Management Of Crystal Arthritis

Content

• Symptoms Of Crystalline Arthropathies
• Maintain A Physical Connection To Crystals
• Treatment Of Pseudogout
• Gout And Calcium Pyrophosphate Deposition Disease
• Risk Factors
• How Doctors Diagnose Pseudogout

This cycle also recruits more white blood cells to the joint, which accelerates the inflammatory process. Crystal deposits are probably related to damage of the cartilage from trauma or chronic inflammation . Recent studies suggest that crystal deposits amplify the degenerative process as the presence of these crystals in the articular space stimulates secretion of cellular proteases to clear the joint . Therefore, treatment of CPDD is based on prevention of crystal formation, dissolution of crystals, and decrease of biologic consequences of crystal-cell interactions. Lavage of the joints or repeated aspiration with injection of intra-articular hyaluronan is proposed for therapeutic management of these patients. Surgical excision of the calcified mass may be attempted to improve joint mobility.

This site is a valuable resource on the spectrum of arthritic disorders. It is important for patients to understand the four stages of gout since the treatment of each is different. It is also important for patients with gout to be carefully counseled to communicate any changes in the frequency of gout attacks to their practitioner. The main message of this review is to emphasize how dramatically effective standard medication is for gout, both in acute treatment and prevention. Many of my patients have explored a variety of non-traditional approaches to gout, often in combination with traditional measures. Now that the FDA has put this warning on febuxostat, even in people with kidney abnormality we would be likely to start allopurinol first.

Symptoms Of Crystalline Arthropathies

Another chemokine named interleukin-8 is also produced by the activated macrophages, which induces the migration of neutrophils into the articular tissues further up-regulating the inflammatory reaction. There is no specific treatment of the joint involvement of Wilson’s disease, apart from the copper chelators (D-penicillamine, zinc, and trientine) used to treat the general disease. Reviews showed a better efficacy for D-penicillamine though rheumatologic symptoms were not assessed and tolerance was poor . Furthermore, D-penicillamine can be responsible for rheumatologic disorders by itself especially with cases of induced lupus . The choice of treatment differs according to the disease’s clinical presentation, mostly according to which hepatic or neurological symptoms prevail . Diets restricted in copper seem unnecessary to the exception of liver and shellfish.

Additional medications, such as IL-1 inhibitors and biologic therapy are being investigated, allowing for additional treatment options for acute crystalline arthritis with gout and CPPD disease. It is essential for practitioners to keep current with new research data on the indications, safety, and efficacy of these drugs to use them competently in clinical practice. Because acute CPPD disease closely resembles gout, the definitive diagnosis often requires synovial fluid analysis.

Maintain A Physical Connection To Crystals

Although uric acid-lowering therapy prevents gout attacks in the long term, they can actually bring about or worsen an acute attack when they are first started. For that reason, these drugs are not started during an acute flare. Anti-inflammatory medications may be given when starting uric acid-lowering therapy. Monosodium urate crystals come from uric acid, a substance that occurs naturally in the blood as a result of the metabolism of purines. Normally, excess uric acid is eliminated in the urine or by the gut. In some patients, the kidneys become less efficient at excreting uric acid, causing levels to increase in the blood.

Are calcium deposits bad?

Occasionally, however, calcium buildup in soft tissues can cause medical problems or skew test results. For example, even if your blood calcium levels are normal, calcium deposits called calcifications may accumulate at the site of tissue damage.

Synovial fluid analysis showed 50% neutrophils and 50% lymphocytes. The fluid was negative for Gram staining organisms and acid-fast bacilli. Polarized light microscopy showed urate and pyrophosphate crystals. She was treated with diclofenac sodium for 5 days and her symptoms subsided.

Rare Disease Database

An X-ray of the joint can be taken to look for the presence of calcium containing crystals located within the cartilage. To diagnose the condition, fluid is removed from the inflamed joint and analyzed under a microscope. Over time, pseudogout attacks may increase, involve more joints, cause more severe symptoms, and last longer. Attacks may occur from once every few weeks to less than once a year.

Whenever possible, however, we try to avoid surgery to remove tophi. The problem is that the crystals are often extensive, and track back to the bone, so there is not a good healing surface once the tophus is removed. In some rare cases, such as when a tophus is infected or when its location is causing major disability, surgical removal may be considered. If a patient can’t tolerate allopurinol, and meets the criteria for probenecid, that can be tried. Like allopurinol, the most common side-effect of febuxostat is causing gout to flare after this drug is started.

Treatment Of Pseudogout

There is no way to prevent the formation of calcium pyrophosphate crystals or to satisfactorily remove existing crystals from the joints. When ANKH activity is increased, levels of PPi accumulate in cartilage, complex with calcium, and form calcium pyrophosphate crystals. This includes over-the-counter drugs such as aspirin or diuretics. Some of the gout medications will not work properly if you are taking other drugs at the same time.

Deposits also may form as a result of metabolic abnormalities such as the body's inability to make urine-less acid. With some people, a diet rich in foods that further increases the production of uric acid may increase their chances of developing kidney stones. If your doctor suspects that diet is a contributing factor, you may be asked to collect several urine samples. Tests then will be conducted to determine the amount of uric acid your body produces. These tests are particularly helpful because some people with gout produce and eliminate a large amount of uric acid.

What are the main types of crystals that deposit within joints and cause arthritis?

Crystalline arthropathies are a group of joint disorders caused by deposits of crystals in joints and the soft tissues around them. The most common types are gout and calcium pyrophosphate deposition (CPPD).

For patients who have acute attacks, the doctor may prescribe nonsteroidal anti-inflammatory drugs, which are commonly calledNSAIDs. NSAIDs, like indomethacin and naproxen , treat pain and swelling during severe attacks. Pseudogout is primarily caused by the precipitation of calcium pyrophosphate dihydrate crystals developing within a joint space. Pseudogout has sometimes been referred to as calcium pyrophosphate deposition disease or CPPD.

Risk Factors

People who have a thyroid condition, kidney failure, or disorders that affect calcium, phosphate, or iron metabolism are at increased risk for pseudogout. X-rays of the affected joints may show uric acid deposits and damage indicative of gouty arthritis. Sometimes other tests, such as an RF or an ANA (anti-nuclear antibody), may be ordered to rule out other causes of arthritis symptoms. A blood culture and/or synovial fluid culture may be ordered if septic arthritis is suspected. Non-steroidal anti-inflammatories are the best treatment for an acute gout attack unless the person has kidney problems or stomach ulcers. Patients who cannot use these anti-inflammatories require corticosteroids, either injected into the joint or taken as tablets .