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Crystal Arthropathy

Crystal Arthropathies


Presentation

  • Five patients had abnormal thyroid hormone levels, but only one presented with clinical hypothyroidism. Four patients showed increased parathormone levels, but only one presented with clinical hyperparathyroidism.[ncbi.nlm.nih.gov]
  • G6PD Risk factors for pseudogout Association with trauma and osteoarthritis Hyperparathyroidism Wilson’s disease Haemochromatosis Loop diuretics causing hypomagnasaemia Presentation of gout (presents in four ways): Acute urate synovitis (acute attack[oxfordmedicaleducation.com]
  • This presentation is not well understood and does not have good treatment alternatives.[mdedge.com]
Soft Tissue Mass
  • Crystal arthropathies are a group of joint disorders due to deposition of crystals in and around joints which lead to joint destruction and soft tissue masses.[radiopaedia.org]
Localized Edema
  • Calcium pyrophosphate deposition disease should be on the differential diagnosis in the elderly patient presenting with a clinical picture that resembles “seronegative” RA, with morning stiffness, synovial thickening, localized edema, and restricted motion[mdedge.com]
Failure to Thrive
  • Fred Ferri’s popular "5 books in 1" format provides quick guidance on menorrhagia, Failure to Thrive (FTT), Cogan’s syndrome, and much more.[books.google.com]
Arthritis
  • The disease course was characterised by acute episodic arthritis in 16 (32%) patients and by persistent symptoms (with or without synovitis) in 34 (68%).[ncbi.nlm.nih.gov]
  • Treatment of disorders associated with gout or calcium pyrophosphate deposition may reduce non-joint morbidity and assist treatment of the arthritis.[ncbi.nlm.nih.gov]
  • Type IIa hyperlipoproteinemia Amyloidosis Multicentric reticulohistiocytosis Hyperparathyroidism Spondyloarthropathy Rheumatoid arthritis Fibromyalgia[en.wikipedia.org]
  • Autoimmune arthritis happens when your body's immune system attacks healthy cells in your body by mistake. Rheumatoid arthritis is the most common form of this kind of arthritis. Juvenile arthritis is a type of arthritis that happens in children.[icdlist.com]
Joint Effusion
  • In the absence of joint effusion or indications to obtain a synovial biopsy, chondrocalcinosis is presumptive of CPPD deposition. One exception is chondrocalcinosis due to CaOx in some patients with chronic renal failure.[what-when-how.com]
  • Spontaneous ruptures of the tibialis anterior, quadriceps, and Achilles tendons have been reported. 5,6 In the acute stage of gout, MRI findings of the joint effusion and synovial thickening are nonspecific.[appliedradiology.com]
  • Treatment  The acute attack  Resting the joint  Applying ice packs if pain is severe,  NSAIDs  Colchicine (may cause diarrhoea, nausea and vomiting)  A tense joint effusion may require aspiration and intra-articular injection of corticosteroids.[slideshare.net]
Joint Swelling
  • This leads to attacks of joint swelling and pain in the knees, wrists, ankles, and other joints. Among older adults, CPPD is a common cause of sudden (acute) arthritis in one joint.[medlineplus.gov]
  • For instance, a 50-year-old woman with symmetric, progressive polyarticular joint swelling and prolonged morning stiffness would seem to have rheumatoid arthritis.[aafp.org]
Arthralgia
  • For example, the acute stage of Lyme disease may include polyarticular arthralgias, whereas the chronic phase may include oligoarthritis, primarily in the knees. 17 SYMMETRY Joint involvement tends to be symmetric in systemic diseases such as rheumatoid[aafp.org]
Self-Mutilation
  • Kelley Geegmiller Syndrome Lesch Nyhan (complete x-linked, MR and self-mutilation) Kelley Geegmiller (incomplete x-linked, no neurologic/behavioral feature) What percentage of patients with hyperuricemia and gout have a deficient RENAL EXCRETION of gout[cram.com]

Workup

Soft Tissue Calcification
Hypocalciuria
  • The phosphocalcium balance was altered in nine (18%) cases: six patients had hypercalciuria two hyperphosphaturia, two hypocalciuria, one hypophosphaturia and one hypercalcemia.[ncbi.nlm.nih.gov]

Treatment

  • Treatment of disorders associated with gout or calcium pyrophosphate deposition may reduce non-joint morbidity and assist treatment of the arthritis.[ncbi.nlm.nih.gov]
  • In trials of gout, studies focus on acute symptomatic treatment, foregoing chronic management, which is aimed at reducing the concentration of serum urate.[ncbi.nlm.nih.gov]
  • What to Expect The diagnosis and treatment of gout and crystal arthropathy requires a careful review of a patient’s symptoms, physical findings, and previous testing.[massgeneral.org]
  • Treat your patients effectively using the latest information on drug treatments, from the recently-approved Uloric to Kristexx and Colcryst, which are still under review.[elsevier.com]
  • This presentation is not well understood and does not have good treatment alternatives.[mdedge.com]

Prognosis

  • Prognosis [ 2 ] Acute attacks usually resolve within ten days. [ 9 ] Some patients develop progressive joint damage with functional limitation. Prognosis will also be dependent on any underlying cause.[patient.info]
  • The prognosis for individual attacks of acute calcium pyrophosphate arthritis is usually excellent. However, chronic arthritis can occur, and severe destructive arthropathy resembling neurogenic arthropathy (Charcot joints) occasionally occurs.[merckmanuals.com]
  • .  Prognosis  1. Acute attacks self-limited, resolve 7-10 days  2. Progressive joint damage; destructive arthropathy resembling neuropathic(Charcot’s) joints  3. Large joint arthropathy may require joint replacement 54. II.[slideshare.net]
  • Prognosis CPPD crystal deposition disease is a chronic (long-lasting) disorder with recurrent flare-ups. This means it may occur periodically throughout your lifetime. Some people have only one or at the most a few attacks in a lifetime.[orthop.washington.edu]
  • As the symptoms and signs of both infectious and acute CPP crystal disease overlap and their treatment and prognosis differ greatly, a correct differential diagnosis is mandatory in clinical practice [ 3 ].[synapse.koreamed.org]

Etiology

  • Prevalence Widespread in older population M:F 3:2 Clinical findings Intermittent attacks May be mono-articular or polyarticular (more often) Pain Redness Swelling Types Frequently occurs in association with osteoarthritis Aging process with no known etiology[learningradiology.com]
  • MRI features associated with crystal deposition diseases include size, soft-tissue signal characteristics, arthritic changes, as well as etiology and common locations of such deposition diseases.[appliedradiology.com]
  • The specific cause of virus-induced arthritis is not always investigated; thus, the prevalence of viruses as the etiology of arthritis may be underestimated. 8 Except for Neisseria gonorrhoeae, direct bacterial infections in joints seldom cause polyarthritis[aafp.org]

Epidemiology

  • His research is focused on a number of key elements in OA including (but not limited to) the epidemiology of osteoarthritis, the application of imaging to better understand structure and function with application to both epidemiologic research and clinical[amazon.com]
  • This article reviews the relevant epidemiologic data, with a focus on recent progress and data on other crystal arthropathies.[ncbi.nlm.nih.gov]
  • Epidemiology 8 Nigel Arden and Michael C. Nevitt: Epidemiology 4. Risk factors 9 Ana M Valdes: Genetics 10 Joanne M. Jordan, Kelli D. Allen and Leigh F.[oupjapan.co.jp]
Sex distribution
Age distribution

Pathophysiology

  • Menschel: Pathophysiology of peri-articular bone changes in osteoarthritis 6 Floris Lafeber, N.J. Besselink and S.C. Mastbergen: Osteoarthritis: synovium and capsule 7 Jason J. McDougall and Joel A. Vilensky: Neuromuscular 3.[oupjapan.co.jp]
  • Providing a historical perspective throughout, this work includes detailed descriptions of the clinical features of these diseases, as well as a current overview of their identification, epidemiology, genetics, and underlying pathophysiology.[crcpress.com]
  • Gout and pseudogout pathophysiology Gout and pseudogout are crystal arthropathies Crystals of urate (in gout) and calcium pyrophosphate (in pseudogout) are precipitated in joints Neutrophils phagocytose the crystals whilst releasing pro-inflammatory cytokines[oxfordmedicaleducation.com]
  • Definition / general Also called pseudogout, chondrocalcinosis Common finding in arthritic joints Pathophysiology Calcium pyrophosphate dehydrate (CPPD) crystals develop first in menisci and intervertebral discs, may seed the joint and elicit neutrophilic[pathologyoutlines.com]

Prevention

  • Identifying and characterizing modifiable risk factors for gout is a major step in preventing and managing this painful condition.[ncbi.nlm.nih.gov]
  • Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets[books.google.com]
  • […] the meaning and significance of hyperuricemia (elevated uric acid levels) in relation to crystal formation, and the clinical manifestations of gout, as well as the importance of treating-to-target when using uric acid-lowering therapy and the need for preventing[massgeneral.org]

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