Crystal arthropathy

Crystal arthropathy
Specialty	Rheumatology

Crystal arthropathy is a class of joint disorder (called arthropathy) that is characterized by accumulation of tiny crystals in one or more joints. Polarizing microscopy and application of other crystallographic techniques have improved identification of different microcrystals including monosodium urate, calcium pyrophosphate dihydrate, calcium hydroxyapatite, and calcium oxalate.[1]

Types include:

Name	Substance	Birefringence
Gout[2]	accumulation of uric acid	negative
Chondrocalcinosis[3] aka Pseudogout	accumulation of calcium pyrophosphate	positive

Risk factors

Obesity
Kidney failure
Hyperphosphatemia
Hyperparathyroidism
Hypercalcemia
Tissue damage (dystrophic calcification)

Causes

Deposition of crystals in joints
Calcium pyrophosphate dihydrate crystal formation:
- Increased production of inorganic pyrophosphate
- Decreased levels of pyrophosphatase in cartilage
- Decreased levels of cartilage glycosaminoglycans
- Hyperparathyroidism
- Hemochromatosis[4]
- Hypophosphatasia[5]
- Hypomagnesemia
Hydroxyapatite deposition:
- Tissue damage
- Hyperparathyroidism[6]
- Hypercalcemia
- Hyperphosphatemia
Calcium oxalate deposition:
- Enhanced production of oxalic acid due to enzyme defect
- Poor excretion of oxalic acid in kidney failure
- Excessive ascorbic acid intake in kidney failure

Differential diagnosis

References

Mcgill NW (2000). "Gout and other crystal-associated arthropathies". Baillière's Clinical Rheumatology. 14 (3): 445–460. doi:10.1053/berh.2000.0087. PMID 10985980.
Choi H (May 2006). "Epidemiology of crystal arthropathy". Rheum. Dis. Clin. North Am. 32 (2): 255–73, v. doi:10.1016/j.rdc.2006.03.002. PMID 16716879.
Canhão H, Fonseca JE, Leandro MJ, et al. (2001). "Cross-sectional study of 50 patients with calcium pyrophosphate dihydrate crystal arthropathy". Clin. Rheumatol. 20 (2): 119–22. doi:10.1007/s100670170081. PMID 11346223. Archived from the original on 2001-05-17. Retrieved 2008-12-16.
Axford, DSc, MD, John S. "Rheumatic manifestations of hereditary hemochromatosis". UpToDate.com. Retrieved 10 September 2014.CS1 maint: multiple names: authors list (link)
"Hypophosphatasia Pathology". Hypophosphatasia.com. Retrieved 10 September 2014.
Geelhoed, GW; Kelly, TR (December 1989). "Pseudogout as a clue and complication in primary hyperparathyroidism". Surgery. 106 (6): 1036–42. PMID 2588110.

External links

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[mcgill-1] Mcgill NW (2000). "Gout and other crystal-associated arthropathies". Baillière's Clinical Rheumatology. 14 (3): 445–460. doi:10.1053/berh.2000.0087. PMID 10985980.

[pmid16716879-2] Choi H (May 2006). "Epidemiology of crystal arthropathy". Rheum. Dis. Clin. North Am. 32 (2): 255–73, v. doi:10.1016/j.rdc.2006.03.002. PMID 16716879.

[pmid11346223-3] Canhão H, Fonseca JE, Leandro MJ, et al. (2001). "Cross-sectional study of 50 patients with calcium pyrophosphate dihydrate crystal arthropathy". Clin. Rheumatol. 20 (2): 119–22. doi:10.1007/s100670170081. PMID 11346223. Archived from the original on 2001-05-17. Retrieved 2008-12-16.

[4] Axford, DSc, MD, John S. "Rheumatic manifestations of hereditary hemochromatosis". UpToDate.com. Retrieved 10 September 2014.CS1 maint: multiple names: authors list (link)

[5] "Hypophosphatasia Pathology". Hypophosphatasia.com. Retrieved 10 September 2014.

[6] Geelhoed, GW; Kelly, TR (December 1989). "Pseudogout as a clue and complication in primary hyperparathyroidism". Surgery. 106 (6): 1036–42. PMID 2588110.