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Zamudio-Cuevas, Yessica, Javier Fernández-Torres, Gabriela Angélica Martínez-Nava, Karina Martínez-Flores e Alberto López-Reyes. "Emergent nanotherapies in microcrystal-induced arthritis". International Immunopharmacology 61 (agosto de 2018): 197–203. http://dx.doi.org/10.1016/j.intimp.2018.06.007.
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Patrón-Ordóñez, Gino, e María I. Anticona-Sayán. "Charcot neuroarthropathy: Differential diagnosis of monoarthritis of the knee in patients with type 2 diabetes mellitus". Revista de la Facultad de Medicina Humana 22, n.º 4 (12 de outubro de 2022): 906–11. http://dx.doi.org/10.25176/rfmh.v22i4.5107.
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A 46-year-old man with long-standing, poorly controlled diabetes is hospitalized for right knee monoarthritis after trauma. His clinical evaluation found joint deformity, synovitis in the right knee and absence of multiple toes due to a history of amputation. With the radiological evaluation that showed bone destruction and the synovial fluid analysis that ruled out infectious causes and microcrystal arthritis, the diagnosis of Charcot neuroarthropathy of the knee was made. Conservative management was indicated with the use of a felt insole for unloading and the use of a walker, the case being followed up to define behavior according to evolution. Despite being rare, it is important to consider Charcot neuroarthropathy in all diabetic patients with monoarthritis of the knee, in order to make an early diagnosis and avoid important complications and sequelae, always ruling out infectious causes and arthritis due to microcrystals.
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Brune, Kay, Käthy Bucher e Dieter Walz. "The avian microcrystal arthritis II. Central versus peripheral effects of sodium salicylate, acetaminophen and colchicine". Agents and Actions 43, n.º 3-4 (dezembro de 1994): 211–17. http://dx.doi.org/10.1007/bf01986691.
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Ferreyra, Marine, Guillaume Coiffier, Jean-David Albert, Claire David, Aleth Perdriger e Pascal Guggenbuhl. "Combining cytology and microcrystal detection in nonpurulent joint fluid benefits the diagnosis of septic arthritis". Joint Bone Spine 84, n.º 1 (janeiro de 2017): 65–70. http://dx.doi.org/10.1016/j.jbspin.2016.04.002.
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Eliseev, M. S., e A. M. Novikova. "Clinical discussion: gout therapy in a comorbid patient". Meditsinskiy sovet = Medical Council, n.º 11 (8 de agosto de 2020): 154–62. http://dx.doi.org/10.21518/2079-701x-2020-11-154-162.
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The data accumulated to date suggests that it is extremely rare for a gout patient to have only his or her main disease and no accompanying pathology. One of the frequent situations is a combination with another microcrystal arthritis, a disease of calcium pyrophosphate crystals deposition. In addition, diseases of the kidneys (including chronic renal failure), cardiovascular system, gastrointestinal tract, as well as metabolic disorders directly associated with gout or indirectly related to taking medications necessary to control the disease, not only affect the quality and longevity of life of the patient, but also create difficulties for its curation. The prescription of drug therapy, both symptomatic and pathogenetic, in such cases involves an assessment of all the associated risks, and the choice of drugs, in addition to efficiency, should be based on their safety profile in relation to comorbid pathology. This article analyzes the main principles and approaches to the treatment of gout and the disease of calcium pyrophosphate crystals deposition in the presence of concomitant diseases (arterial hypertension, chronic kidney disease, chronic heart failure, obesity, dyslipidemia, etc.) on the example of a 50-year-old patient. The possibilities of combined symptomatic therapy including colchicine, non-steroidal anti-inflammatory drugs and glucocorticoids are shown. The necessity and tactics of choice of preventive prophylactic therapy for arthritis attacks and use of phebuxostat in the presence of contraindications for prescription or ineffectiveness of allopurinol are also discussed.
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Peral, M. L., I. Calabuig, A. Martín-Carratalá, M. Andrés e E. Pascual. "THU0406 IDENTIFICATION OF INTRACELLULAR VACUOLES IN SYNOVIAL FLUID WITH CALCIUM PYROPHOSPHATE AND MONOSODIUM URATE CRYSTALS". Annals of the Rheumatic Diseases 79, Suppl 1 (junho de 2020): 440.1–441. http://dx.doi.org/10.1136/annrheumdis-2020-eular.3851.
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Background:Synovial fluid analysis using polarized microscopy is the gold standard for the diagnosis of crystal-related arthritis. In our experience, we have noted that, when calcium pyrophosphate (CPP) crystals are observed, they sometimes appear within intracellular vacuoles. However, this phenomenon is not seen in those samples containing monosodium urate (MSU) crystals. This finding has been scantly reported in the literature, but may be useful in clinical practice to ensure accurate crystal identification.Objectives:Our study aims to assess whether the presence of vacuoles contributes to identifying the type of crystal, and also to gauge the frequency of their presentation.Methods:We conducted an observational study in a rheumatology unit between February and June of 2019. Synovial fluids containing CPP or MSU crystals, obtained in daily clinical practice, were consecutively included for analysis. Two observers simultaneously analyzed the presence of vacuoles by ordinary light and phase contrast microscopy in less than 24 hours after their extraction, using a microscope equipped with two viewing stations. The primary study variable was to determine whether CPP and MSU crystals are seen inside intracellular vacuoles, and to calculate the frequency of this finding for each type of crystal, estimating their 95% confidence interval (95% CI) and comparing rates using Fisher’s exact test.Results:Twenty-one samples were obtained. Data is given in the Table. MSU crystals were present in 7 (33.3%) and CPP crystals in 14 (66.6%). Interestingly, none of the MSU samples showed crystal-containing vacuoles (95% CI 0-35.4%). On the contrary, cytoplasmic vacuoles containing crystals were present in all of the CPP samples (95% CI 78.5-100%). The findings were confirmed by phase-contrast microscopy. Differences were statistically significant (p<0.001).Table.SAMPLES ACCORDING TO TYPE OF MICROCRYSTAL(n=21)SAMPLES WITH VACUOLS(UNDER ORDINARY LIGHT)SAMPLES WITH VACUOLS(UNDER PHASE CONTRAST)CPP (14; 66.6%)14 (100%)(95%CI 78.5-100%)14 (100%)(95%CI 78.5-100%)MSU (7; 33.3%)0 (0%)(95%CI 0-35.4%)0 (0%)(95%CI 0-35.4%)Conclusion:The presence of vacuoles may be a useful and easy way to differentiate MSU and CPP crystals when performing synovial fluid microscopy in clinical practice, since it appears to be a distinctive feature in CPP crystal fluids.References:[1]Kohn NN, Hughes RE, McCarty DJ Jr, Faires JS. The significance of calcium phosphate crystals in the synovial fluid of arthritic patients: the «pseudogout syndrome». II. Identification of crystals. Ann InternMed. 1962 May;56:738-45.[2]Pascual E, Sivera F, Andrés M. Synovial Fluid Analysis for Crystals. CurrOpRheumatol 2011;23:161-169.[3]McCarty DJ, Koopman WJ. Arthritis and allied conditions: A textbook of rheumatology, volumen 1. Lea &Febiger. 1993.[4]Pascual E, Sivera F. Synovial fluid crystal Analysis. En Gout and other crystal arthropathies. Terkeltaub R ed. Elsevier; 2012: p.20-34.[5]Hwang HS, Yang CM, Park SJ, Kim HA. Monosodium Urate Crystal-Induced Chondrocyte Death via Autophagic Process. Int J Mol Sci. 2015 Dec 8;16(12):29265-77.Image 1. Microscopy with ordinary light. Cells with cytoplasmic vacuoles are observed, as well as abundant intra and extracellular CPP crystals.Image 2. Microscopy with phase contrast technique. Cells with intracellular vacuoles are observed inside which have microcrystals with parallelepiped morphology, compatible with CPP.Disclosure of Interests: :None declared
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Duse, Adina Octavia, Delia Berceanu Vaduva, Mirela Nicolov, Cristina Trandafirescu, Marcel Berceanu Vaduva, Mariana Cevei e Alina Heghes. "Biostatistical Analysis and Possible Forecasting of Relationship Between Uric Acid and Specific Laboratory Tests in Cases of Gouty Arthritis". Revista de Chimie 68, n.º 6 (15 de julho de 2017): 1234–41. http://dx.doi.org/10.37358/rc.17.6.5648.
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Acute gouty arthritis represents an inflammatory response to microcrystals of monosodium urate that precipitate in joint tissues from supersaturated body fluids or are shed from preexisting articular deposits [1]. Gout is a metabolic disease characterized by recurrent episodes of arthritis associated with the presence of monosodium urate crystals in the tissue or synovial fluid during the attack.These forms of crystal-induced arthritis usually affect peripheral joints, including knee, ankle, wrist, and metacarpophalangeal and metatarsophalangeal joints. All of them may be associated with other inflammatory, endocrine diseases [2]. The present study was done to highlight the relationship between increased levels of uric acid and specific laboratory tests in order to possible forecast development of further disease in patients with gouty arthrithis.The present study was done on 34 patients hospitalized in Felix Hospital of Rehabilitation in 2015-2016, with age between 44 and 74, having the main diagnosis of gouty arthritis.We studied the following laboratory tests:urea and other related analysis, like uric acid, creatinine, cholesterol, glutamate pyruvate transaminase and glutamate oxalate transaminase.
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Pouliot, Marc, Michael J. James, Shaun R. McColl, Paul H. Naccache e Leslie G. Cleland. "Monosodium Urate Microcrystals Induce Cyclooxygenase-2 in Human Monocytes". Blood 91, n.º 5 (1 de março de 1998): 1769–76. http://dx.doi.org/10.1182/blood.v91.5.1769.
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Abstract The formation and deposition of monosodium urate (MSU) microcrystals in articular and periarticular tissues is the causative agent of acute or chronic inflammatory responses known as gouty arthritis. Mononuclear phagocyte activation is involved in early triggering events of gout attacks. Because stimulated mononuclear phagocytes can constitute an important source of the inducible isoform of cyclooxygenase (COX-2), we evaluated the effects that proinflammatory microcrystals might have on COX-2 protein expression in crystal-stimulated monocytes. We found that MSU crystals, but not calcium pyrophosphate dihydrate (CPPD) crystals, induced COX-2, which correlated with the synthesis of prostaglandin E2 (PGE2) and thromboxane A2(TXA2). Crystal-induced de novo synthesis of COX-2 was dependent on transcriptional and translational events. Inhibition of tyrosine phosphorylation, by herbimycin A, blocked crystal-induced COX-2. Similarly, an inhibitor of the p38 mitogen-activated protein kinase, SB 203580, inhibited the stimulation of COX-2. Colchicine inhibited crystal-induced COX-2. In all cases, prostanoid synthesis was concomitantly inhibited. Taken together, these results implicate COX-2 in the development of MSU-induced inflammation.
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Pouliot, Marc, Michael J. James, Shaun R. McColl, Paul H. Naccache e Leslie G. Cleland. "Monosodium Urate Microcrystals Induce Cyclooxygenase-2 in Human Monocytes". Blood 91, n.º 5 (1 de março de 1998): 1769–76. http://dx.doi.org/10.1182/blood.v91.5.1769.1769_1769_1776.
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The formation and deposition of monosodium urate (MSU) microcrystals in articular and periarticular tissues is the causative agent of acute or chronic inflammatory responses known as gouty arthritis. Mononuclear phagocyte activation is involved in early triggering events of gout attacks. Because stimulated mononuclear phagocytes can constitute an important source of the inducible isoform of cyclooxygenase (COX-2), we evaluated the effects that proinflammatory microcrystals might have on COX-2 protein expression in crystal-stimulated monocytes. We found that MSU crystals, but not calcium pyrophosphate dihydrate (CPPD) crystals, induced COX-2, which correlated with the synthesis of prostaglandin E2 (PGE2) and thromboxane A2(TXA2). Crystal-induced de novo synthesis of COX-2 was dependent on transcriptional and translational events. Inhibition of tyrosine phosphorylation, by herbimycin A, blocked crystal-induced COX-2. Similarly, an inhibitor of the p38 mitogen-activated protein kinase, SB 203580, inhibited the stimulation of COX-2. Colchicine inhibited crystal-induced COX-2. In all cases, prostanoid synthesis was concomitantly inhibited. Taken together, these results implicate COX-2 in the development of MSU-induced inflammation.
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Chemes, V., O. Abrahamovych, U. Abrahamovych, R. Ivanochko e L. Kobak. "Calcium-phosphorus metabolism and markers of its regulation in patients with rheumatoid arthritis with violation of bone mineral density: character and diagnostic value". Lviv clinical bulletin 3-4, n.º 39-40 (2 de janeiro de 2023): 76–82. http://dx.doi.org/10.25040/lkv2022.03-04.076.
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Introduction. Patients with rheumatoid arthritis (RA) are twice as likely to have osteoporosis (OP) compared to the general population. The strength of bones depends on mineral substances, mainly represented by calcium phosphate microcrystals. The chief role in the regulation of calcium-phosphorus metabolism is played by vitamin D and parathormone (PTH). The aim of the study. To investigate markers of calcium-phosphorus metabolism in patients with rheumatoid arthritis accompanied by bone mineral density (BMD) disorders and to find out their diagnostic value. Materials and methods. 76 patients with RA (64 premenopausal women and 12 mature men) were included in the study. All patients with RA were subjected to ultrasound bone densitometry and according to its results, patients were divided into three groups: patients with RA and osteopenia, patients with RA and OP; RA patients without BMD disorders. The control group included 22 healthy individuals of both genders without BMD abnormalities. To evaluate calcium-phosphorus metabolism, ionized calcium, total calcium, phosphorus, PTH, and vitamin D in blood serum, and levels of calcium and phosphorus in urine were detected. Results. It was revealed that concentration of total calcium in blood serum of patients with RA is lower compared to healthy individuals, while the same index in urine of patients with RA accompanied by osteopenia, OP or without BMD disorders is higher compared to healthy people. The concentration of vitamin D is significantly lower in patients with RA and OP compared to patients with RA with osteopenia, without BMD disorders, or healthy individuals. The concentration of PTH is higher in healthy individuals compared to patients with RA without BMD abnormalities or with osteopenia. Conclusions. In patients with rheumatoid arthritis with osteopenia or osteoporosis, significantly more often than in patients with rheumatoid arthritis without a violation of bone mineral density, ionized and total calcium, phosphorus in serum and urine, as well as vitamin D indices have deviations from the reference values and are of diagnostic significance.
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Novikova, A., M. Elisеev, O. Sheliabina e H. Gerasimova. "THU0436 ASSESSMENT OF CARDIOVASCULAR RISK LEVELS IN CPPD VERSUS RA AND GOUT, AND RISK-FLUCTUATION ANALYSIS BASED ON CALCULATOR TYPE: ATP III AND REYNOLDS RISK SCORE". Annals of the Rheumatic Diseases 79, Suppl 1 (junho de 2020): 455.2–455. http://dx.doi.org/10.1136/annrheumdis-2020-eular.5190.
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Background:Cardiovascular risk in CPPD patients is not so well evaluated as in other rheumatic diseases, and optimal risk calculators for patients withcalcium pyrophosphatecrystal deposition disease have not yet been studied.Objectives:To assess CVR and compare stratification results using АТР III and Reynolds Risk Score (RRS) calculators in CPPD, RA and gout patients versus the control subjects.Methods:The case-control study included 168 patients aged 18 - 80 years old, with 42 participants in each subgroup – CPPD, gout, RA patients and healthy volunteers, matched by gender (10 males and 32 females) and age (mean age 54 years). CPPD diagnosis was based on McCarty 1961 y criteria, RA – following ACR/EULAR 2010 y criteria, and gout - ACR/EULAR 2015 criteria. CPPD and gout diagnosis was crystal- verified in all cases. Exclusion criteria were as follows: diabetes mellitus and eGFR<60 ml/min/1.73m2. The following data was collected for all patients: anthropometric parameters, BP, lab tests, including serum glucose level, creatinine, total cholesterol (TC), HDLp, CRP; CVR was assessed using АТР III and RRS scales. Statistica 12.0 package was used for statistical data processing.Results:Both groups were comparable in terms of anthropometric parameters, rates of individual indicators and factors did not differ, except for family history of cardiovascular disease, systolic BP, HDLp, hsCRP (see Table).Table 1.Risk factors and CVR stratification by ATP III and RRS in CPPD, RA, gout and control group.CPPD (n=42)RA (n=42)Gout (n=42)Control (n=42)Smoking, n (%)11 (26,2)12 (28,6)8 (19,0)12 (28,6)Systolic BP, mmHg, M±SD124±14*/**138±17##144±26###127±16TC, mg/dl, M±SD261.9±64.2244.1±77.5249.3±62.7244.1±52.6HDLp, mg/dl, M±SD63.2±20.2*/**49.2±16.5##52.0±9.7###58.1±16.4hsCRP, mg/l, Me [25-75thpercentiles]3.8 [1,0;12,4] */**/***8,6 [4.1;20.6]##8.5 [4.1;2.9]###1,5[0.8;2.6]hsCRP ≥5 mg/l,n (%)18 (43)*/**/***27 (64)##29 (69)###3 (7)Family history of CVD, n %6 (14)*/***16 (38)#4 (10)###17 (40)High and very high CVR levels, ATP III scale (>10%), n (%)5 (12)9 (21)7 (17)8 (19)High and very high CVR levels, RRS scale (>10%), n (%)9 (21)14 (33)12 (29)7 (17)*p<0.05 between CPPD and RA, **р<0.05 between CPPD and gout, ***р<0.05 between CPPD and controls,#р<0.05 between RA and gout,##р<0.05 between RA and controls,###р<0.05 between gout and controls.Based on ATP III risk calculation the number of CPPD patients with high and very high CVR was 5 (12%) patients and was close to that in RA (9(21%)), gout (7 (17%)) and the control group (8 (19%)). Mean CRP levels and number of pts with CRP ≥5 mg/l were significantly lower in CPPD and control group pts, than in RA and gout, however CRP ≥5 mg/l levels were documented almost in half of CPPD pts (43%) and only in 7% of pts from the control group (р<0.05).Although CVR calculations based on RRS scale yielded similar results, and all groups remained comparable, nevertheless, the number of pts with high and very high CVR increased in each group, except for the control. There were no meaningful differences in between the groups in TC levels, however HDLp was significantly higher in CPPD pts (p<0.05), than in RA and gout, and in the control group pts vs RA pts (p<0.05).Conclusion:CPPD associated cardiovascular risk is considerably high and comparable to CVR levels in RA and gout. Given that RRS based CVR calculation resulted in increased number of patients with high and very high risks in all groups, except for the control group, it can be suggested that use of calculators including CRP is appropriate not only in RA pts, but also in microcrystal deposition arthritis, associated with inflammation, therefore prospective studies on larger samples are deemed necessary.Disclosure of Interests: :Aleksandra Novikova: None declared, Maxim Elisеev Speakers bureau: Novartis, Menarini Group, Alium, Olga Sheliabina: None declared, Helen Gerasimova: None declared
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Rahim, Ina, e Jamal Pasha Chowdhury. "Evaluation of Diff Quik Staining Method for Detection of Mono Sodium Urate Crystals in Synovial Fluid Using Light and Polarizing Microscopy: A Cross-Sectional Study". Bangladesh Journal of Medical Microbiology 12, n.º 2 (16 de agosto de 2018): 10–13. http://dx.doi.org/10.3329/bjmm.v12i2.51693.
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Gout is one of the oldest diseases of the medical history that results from the deposition of monosodium urate crystals in joint structures and in periarticular sites in the form of tophi. The evaluation of synovial fluid is integral for the diagnosis of gout and other arthritis of microcrystals. The objective of this cross-sectional study was to evaluate the analysis of synovial fluid by polarizing and light microscopy using wet film and Diff Quik stained films and evaluating usefulness of Diff Quik stain in identifying monosodium urate (MSU) crystals on permanent mounted slides. It was conducted on 100 clinically suspected gout patients in the Department of Clinical Pathology, Bangabandhu Sheikh Mujib Medical University, Dhaka from May 2008 to April 2009. Polarizing Microscopy detected the presence of MSU crystals in 35.71% cases from wet films and 36.73% cases from Diff Quik stained films. Light Microscopy detected crystals in 28 (28.57%) cases from Diff Quik stained samples and in 31.63% cases from wet film samples. Considering wet film polarizing microscopy as gold standard, the sensitivity and specificity of wet film light microscopy was 88.6% and 100.0% respectively, whereas sensitivity and specificity were 80.0% and 100.0% respectively in Diff Quik light microscopy.In Diff Quik polarizing microscopy, sensitivity and specificity were100.0% and 98.4% respectively. The sensitivity and specificity was highest in Diff Quik stained films examined by polarizing microscopy
Bangladesh J Med Microbiol 2018; 12 (2): 10-13
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Migalkin, N. S., T. A. Stupina, A. V. Kaminsky, D. S. Mokhovikov, D. A. Shabalin, B. V. Kamshilov e A. Yu Kirsanova. "FEATURES OF THE PATHOMORPHOLOGICAL DIAGNOSIS OF MICROCRYSTALLINE ARTHROPATHIES IN THE PRACTICE OF SURGICAL MATERIAL EXAMINATION". Rheumatology Science and Practice 58, n.º 3 (24 de junho de 2020): 286–89. http://dx.doi.org/10.14412/1995-4484-2020-286-289.
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The development of microcrystalline arthritides is most frequently associated with the formation of monosodium urate (MSU) and calcium pyrophosphate (CPP) crystals. Their identification is of crucial importance in recognizing these diseases. Objective: to determine the possibilities of histological techniques in identifying MSU and CPP crystals and to evaluate the effectiveness of the techniques. Subjects and methods. Twenty-four tissue blocks (fragments of the affected areas of the elbow joint, the interphalangeal joint of the index finger, and hip joint) from 7 patients were examined. Paraffin sections were stained with a 0.5% alcohol solution of eosin, as well as with hematoxylin and eosin. Tissue specimens were examined and digitized using an AxioScope.A1 stereo microscope with Zenblue software (Carl Zeiss MicroImaging GmbH, Germany). Results and discussion. When staining the tissue sections with hematoxylin and eosin, microcrystals were not visualized; the major portions of MSU crystals was dissolved during fixation and staining, whereas CPP crystals were masked with hematoxylin as focal basophilic aggregates. The staining technique with an alcohol solution of eosin and short formalin fixation (within 12 hours) made it possible to avoid dissolution of MSU crystals and to visualize both MSU and CPP crystals, and to determine their shape and color. Conclusion. Light microscopy of the tissue sections stained with an alcohol solution of eosin along with short formalin fixation is a reliable method to differentiate MSU and CPP crystals. In patients undergoing endoprosthetic replacement, the significance of this technique for the pathomorphological study of surgical material consists in assessing inflammatory activity and in eliminating a disease, such as microcrystalline arthropathy.
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Garcia-Gonzalez, Estrella, Alessandra Gamberucci, Orso-Maria Lucherini, Alessandra Alì, Antonella Simpatico, Sauro Lorenzini, Pietro-Enea Lazzerini, Sergio Tripodi, Bruno Frediani e Enrico Selvi. "Neutrophil extracellular traps release in gout and pseudogout depends on the number of crystals regardless of leukocyte count". Rheumatology, 30 de janeiro de 2021. http://dx.doi.org/10.1093/rheumatology/keab087.
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Abstract Objectives Microcrystal-induced arthritis is still an unresolved paradigm for medicine. Overt inflammation may be absent even when crystals occur in SF. Recently, the production of neutrophil extracellular traps (NETs) embedding MSU crystals has been proposed as a possible mechanism of the auto-resolution of the inflammatory phase during gout. We aimed to verify and quantify the release of NETs in SFs during gout and pseudogout attacks and to compare any differences with respect to crystals and neutrophils number, and to analyse activation of necroptosis pathway in SF from crystal-induced arthritis. Methods SF samples were obtained by arthrocentesis from 22 patients presenting acute crystal-induced arthritis, gout or pseudogout (n = 11 each group), and from 10 patients with acute non-crystal arthritis as controls. NETosis was quantified in SF by nucleic acid stain and by quantification of human neutrophil elastase. Activation of phosphorylated MLKL was assessed by western blot. Results We observed that SF neutrophils encountering MSU and CPPD crystals during episodes of gout and pseudogout release NETs in relation to the number of crystals in SF and irrespective of neutrophil density and type of crystal. This release was accompanied by necroptosis through the activation of the MLKL pathway. Conclusions Our findings suggest that a role of NETs in crystal-induced arthritis is to ‘trap extracellular particles’, including microcrystals. Embedding crystals in aggregates of NETs may be the basis of tophi and CPPD deposition, and may have implications for disease evolution rather than for spontaneous resolution of the acute attack.
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Belfiore, Norma, Vito Privitera, Giampaolo Carmosino e Giulio Doveri. "Crowned dens syndrome". Italian Journal of Medicine, 23 de outubro de 2012. http://dx.doi.org/10.4081/itjm.2012.210.
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Introduction Microcrystalline deposition in peri-odontoid articular structures is mainly responsible for acute or chronic cervical pain and is known as “crowned dens syndrome”.Materials and methods We described two cases of acute cervical pain associated with onset of fever and peripheral acute monoarthritis. Cervical computed tomography (CT) scan showed linear calcification of the retrodens ligament and calcium pyrophosphate dehydrate (CPPD) crystals were found in synovial fluid of inflamed joints. Both patients were treated with anti-inflammatory drugs and colchicine.Discussion Calcium depositions around the odontoid process of the axis can be occasionally detected by radiological studies. They are frequently asymptomatic but sometimes can be associated with severe neurological abnormalities, fever and acute neck pain. CPPD crystals are usually deposited in joints and bursae but occasionally can disrupt these anatomical confines and deposit in periarticular tissues, sometimes forming large masses confused with tumours.Conclusions Acute onset of cervical neck pain associated with elevation of inflammatory indicators and/or signs of cervical myelopathy should suggest CT scans searching for microcrystal depositions in the peryodonthoid tissue. Differential diagnosis of fever of unknown origin (FUO) should include crowned dens syndrome specially in the elderly after exclusion of several endocrine or metabolic disorders, infection diseases (meningitis), arthritis (psoriatic arthritis and ankylosing spondylitis) and tumours (chordoma, meningioma, osteoblastoma).
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Xu, Yang, Ziqi Chen, Zunkai Xu, Yanyan Du, Jianghao Han, Xiaoyong Yuan, Shubiao Zhang e Shutao Guo. "Intra-Articular injection of acid-sensitive stearoxyl-ketal-dexamethasone microcrystals for long-acting arthritis therapy". Asian Journal of Pharmaceutical Sciences, julho de 2020. http://dx.doi.org/10.1016/j.ajps.2020.07.002.
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