{"id":8567,"date":"2021-11-30T07:46:06","date_gmt":"2021-11-30T05:46:06","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/rheumatology\/crystal-induced-arthropathies\/"},"modified":"2022-04-20T07:32:56","modified_gmt":"2022-04-20T05:32:56","slug":"crystal-induced-arthropathies","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/rheumatology\/crystal-induced-arthropathies\/","title":{"rendered":"Crystal induced arthropathies"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><div class=\"intro\"> Crystal-induced arthropathies are a group of diseases in which crystals form within joints. The different entities are determined based on the type of crystal, and generally, they all lead to joint inflammation, pain, and disability.<\/div><\/p>\n\n\n<span class=\"block-heading\" id=\"header_1\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Gout<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<p class=\"wp-block-paragraph\">Gout is an inflammatory disease in which <strong>monosodium urate<\/strong> (MSU) crystals are deposited within joints and other extra-articular tissues.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Uric acid is produced as a product of <strong>purine <\/strong>metabolism. Excessive production\/intake or reduced elimination leads to its accumulation (hyperuricemia).<\/li><li>Gout can be <strong>primary <\/strong>(most cases, appears in adult men) or <strong>secondary<\/strong> to metabolic or systemic disease, and certain drugs (thiazides, cyclosporin).<\/li><li><strong>Lesh-Nyhan syndrome <\/strong>is a rare, X-linked disorder caused by HPRT deficiency leading to the excessive degradation of purines into urate. Presents with mental retardation, and the consequences of hyperuricemia (gout, nephropathy).<\/li><li>Renal damage is a major complication of gout (urate nephropathy and nephrolithiasis).<\/li><li>Cold temperature, low pH, dehydration and injury can contribute to gouty inflammation. <\/li><li>Gout can manifest in sites of previous fractures.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Stages<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Asymptomatic hyperuricemia<\/strong>. Urate level of &gt;8mg\/dL, clinically silent.<\/li><li><strong>Acute gouty arthritis<\/strong>. Presents as an inflammation of a single joint, typically of the 1st MTP joint. Sudden, severe pain and disability, reddening and swelling. Most frequently, associated with alcohol consumption. Resolves within days to weeks.<ul><li><strong>Intercritical gout<\/strong>. Refers to the symptom-free period in-between the gouty attacks. With time, these periods become shorter, as attacks become more frequent.<\/li><\/ul><\/li><li><strong>Chronic gout<\/strong>. Long-lasting, low-grade inflammation and structural changes, often involving the joints of the upper limb as well. Characterized by the formation of urate-containing masses (tophi) in the fingers, feet, external ear, and around tendons, but may also appear within organs (kidneys) and the skin.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<p class=\"wp-block-paragraph\">The ACR\/EULAR classification criteria use clinical, laboratory, and imaging investigations as a scoring system for the determination of gout.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Entry criteria: at least 1 episode of peripheral joint swelling, pain, or tenderness.<\/li><li>Complaints fitting the diagnosis of gout.<\/li><li>Serum urate, and arthrocentesis (synovial fluid aspiration; gold standard).<\/li><li>Imaging studies<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<ul class=\"wp-block-list\"><li>Lifestyle modification (avoid red meat, seafood, alcohol, sugary drinks) and control of co-morbidities (DM, HTN, CKD).<\/li><li>Acute attacks should be treated with <strong>colchicine <\/strong>(microtubule dimerization and neutrophil migration inhibitor) as soon as possible, along with an NSAID, systemic or local corticosteroids.<\/li><li><strong>Urate-lowering therapy<\/strong>, increasing the dose until the desired serum urea level is reached (see Table 1).<\/li><\/ul>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"pure-table\"><thead><tr><th>Group<\/th><th>Mechanism<\/th><th>Examples<\/th><\/tr><\/thead><tbody><tr><td>Xanthine oxidase inhibitors<\/td><td>Inhibit the synthesis of purine bases.<\/td><td>Allopurinol<br>Febuxostat (non-purine-based, safer)<\/td><\/tr><tr><td>Reabsorption inhibitors<\/td><td>Inhibit the reabsorption of uric acid in the kidney.<\/td><td>High-dose sulfinpyrazone<br>Probenecid<\/td><\/tr><tr><td>Recombinant uricases<\/td><td>Convert urate into allantoin, which is excreted in the stool. <br>Can only be used short-term in severe gout, as their efficacy decreases due to the production of antibodies.<\/td><td>Rasburicase<br>Pegloticase (longer half-life)<\/td><\/tr><\/tbody><\/table><figcaption><strong>Table 1. Treatment of gout<\/strong><\/figcaption><\/figure>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Calcium-pyrophosphate-dihydrate (CPPD) arthropathy<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<p class=\"wp-block-paragraph\">CPPD arthropathy is characterized by the deposition of CPPD crystals within joints. This leads to joint pain, and degeneration of the cartilage over time, leading to disability. It presents clinically as one of several forms:<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"pure-table\"><thead><tr><th>Form<\/th><th>Presentation<\/th><\/tr><\/thead><tbody><tr><td><strong>Asymptomatic CPPD<\/strong><\/td><td>CPPD with no apparent clinical symptoms apart from chondrocalcinosis (calcification of cartilage).<\/td><\/tr><tr><td><strong>Acute CPP crystal arthritis<\/strong> (&#8220;pseudo-gout&#8221;)<\/td><td>Appears abruptly, self-limiting synovitis with CPPD. Joint pain that lasts days, typically in the knee.<\/td><\/tr><tr><td><strong>Chronic CPP crystal inflammatory arthritis<\/strong> (&#8220;pseudo-RA&#8221;)<\/td><td>May mimic RA; long-lasting symmetrical inflammation of the wrists and finger joints.<\/td><\/tr><tr><td><strong>Osteoarthritis with CPPD crystals<\/strong> (&#8220;pseudo-OA&#8221;)<\/td><td>Presence of CPPD crystals with changes seen in osteoarthritis.<\/td><\/tr><\/tbody><\/table><figcaption><strong>Table 2. Forms of CPPD arthropathy and their presentation.<\/strong><\/figcaption><\/figure>\n\n\n\n<ul class=\"wp-block-list\"><li>CPPD arthropathy can be <strong>primary <\/strong>(sporadic\/familial) or <strong>secondary <\/strong>to metabolic disease (hyperparathyroidism, hypermagnesemia, hemochromatosis).<\/li><li><strong>Diagnosis.<\/strong> Imaging studies, and arthrocentesis.<ul><li><strong>Ultrasound<\/strong>. Chondrocalcinosis (calcification of cartilage) is evident in all types of CPPD arthropathy.<\/li><li><strong>Arthrocentesis<\/strong>. The crystals appear in a rhomboid<strong> <\/strong>shape (instead of a needle shape seen in gout).<\/li><\/ul><\/li><li><strong>Treatment<\/strong>. Rest, ice, NSAIDs, joint replacement surgery.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Basic calcium-phosphate (hydroxyapetite) arthropathy<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<p class=\"wp-block-paragraph\">Calcium-phosphate arthropathy is characterized by the deposition of basic calcium-phosphate crystals within joints.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>The deposits may cause inflammation, leading to tendinitis and bursitis, and may cause joint destruction (<strong>Milwaukee shoulder\u00a0syndrome<\/strong>).<\/li><li>Presents as abrupt, sharp pain, with movement restriction, typically in the shoulder and knee joints.<\/li><li><strong>Diagnosis.<\/strong> Imaging studies, and arthrocentesis.<\/li><li><strong>Treatment.<\/strong> Physiotherapy and symptomatic therapy, including intra-articular steroids, NSAIDs, and colchicine. Joint replacement surgery (in Milwuakee shoulder syndrome).<\/li><\/ul>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Gout<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Stages<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Calcium-pyrophosphate-dihydrate (CPPD) arthropathy<\/h3><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Basic calcium-phosphate (hydroxyapetite) arthropathy<\/h3><\/div>","protected":false},"excerpt":{"rendered":"<p>Gout Gout is an inflammatory disease in which monosodium urate (MSU) crystals are deposited within joints and other extra-articular tissues. Uric acid is produced as a product of purine metabolism. Excessive production\/intake or reduced elimination leads to its accumulation (hyperuricemia). Gout can be primary (most cases, appears in adult men) or secondary to metabolic or [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":8424,"menu_order":6,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-8567","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Crystal induced arthropathies &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/rheumatology\/crystal-induced-arthropathies\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/rheumatology\\\/crystal-induced-arthropathies\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/rheumatology\\\/crystal-induced-arthropathies\\\/\",\"name\":\"Crystal induced arthropathies &#8211; Meddists\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/#website\"},\"datePublished\":\"2021-11-30T05:46:06+00:00\",\"dateModified\":\"2022-04-20T05:32:56+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/rheumatology\\\/crystal-induced-arthropathies\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/rheumatology\\\/crystal-induced-arthropathies\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/rheumatology\\\/crystal-induced-arthropathies\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"http:\\\/\\\/meddists.com\\\/learn\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Clinical\",\"item\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Internal medicine\",\"item\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/\"},{\"@type\":\"ListItem\",\"position\":4,\"name\":\"Rheumatology\",\"item\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/rheumatology\\\/\"},{\"@type\":\"ListItem\",\"position\":5,\"name\":\"Crystal induced arthropathies\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/#website\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/\",\"name\":\"Meddists\",\"description\":\"Let&#039;s Get Studying\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/meddists.com\\\/learn\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Crystal induced arthropathies &#8211; Meddists","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/rheumatology\/crystal-induced-arthropathies\/","twitter_misc":{"Est. reading time":"4 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/rheumatology\/crystal-induced-arthropathies\/","url":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/rheumatology\/crystal-induced-arthropathies\/","name":"Crystal induced arthropathies &#8211; Meddists","isPartOf":{"@id":"https:\/\/meddists.com\/learn\/#website"},"datePublished":"2021-11-30T05:46:06+00:00","dateModified":"2022-04-20T05:32:56+00:00","breadcrumb":{"@id":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/rheumatology\/crystal-induced-arthropathies\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/rheumatology\/crystal-induced-arthropathies\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/rheumatology\/crystal-induced-arthropathies\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"http:\/\/meddists.com\/learn\/"},{"@type":"ListItem","position":2,"name":"Clinical","item":"https:\/\/meddists.com\/learn\/clinical\/"},{"@type":"ListItem","position":3,"name":"Internal medicine","item":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/"},{"@type":"ListItem","position":4,"name":"Rheumatology","item":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/rheumatology\/"},{"@type":"ListItem","position":5,"name":"Crystal induced arthropathies"}]},{"@type":"WebSite","@id":"https:\/\/meddists.com\/learn\/#website","url":"https:\/\/meddists.com\/learn\/","name":"Meddists","description":"Let&#039;s Get Studying","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/meddists.com\/learn\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"}]}},"_links":{"self":[{"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/pages\/8567","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/comments?post=8567"}],"version-history":[{"count":21,"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/pages\/8567\/revisions"}],"predecessor-version":[{"id":10702,"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/pages\/8567\/revisions\/10702"}],"up":[{"embeddable":true,"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/pages\/8424"}],"wp:attachment":[{"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/media?parent=8567"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}