Crystal arthropathy
| Crystal arthropathy | |
|---|---|
| Specialty | Rheumatology |
Crystal arthropathy is a class of joint disorder (called
Types
| Name | Substance | Birefringence |
|---|---|---|
| Gout[2] | accumulation of uric acid | negative |
Pseudogout
|
accumulation of calcium pyrophosphate | positive |
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 glycosaminoglycans
- Hyperparathyroidism
- Hemochromatosis[4]
- Hypophosphatasia[5]
- Hypomagnesemia
- Hydroxyapatitedeposition:
- 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
Risk factors
- Obesity
- Kidney failure
- Hyperphosphatemia
- Hyperparathyroidism
- Hypercalcemia
- Tissue damage (dystrophic calcification)
Diagnosis
Differential diagnosis
- Septic arthritis
- Type IIa hyperlipoproteinemia
- Amyloidosis
- Multicentric reticulohistiocytosis
- Hyperparathyroidism
- Spondyloarthropathy
- Rheumatoid arthritis
Treatment
1. Steroid - options are intra-articular injection, oral steroid, or intramuscular injection of steroid. Intra-articular steroid + lido w/o (I like triamcinolone the best) 20 mg for small joints is perfect. For the intramuscular injection, I personally like 40 mg triamcinolone and 20 mg dexamethasone in the same syringe injected into the gluteus. For the oral steroid, I like Prednisone 40 mg every morning for seven days. Prescription will read prednisone 20 mg, two tabs PO Qa.m. x 7d, #14 0RF.
2. Colchicine 0.6 mg tabs - two tabs by mouth once and then one tab by mouth an hour later.
3. NSAID - I prefer 500 mg naproxen twice a day for seven days. Just be careful with the NSAID and steroid combination. If prescribing oral steroids, I put patients on famotidine 40 mg one tablet by mouth twice a day for 14 days
Do not prescribe allopurinol for acute gout flair. Wait until they are six weeks resolved to initiate that, otherwise you can cause an acute flare/worsening of the gout. However, they are already on allopurinol, continue it.
References
- PMID 10985980.
- PMID 16716879.
- S2CID 19200365. Archived from the originalon 2001-05-17. Retrieved 2008-12-16.
- ^ Axford, DSc, MD, John S. "Rheumatic manifestations of hereditary hemochromatosis". UpToDate.com. Retrieved 10 September 2014.
{{cite web}}: CS1 maint: multiple names: authors list (link) - ^ "Hypophosphatasia Pathology". Hypophosphatasia.com. Retrieved 10 September 2014.
- PMID 2588110.