Crystal arthritis: Difference between revisions

	Crystal arthritis Main page
Patient Information Gout (patient information) Pseudogout (patient information)
Overview
Causes
Classification Gout Pseudogout
Differentiating Gout from Pseudogout

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Latest revision as of 22:01, 5 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2] Sudarshana Datta, MD [3]

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

Common causes of crystal arthritis include:

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 creatinine 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

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Crystal arthritis}}
-{{CMG}} ; {{AE}} {{ADG}}
+{{CMG}} ; {{AE}} {{ADG}} {{Cherry}}
 ==Overview==
-Crystal deposition disease is a relatively common condition. Gout and CPPD disease are the most common of these disorders, but practitioners need to be aware of the presence of other types of crystal arthropathy, such as hydroxyapatite crystal deposition disease. In this case, crystals might not be seen on classic synovial analysis and some may require special staining.
+Crystal induced arthritis is a relatively common condition that involves deposition of crystals in [[Joint|joints]] and soft tissues. A variety of [[Crystal|crystals]] can deposit in and around [[Joint|joints]] and soft tissues, resulting in [[articular]] and periarticular inflammation. [[Urate|Monosodium urate (MSU)]] and [[Calcium pyrophosphate|calcium pyrophosphate dihydrate (CPPD)]] are the most commonly involved crystals in the pathogenesis of crystal induced [[Arthropathy|arthropathies]]. Other rare types of crystal arthropathy include [[Hydroxylapatite|hydroxyapatite]] crystal deposition [[arthropathy]]. [[Gout]] and [[Pseudogout|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.
-Gout and pseudogout can manifest with similar symptoms, and their clinical presentation might not be distinguishable; thus, it is essential to aspirate the affected joint or bursa for synovial fluid and crystal analysis whenever possible. Cell count, Gram stain, and culture, in the right clinical setting, should be sought.
+==Causes==
+Common causes of crystal arthritis include:
-Once the diagnosis is made, treatment for acute attack should be commenced using the least toxic agent or the one that carries least risk for the patient. Treatment should be initiated while taking into consideration other comorbid conditions, such as renal disease, gastric disease, organ transplant, drug interactions, and others, because these will affect the choice of therapy. In the case of gout, once the acute disease has resolved, the patient should be followed to assess for indications and need for hypouricemic therapy.Crystal-induced arthritis  are a group of disorders that involve deposition of crystals in joints and soft tissues, resulting in articular and periarticular inflammation and injury. Two types of crystals — monosodium urate (MSU) and calcium pyrophosphate dihydrate (CPPD) — are commonly involved in gout and CPPD disease, which are described in this chapter.
+*[[Gout]]
+*[[Pseudogout]] ([[Calcium pyrophosphate|Calcium pyrophosphate dihydrate]])
+*[[Calcium apatite deposition disease]]
-==Causes==
 ==Classification==
-==Differentiating Crystal arthritis from other diseases==
+{{Family tree/start}}
+{{Family tree | | | | | | | | | | | | | | | | | | | | A01 | | | | | | | | | | A01=Arthritis}}
+{{Family tree | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | | | |}}
+{{Family tree | | | | | | | | | | | | | | |,|-|-|-|-|-|^|-|-|-|-|-|.| | | | |}}
+{{Family tree | | | | | | | | | | | | | | B01 | | | | | | | | | | B02 | | | | |B01=Inflammatory|B02=Non-Inflammatory}}
+{{Family tree | | | | | | | | | | | | | | |!| | | | | | | | | | | |!| | | | }}
+{{Family tree | | | | | | | | |,|-|-|-|-|-|+|-|-|-|-|-|.| | | | | C01 | | | |C01=Osteoarthritis}}
+{{Family tree | | | | | | | | C02 | | | | C03 | | | | C04 | | | | | | |C02=Rheumatoid factor|C03=Infectious|C04=Crystalloid }}
+{{Family tree | | | | | | | | |!| | | | | | | | | | | |!| | | | | |}}
+{{Family tree | | | | |,|-|-|-|^|-|-|-|.| | | | | | | |!| | | | | |}}
+{{Family tree | | | | D01 | | | | | | D02 | | | | | | |!| | | | | |D01=Rheumatoid positive|D02=Rheumatoid negative}}
+{{Family tree | | | | |!| | | | | | | |!| | | |,|-|-|-|+|-|-|-|.|}}
+{{Family tree | | | | E04 | | | | | | E05 | | E01 | | E02 | | E03 | | |E04=RA<br>Lupus<br>Scleroderma|E05=AKS<br>Psoriatic arthritis<br>Reactive arthritis|E01=Gout|E02=Pseudogout|E03=Calcium hydroxapatite crystals}}
+{{Family tree/end}}
+==Differentiating Gout from Pseudogout==
+Gout can be differentiated from pseudogout based on the following characteristics:
+{| class="wikitable"
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Gout
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Pseudogout
+|-
+| style="background:#DCDCDC; + " |'''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.
+|
+* Acute and chronic inflammatory joint disease leading to deposition of [[Calcium pyrophosphate|calcium pyrophosphate dihydrate (CPPD)]] deposition in the joints leads to [[Chondrocalcinosis|pseudogout]].
+|-
+| style="background:#DCDCDC; + " |'''Pathogenesis'''
+|
+* Increased production or decreased excretion of [[uric acid]] leads to hyperuricemia.
+|
+* 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]].
+|-
+| style="background:#DCDCDC; + " |'''Clinical Features'''
+|
+* [[Arthritis|Acute arthritis]]:
+** [[Pain]]
+** [[Swelling]] of the joint
+** Warmth
+** [[Tenderness]]
+* [[Arthritis|Chronic arthritis]]:
+** Chronic nonsymmetric [[synovitis]]
+** Periarticular [[Tophus|tophi]] formation
+* [[Kidney stone|Nephrolithiasis]]
+** [[Renal colic]]
+|
+* Acute CPPD arthritis:
+** [[Pain]]
+** [[Swelling]], frequently involving the knee
+** Redness
+* Chronic arthropathy:
+** Progressive degeneration in multiple joints
+* Symmetric proliferative synovitis
+|-
+| style="background:#DCDCDC; + " |'''Diagnosis'''
+|
+* [[Aspiration|Joint aspiration]]
+** [[Synovial fluid]] analysis shows both intracellular and extracellular needle-shaped negatively birefringent MSU crystals by polarizing microscopy
+* [[Uric acid|Serum uric acid levels]]
+* Urine [[uric acid]]
+* [[Serum creatinine|Serum creatinine levels]]
+|
+* [[Synovial fluid]] analysis:
+** Demonstration of CPPD crystals appearing as rhomboids with weak positive birefringece by polarizing microscopy
+|-
+| style="background:#DCDCDC; + " |'''Treatment'''
+|
+* [[Analgesia]]
+* [[Non-steroidal anti-inflammatory drug|NSAIDs]]
+* [[Glucocorticoid|Intraarticular glucocorticoids]]
+* [[Glucocorticoid|Systemic glucocorticoids]]
+* [[Allopurinol]], [[Febuxostat]]
+* [[Probenecid]], [[Sulfinpyrazone]]
+|
+* [[Non-steroidal anti-inflammatory drug|NSAIDs]]
+* Intraarticular injection of [[glucocorticoids]]
+* [[Colchicine]]
+|}