Skip to main content

Crystal Arthritis

  • Chapter
  • First Online:
Absolute Rheumatology Review

Abstract

The formation or liberation of crystals, whether of an organic or inorganic composition, can activate the innate immune system to produce both acute and chronic inflammation. Thus, the inflammatory responses to all crystal diseases are similar, though they may vary in degree or kinetics. Crystal diseases differ more dramatically in their epidemiology, the metabolism, biology and chemistry of their crystal formations, their anatomic localizations, and their potentials for deposition and tissue disruption. Here, we review the two most common classes of crystal diseases—gout and crystals that are composed of calcium with various anions. Additionally, we briefly review several other crystals that may be encountered.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum. 2011;63(10):3136–41.

    Article  Google Scholar 

  2. Hak AE, Curhan GC, Grodstein F, Choi HK. Menopause, postmenopausal hormone use and risk of incident gout. Ann Rheum Dis. 2010;69(7):1305–9.

    Article  Google Scholar 

  3. Kuo CF, See LC, Luo SF, Ko YS, Lin YS, Hwang JS, et al. Gout: an independent risk factor for all-cause and cardiovascular mortality. Rheumatology (Oxford). 2010;49(1):141–6.

    Article  Google Scholar 

  4. Dehghan A, Kottgen A, Yang Q, Hwang SJ, Kao WL, Rivadeneira F, et al. Association of three genetic loci with uric acid concentration and risk of gout: a genome-wide association study. Lancet (London, England). 2008;372(9654):1953–61.

    Article  CAS  Google Scholar 

  5. Moi JH, Sriranganathan MK, Falzon L, Edwards CJ, van der Heijde DM, Buchbinder R. Lifestyle interventions for the treatment of gout: a summary of 2 Cochrane systematic reviews. J Rheumatol Suppl. 2014;92:26–32.

    Article  Google Scholar 

  6. Kuo CF, Grainge MJ, Zhang W, Doherty M. Global epidemiology of gout: prevalence, incidence and risk factors. Nat Rev Rheumatol. 2015;11(11):649–62.

    Article  Google Scholar 

  7. Emmerson BT. Identification of the causes of persistent hyperuricaemia. Lancet. 1991;337(8755):1461–3.

    Article  CAS  Google Scholar 

  8. Desai J, Steiger S, Anders HJ. Molecular pathophysiology of gout. Trends Mol Med. 2017;23(8):756–68.

    Article  CAS  Google Scholar 

  9. So AK, Martinon F. Inflammation in gout: mechanisms and therapeutic targets. Nat Rev Rheumatol. 2017;13(11):639–47.

    Article  CAS  Google Scholar 

  10. Tramontini N, Huber C, Liu-Bryan R, Terkeltaub RA, Kilgore KS. Central role of complement membrane attack complex in monosodium urate crystal-induced neutrophilic rabbit knee synovitis. Arthritis Rheum. 2004;50(8):2633–9.

    Article  Google Scholar 

  11. Terkeltaub R. What makes gouty inflammation so variable? BMC Med. 2017;15(1):158.

    Article  Google Scholar 

  12. Neogi T, Jansen TL, Dalbeth N, Fransen J, Schumacher HR, Berendsen D, et al. 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2015;74(10):1789–98.

    Article  CAS  Google Scholar 

  13. Shah K, Spear J, Nathanson LA, McCauley J, Edlow JA. Does the presence of crystal arthritis rule out septic arthritis? J Emerg Med. 2007;32(1):23–6.

    Article  Google Scholar 

  14. Khanna D, Fitzgerald JD, Khanna PP, Bae S, Singh MK, Neogi T, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken). 2012;64(10):1431–46.

    Article  CAS  Google Scholar 

  15. Khanna D, Khanna PP, Fitzgerald JD, Singh MK, Bae S, Neogi T, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 2: therapy and antiinflammatory prophylaxis of acute gouty arthritis. Arthritis Care Res (Hoboken). 2012;64(10):1447–61.

    Article  CAS  Google Scholar 

  16. Choi H, Neogi T, Dalbeth N, Terkeltaubb R. New perspectives in rheumatology: Implications of the Cardiovascular Safety of Febuxostat and Allopurinol in Patients With Gout and Cardiovascular Morbidities Trial and the associated Food and Drug Administration public safety alert. Arthritis Rheumatol. 2018;70(11):1702–1709.

    Article  Google Scholar 

  17. Latourte A, Bardin T, Richette P. Prophylaxis for acute gout flares after initiation of urate-lowering therapy. Rheumatology (Oxford). 2014;53(11):1920–6.

    Article  CAS  Google Scholar 

  18. Neame RL, Carr AJ, Muir K, Doherty M. UK community prevalence of knee chondrocalcinosis: evidence that correlation with osteoarthritis is through a shared association with osteophyte. Ann Rheum Dis. 2003;62(6):513–8.

    Article  CAS  Google Scholar 

  19. Kleiber Balderrama C, Rosenthal AK, Lans D, Singh JA, Bartels CM. Calcium pyrophosphate deposition disease and associated medical comorbidities: a National Cross-Sectional Study of US Veterans. Arthritis Care Res. 2017;69(9):1400–6.

    Article  CAS  Google Scholar 

  20. Williams CJ, Zhang Y, Timms A, Bonavita G, Caeiro F, Broxholme J, et al. Autosomal dominant familial calcium pyrophosphate dihydrate deposition disease is caused by mutation in the transmembrane protein ANKH. Am J Hum Genet. 2002;71(4):985–91.

    Article  Google Scholar 

  21. Rosenthal AK, Ryan LM. Calcium pyrophosphate deposition disease. N Engl J Med. 2016;374(26):2575–84.

    Article  CAS  Google Scholar 

  22. Ea HK, Liote F. Calcium pyrophosphate dihydrate and basic calcium phosphate crystal-induced arthropathies: update on pathogenesis, clinical features, and therapy. Curr Rheumatol Rep. 2004;6(3):221–7.

    Article  Google Scholar 

  23. Zhang W, Doherty M, Bardin T, Barskova V, Guerne PA, Jansen TL, et al. European league against rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann Rheum Dis. 2011;70(4):563–70.

    Article  CAS  Google Scholar 

  24. Grassi W, Okano T, Filippucci E. Use of ultrasound for diagnosis and monitoring of outcomes in crystal arthropathies. Curr Opin Rheumatol. 2015;27(2):147–55.

    Article  Google Scholar 

  25. Andrés M, Sivera F, Pascual E. Therapy for CPPD: options and evidence. Curr Rheumatol Rep. 2018;20(6):31.

    Article  Google Scholar 

  26. Bosworth B. Calcium deposits in the shoulder and subacromial bursitis: a survey of 12,122 shoulders. J Am Med Assoc. 1941;116(22):2477–82.

    Article  Google Scholar 

  27. Clavert P, Sirveaux F. Shoulder calcifying tendinitis. Revue de chirurgie orthopedique et reparatrice de l’appareil moteur 2008;94(8 Suppl):336–55.

    Google Scholar 

  28. Stack J, McCarthy G. Basic calcium phosphate crystals and osteoarthritis pathogenesis: novel pathways and potential targets. Curr Opin Rheumatol. 2016;28(2):122–6.

    Article  CAS  Google Scholar 

  29. Whyte MP. Hypophosphatasia: enzyme replacement therapy brings new opportunities and new challenges. J Bone Miner Res. 2017;32(4):667–75.

    Article  CAS  Google Scholar 

  30. Harvie P, Pollard TC, Carr AJ. Calcific tendinitis: natural history and association with endocrine disorders. J Shoulder Elb Surg. 2007;16(2):169–73.

    Article  Google Scholar 

  31. O’Shea FD, McCarthy GM. Basic calcium phosphate deposition in the joint: a potential therapeutic target in osteoarthritis. Curr Opin Rheumatol. 2004;16(3):273–8.

    Article  Google Scholar 

  32. Ea HK, Liote F. Diagnosis and clinical manifestations of calcium pyrophosphate and basic calcium phosphate crystal deposition diseases. Rheum Dis Clin N Am. 2014;40(2):207–29.

    Article  Google Scholar 

  33. Rosenthal AK. Basic calcium phosphate crystal-associated musculoskeletal syndromes: an update. Curr Opin Rheumatol. 2018;30(2):168–72.

    Article  CAS  Google Scholar 

  34. Lorenz EC, Michet CJ, Milliner DS, Lieske JC. Update on oxalate crystal disease. Curr Rheumatol Rep. 2013;15(7):340.

    Article  Google Scholar 

  35. Hoppe B, Beck BB, Milliner DS. The primary hyperoxalurias. Kidney Int. 2009;75(12):1264–71.

    Article  CAS  Google Scholar 

  36. Asplin JR. The management of patients with enteric hyperoxaluria. Urolithiasis. 2016;44(1):33–43.

    Article  CAS  Google Scholar 

  37. Wise CM, White RE, Agudelo CA. Synovial fluid lipid abnormalities in various disease states: review and classification. Semin Arthritis Rheum. 1987;16(3):222–30.

    Article  CAS  Google Scholar 

  38. Reginato AJ, Schumacher HR, Allan DA, Rabinowitz JL. Acute monoarthritis associated with lipid liquid crystals. Ann Rheum Dis. 1985;44(8):537–43.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Michael H. Pillinger .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Slobodnick, A., Toprover, M., Pillinger, M.H. (2020). Crystal Arthritis. In: Efthimiou, P. (eds) Absolute Rheumatology Review. Springer, Cham. https://doi.org/10.1007/978-3-030-23022-7_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-23022-7_15

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-23021-0

  • Online ISBN: 978-3-030-23022-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics