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==Overview== | ==Overview== | ||
Crystal induced arthritis is a relatively common condition that involves deposition of crystals in [[Joint|joints]] and soft tissues. A variety of crystals can deposit in and around [[Joint|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 [[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. | 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. | ||
==Causes== | ==Causes== | ||
Common causes of crystal arthritis include: | |||
*[[Gout]] | *[[Gout]] | ||
*[[Pseudogout]] (Calcium pyrophosphate dihydrate) | *[[Pseudogout]] ([[Calcium pyrophosphate|Calcium pyrophosphate dihydrate]]) | ||
*[[Calcium apatite deposition disease]] | *[[Calcium apatite deposition disease]] | ||
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{| class="wikitable" | {| class="wikitable" | ||
! | ! style="background:#4479BA; color: #FFFFFF;" align="center" + | | ||
!Gout | ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Gout | ||
!Pseudogout | ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Pseudogout | ||
|- | |- | ||
|Definition | | style="background:#DCDCDC; + " |'''Definition''' | ||
| | | | ||
* Supersaturation of extracellular fluids and plasma with uric acid leading to monosodium urate (MSU) crystal deposition in the joint spaces is called gout. | * 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 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 | | style="background:#DCDCDC; + " |'''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 | | style="background:#DCDCDC; + " |'''Clinical Features''' | ||
| | | | ||
* Acute arthritis: | * [[Arthritis|Acute arthritis]]: | ||
** Pain | ** [[Pain]] | ||
** Swelling of the joint | ** [[Swelling]] of the joint | ||
** Warmth | ** Warmth | ||
** Tenderness | ** [[Tenderness]] | ||
* Chronic arthritis: | * [[Arthritis|Chronic arthritis]]: | ||
** Chronic nonsymmetric synovitis | ** Chronic nonsymmetric [[synovitis]] | ||
** Periarticular tophi formation | ** Periarticular [[Tophus|tophi]] formation | ||
* Nephrolithiasis | * [[Kidney stone|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 71: | Line 73: | ||
* Symmetric proliferative synovitis | * Symmetric proliferative synovitis | ||
|- | |- | ||
|Diagnosis | | style="background:#DCDCDC; + " |'''Diagnosis''' | ||
| | | | ||
* Joint aspiration | * [[Aspiration|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 | ||
* Serum uric acid levels | * [[Uric acid|Serum uric acid levels]] | ||
* Urine uric acid | * Urine [[uric acid]] | ||
* Serum | * [[Serum creatinine|Serum creatinine 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 | | style="background:#DCDCDC; + " |'''Treatment''' | ||
| | | | ||
* Analgesia | * [[Analgesia]] | ||
* NSAIDs | * [[Non-steroidal anti-inflammatory drug|NSAIDs]] | ||
* Intraarticular glucocorticoids | * [[Glucocorticoid|Intraarticular glucocorticoids]] | ||
* Systemic glucocorticoids | * [[Glucocorticoid|Systemic glucocorticoids]] | ||
* Allopurinol, Febuxostat | * [[Allopurinol]], [[Febuxostat]] | ||
* Probenecid, Sulfinpyrazone | * [[Probenecid]], [[Sulfinpyrazone]] | ||
| | | | ||
* NSAIDs | * [[Non-steroidal anti-inflammatory drug|NSAIDs]] | ||
* Intraarticular injection of glucocorticoids | * Intraarticular injection of [[glucocorticoids]] | ||
* Colchicine | * [[Colchicine]] | ||
|} | |} | ||
Latest revision as of 22:01, 5 July 2020
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Crystal arthritis Main page |
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 | |
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| Definition |
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| Pathogenesis |
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| Clinical Features |
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| Diagnosis |
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| Treatment |
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