil, W Rüther
BACKGROUND: Radiosynoviorthesis (RSO) provides a simple method for the treatment of patients with chronic synovitis and has only few side effects. OBJECTIVES: Evidence-based indications and contraindications for performing RSO based on the current literature are presented. MATERIAL AND METHODS: Published information on the indications and contraindications for performing RSO in chronic synovitis were analyzed and summarized. RESULTS: According to the guideline recommendations of the German Society of Rheumatology indications for RSO are given in patients with rheumatoid arthritis, seronegative spondyloarthropathy, crystal arthropathy, villonodular synovitis and hemophilia with recurrent joint bleeding...
November 2015: Zeitschrift Für Rheumatologie
Gregory S Mittl, Joseph D Zuckerman
Patients with significant gouty arthritis can develop disabling joint pain secondary to monosodium urate (MSU) articular deposition. We report a case of white, chalky MSU crystal deposition covering the articular surfaces of the knee as discovered by total knee arthroplasty. A 65-year-old male with a history of gout presented with bilateral knee pain. His radiographic imaging was negative for gouty tophi, and he elected to undergo left total knee arthroplasty. Intraoperatively a distinct chalky, white paste consistent with MSU deposition was observed covering the articular surfaces of the knee consistent with the diagnosis of gouty arthritis...
July 2015: Bulletin of the Hospital for Joint Diseases
Nicholas Kennedy, Steven T Chambers, Imogen Nolan, Kate Gallagher, Anja Werno, Melanie Browne, Lisa K Stamp
OBJECTIVE: To determine the epidemiology, clinical features, and microbiology of adult native joint septic arthritis in Canterbury, New Zealand, over a 5-year period in individuals with and without an underlying rheumatic disorder. METHODS: Patients with native joint septic arthritis were identified retrospectively and classified by Newman's criteria. The clinical characteristics were described and comparisons made between those with and without underlying rheumatic disease...
December 2015: Journal of Rheumatology
Wolfgang Gröbner
In most cases (98-99 %) primary hyperuricemia is caused by impaired renal excretion of uric acid. Overproduction of uric acid is rare. Secondary hyperuricemia has to be differentiated from primary forms. Clinical manifestations of hyperuricemia are acute inflammatory arthritis, tenosynovitis, bursitis, chronic arthropathy and accumulation of urate crystals in the form of tophaceous deposits. In addition renal complications can occur. Pathophysiology and diagnosis of gout were described. Treatment of gout has two goals: Treatment of the acute gout attack, to terminate pain and disability and treatment of hyperuricemia by lifestyle modification and with urate lowering drugs...
October 2015: Deutsche Medizinische Wochenschrift
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