Considering the growing evidence supporting a role of low-grade inflammation in OA pathogenesis, the results of this study suggest a role for calcium crystals in the development of the disease.īasic calcium phosphate crystals Calcium pyrophosphate crystals Inflammation Power Doppler Scanning electron microscopy Synovial fluid. No change in crystal morphology was detected and, apart from one fluid kept at room temperature in which fungal hyphae were noted at six weeks, no new crystals. No association between the presence of crystals and the radiographic scores has been observed. The prevalence of BCP crystals alone was, instead, higher in the early (23%) with respect to the late group (19.4%). Classifying our patients according the severity Kellgre-Lawrence score, we found that the prevalence of CPP alone (27.8%) or in combination with BCP (11.1%) was higher in the late stage group with respect to the early one (CPP 21.6% and CPP + BCP 4.1%, respectively). Categorizing patients according to SF crystal type, a strong association between BCP crystal presence, and higher WOMAC and Lequesne index scores has been uncovered. It's diagnosed by the study of the synovial fluid from the inflamed joint, which is observed under a microscope for CPPD crystals. SEM analyses uncovered CPP crystals in 26 patients (23.6%), BCP crystals in 24 patients (21.8%), and both types of crystals in 7 patients (6.3%). How is calcium pyrophosphate dihydrate crystal deposition disease (CPPD, or pseudogout) diagnosed CPPD can't be diagnosed simply from a blood test. Scanning electron microscopy (SEM) was used to detect SF crystals. Ultimately, CPPD disease is diagnosed by the presence of positively birefringent CPPD crystals in the synovial fluid, whereas gout involves the presence of negatively birefringent crystals when viewed under polarized light microscopy. The demonstrable presence of CPPD crystals in synovial fluid or in tissues using compensated polarized light microscopy (as discussed earlier for gout vs. One-hundred-and-ten patients with knee OA completed the Western Ontario and McMaster Universities Arthritis Index (WOMAC) self-assessment questionnaire, the Lequesne algofunctional index survey, and the visual analogic scale forms they also underwent power Doppler ultrasonography (PDUS) to assess synovial inflammation. Joint washout ( arthrocentesis) is an option in severe cases.The current study aimed to investigate the association of calcium pyrophosphate (CPP) and basic calcium phosphate (BCP) crystals in synovial fluid (SF) of patients with osteoarthritis (OA) with disease severity, clinical symptoms, and synovial inflammation. Symptoms usually resolve spontaneously over several weeks. Remember the mnemonic LOSS:Ĭhronic asymptomatic changes found on an xray do not require any action. Other joint xray changes are similar to osteoarthritis. This is pathognomonic (diagnostic) of pseudogout. It appears as a thin white line in the middle of the joint space caused by the calcium deposition. The underlying mechanism is the same as in gout (see Gout). Positive birefringent of polarised lightĬhondrocalcinosis is the classic xray change in pseudogout. CPP crystals formed in cartilage may move to synovium and synovial fluid and cause inflammation.To establish a definitive diagnosis the joint needs to be aspirated for synovial fluid. It tends the be milder in presentation compared with gout and septic arthritis. Calcium pyrophosphate dihydrate crystals are found in the SF in 2 major settings: osteoarthritis (OA) and acute CPP arthritis. In any patient presenting with a hot, painful and swollen joint, septic arthritis needs to be excluded as it is a medical emergency that is joint and life threatening. Gout Definition Gout is a crystal-deposition disease caused by the super saturation and precipitation of MSU crystals in tissues resulting in inflammation and tissue damage. It can also be asymptomatic and picked up incidentally on an xray of the joint. 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. It can be a chronic condition and affect multiple joints. Other joints that are commonly affected are the shoulders, wrists and hips. Pseudogout is a crystal arthropathy, which may cause an acute inflammatory arthritis from deposition of calcium pyrophosphate. It is also known as chondrocalcinosis.Ī typically presentation of pseudogout is an older adult with a hot, swollen, stiff, painful knee. Calcium pyrophosphate crystals are deposited in the joint causing joint problems. Pseudogout is a crystal arthropathy caused by calcium pyrophosphate crystals.
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