Rheumatology 1999; 38: 912-916
© 1999 British Society for Rheumatology
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Management of crystal arthritis
Sección de Reumatología, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Spain
Correspondence to:
E. Pascual, Sección de Reumatología, Hospital General Universitario de Alicante, Maestro Alonso 109, 03010 Alicante, Spain.
The joint inflammation which characterizes gout and calcium pyrophosphate dihydrate (CPPD) crystal arthropathy requires the presence of either monosodium urate (MSU) or CPPD crystals in the joint cavity. Crystals were associated with arthritis after their identification in the synovial fluid (SF) of inflamed joints; subsequently, it was noted that crystal injection into healthy joints reproduced the attacks of inflammation. From these observations, it was concluded that the arthritis was triggered by shedding or injection of crystals from synovial or cartilage deposits into the joint cavity, followed by their phagocytosis by cells which resulted in intense inflammation. However, it is now evident that both in gout and CPPD arthropathy, after the crystals form in the joints, they stay in them indefinitely (in the case of gout, if the patients have not received hypouricaemic treatment): the crystals are regularly found in the SF of previously inflamed but currently asymptomatic joints, where finding
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