![]() ![]() X-rays show calcium deposits within cartilage and fibro cartilage, mainly in knees, wrists and shoulders. Diagnostic methodsĭiagnosis of CPPD is based on the identification of CPP crystals in synovial fluid by compensated polarized light. ![]() ![]() Mutations in the collagen α-1(II) chain gene ( COL2A1 12q12-13.2), that codes for the major structural protein of cartilage, have been found to cause a particular form of chondrocalcinosis characterized by severe early onset OA, spondylo-epiphysial dysplasia and secondary CPPD. Other familial cases have been linked to mutation in the Tumor Necrosis Factor Receptor Super Family member 11B ( TNFRSF11B) gene coding for osteoprotegerin (OPG) Other causative genes are yet to be determined. Mutations in the ANKH gene (human homologue of progressive ankylosis 5p15.2), encoding a protein involved in cellular inorganic pyrophosphate transport, were identified in some cases of familial CPPD. Very rarely, familial CPPD can be associated with non rheumatological features, such as recurrent infantile seizures as was the case in a British family with CPPD and polyarticular chondrocalcinosis but without structural arthropathy. Chronic inflammatory arthropathy usually affects the knee, wrist, elbow, shoulder and hip, and can induce a severe OA-like arthropathy. The attacks can last from hours (6-24) to days and can induce a limited range of motion. In acute CPP crystal arthritis cases, acute episodes of pain, stiffness, swelling and sometimes ankylosis, can be observed in any joint, the knees or the wrist being the most affected. Generally, it is associated with acute CPP crystal arthritis involving the knees, the wrists, the shoulders, and/or a severe chronic inflammatory arthropathy, mimicking osteoarthritis (OA). Clinical descriptionįamilial CPPD manifests in early adulthood (20-40 years old) and has a variable clinical phenotype. It is rare: about 100 affected families have been identified to date. 1970 211:807–9.Familial calcium pyrophosphate deposition (CPPD) prevalence is unknown. Corticosteroid crystals in synovial fluid. Electron microscopic study of depot corticosteroid crystals with clinical studies after intra-articular injection. Detection of calcium crystals in knee osteoarthritis synovial fluid: a comparison between polarized light and scanning electron microscopy. 1999 58:582–4.įrallonardo P, Oliviero F, Peruzzo L, Tauro L, Scanu A, Galozzi P, Ramonda R, Punzi L. Most calcium pyrophosphate crystals appear as non-birefringent. Analysis for crystals in synovial fluid: training of the analysts results in high consistency. Lumbreras B, Pascual E, Frasquet J, González-Salinas J, Rodríguez E, Hernández-Aguado I. Arthrocentesis and synovial fluid analysis in clinical practice: value of sonography in difficult cases. ![]() Detection and identification of crystals in synovial fluid. Atlas of synovial fluid analysis and crystal identification. The ordinary light microscope: an appropriate tool for provisional detection and identification of crystals in synovial fluid. Prevalence of calcium pyrophosphate and monosodium urate crystals in synovial fluid of patients with previously diagnosed joint diseases. Oliviero F, Scanu A, Galozzi P, Gava A, Frallonardo P, Ramonda R, Punzi L. Update on calcium pyrophosphate deposition. Punzi L, Scanu A, Galozzi P, Luisetto R, Spinella P, Scirè CA, Oliviero F. Monosodium urate and calcium pyrophosphate crystals exhibit opposite colors which allow the analyst to establish their molecular nature. When coupled with a red compensator, polarized light permits distinction between the two types of crystals on the basis of the color produced based on the orientation of the crystal in relation to the optical axis of the compensator. A second polarizing lens placed between the objectives and the oculars serves to detect birefringent crystals which appear bright in a dark background. Using the optical microscope, polarized light is produced by the insertion of a polarizer between the light source and the specimen. The basis of this technique relies on the characteristic property of these crystals to be birefringent, predictably deviating a polarized light plane. In synovial fluid analysis, polarized light represents a fundamental tool in the search for pathogenic monosodium urate and calcium pyrophosphate crystals. Polarized light microscopy allows the detection of birefringent materials in biological samples. ![]()
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