Rheumatology International

, Volume 7, Issue 5, pp 217–221 | Cite as

Interaction of polymorphonuclear leukocytes with calcium pyrophosphate dihydrate crystals deposited in chondrocalcinosis cartilage

  • H. Ishikawa
  • Y. Ueba
  • T. Isobe
  • K. Hirohata


Electron microscopy was used to investigate the characteristics of calcium pyrophosphate dihydrate (CPPD) crystals in chondrocalcinosis (pseudogout syndrome). Crystals in midzone cartilage were frequently seen adjacent to chondrocytes. Great variation in crystal size and shape was observed. Most of the pyrophosphate crystals that had been phagocytosed by polymorphonuclear leukocytes of synovial fluid from patients with acute pseudogout were small (≦1 μm), indicating that small crystals can cause intense inflammation. Large numbers of polymorphonuclear leukocytes became attached to the eroded articular surface and phagocytosed microcrystals. Interaction of polymorphonuclear leukocytes with CPPD crystals in the superficial region of articular cartilage may stimulate the release of inflammatory mediators.

Key words

Chondrocalcinosis Calcium pyrophosphate dihydrate crystals Polymorphonuclear leukocyte Articular cartilage Electron microscopy 


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  1. 1.
    McCarty DJ, Hogan JM, Gatter RA (1966) Studies on pathological calcification in human cartilage. Prevalence and types of crystal deposits in menisci of two hundred and fifteen cadavers. J Bone Joint Surg [Am] 48:309–325Google Scholar
  2. 2.
    Ryan LM, Cheung HS, McCarty DJ (1981) Release of pyrophosphate by normal mammalian articular hyaline and fibrocartilage in organ culture. Arthritis Rheum 24:1522–1527Google Scholar
  3. 3.
    Howell DS, Muniz O, Pita JC (1975) Extrusion of pyrophosphate into extracellular media by osteoarthritis cartilage incubates. J Clin Invest 56:1473–1480Google Scholar
  4. 4.
    McCarty DJ (1977) Calcium pyrophosphate dihydrate crystal deposition disease: nomenclature and diagnostic criteria. Ann Int Med 87:240–242Google Scholar
  5. 5.
    McCarty DJ (1984) Crystal deposition disease. In: McCarty DJ (ed) Landmark advances in rheumatology. American Rheumatism Association, Atlanta, pp 74–88Google Scholar
  6. 6.
    Gatter RA (1975) The compensated polarized light microscope in clinical rheumatology. Arthritis Rheum 17:235–255Google Scholar
  7. 7.
    Bjelle A, Crocker P, Willoughby A (1980) Ultra-microcrystals in pyrophosphate arthropathy. Acta Med Scand 207:89–92Google Scholar
  8. 8.
    Kohn NN, Hughes RE, McCarty DJ (1962) The significance of calcium pyrophosphate crystals in the synovial fluid of arthritic patients: the pseudogout syndrome. II. Identification of crystals. Ann Intern Med 56:738–745Google Scholar
  9. 9.
    McCarty DJ (1977) Calcium pyrophosphate dihydrate crystal deposition disease (pseudogout syndrome) — clinical aspect. Clin Rheum Dis 3:61–89Google Scholar
  10. 10.
    Reginato AJ, Schumacher HR, Martinez VA (1974) The articular cartilage in familial chondrocalcinosis and pseudogout. Arthritis Rheum 17:977–992Google Scholar
  11. 11.
    Schumacher HR (1976) Ultrastructural findings in chondrocalcinosis and pseudogout. Arthritis Rheum 19:413–425Google Scholar
  12. 12.
    Lagier R, Boivin G, Gerster J (1985) Carpal tunnel syndrome associated with mixed calcium pyrophosphate dihydrate and apatite crystal deposition in tendon synovial sheath. Arthritis Rheum 27:1190–1195Google Scholar
  13. 13.
    McCarty DJ (1985) Crystal induced inflammation and its treatment. In: Arthritis and allied conditions, 10th edn. Lea and Febiger, Philadelphia, pp 1494–1514Google Scholar
  14. 14.
    Miltrovic DR (1983) Pathology of articular deposition of calcium salts and their relationship to osteoarthritis. Ann Rheum Dis 42:519–526Google Scholar
  15. 15.
    Boivin G, Lagier R (1983) An ultrastructural study of articular chondrocalcinosis in cases of knee osteoarthritis. Virchows Arch 400:13–29Google Scholar
  16. 16.
    Cheung HE, Halverson PB, McCarty DJ (1983) Phagocytosis of hydroxyapatite or calcium pyrophosphate dihydrate crystals by rabbit chondrocytes stimulates release of collagenase, neutral protease and prostagrandins E2 and F2. Proc Soc Exp Biol Med 173:181–189Google Scholar
  17. 17.
    McCarty DJ (1972) Pseudogout. In: Hollander JL, McCarty DJ (eds) Arthritis and allied conditions. Lea and Febiger, Philadelphia, pp 1140–1160Google Scholar
  18. 18.
    Ishikawa H, Smiley JD, Ziff M (1976) Electron microscopic demonstration of immunoglobulin deposition in rheumatoid cartilage. Arthritis Rheum 18:563–576Google Scholar
  19. 19.
    Ugai K, Ishikawa H, Hirohata K (1983) Interaction of polymorphonuclear leukocytes with immune complexes trapped in rheumatoid articular cartilage. Arthritis Rheum 26:1434–1441Google Scholar
  20. 20.
    Weissman G (1977) Lysosomes and rheumatoid inflammation. Arthritis Rheum 20:s193-s204Google Scholar
  21. 21.
    Henson PM (1971) The immunologic release of constituents from neutrophilic leukocytes. I. The role of antibody and complement on non-phagocytable surface or phagocytosable particles. J Immunol 107:1535–1546Google Scholar
  22. 22.
    McCarty DJ (1976) Calcium pyrophosphate dihydrate crystal deposition disease-1975. Arthritis Rheum 19:275–285Google Scholar
  23. 23.
    Howell DS, Muniz O, Pita JC (1976) Pyrophosphate release by osteoarthritis cartilage incubates. Arthritis Rheum 19:488–494Google Scholar
  24. 24.
    Rusell RGG, Biasz S, Fleisch H et al (1970) Inorganic pyrophosphate in plasma, urine, and synovial fluid of patients with pyrophosphate arthropathy (chondrocalcinosis or pseudogout). Lancet II:899–902Google Scholar
  25. 25.
    McCarty DJ, Solomon SD, Warnock ML (1971) Inorganic pyrophosphate concentrations in synovial fluid of arthritis patients. J Lab Clin Med 78:216–229Google Scholar
  26. 26.
    Silcox DC, McCarty DJ (1974) Elevated inorganic pyrophosphate concentration on synovial fluid in osteoarthritis and pseudogout. J Lab Clin Med 83:518–531Google Scholar
  27. 27.
    Camerlain M, McCarty DJ, Silcox DC et al (1975) Inorganic pyrophosphate pool size and turnover rate in arthritis joint. J Clin Invest 55:1373–1381Google Scholar
  28. 28.
    Bennet RM, Lehr JR, McCarty DJ (1976) Crystal shedding and acute pseudogout: a hypothesis based on a therapeutic failure. Arthritis Rheum 19:93–97Google Scholar

Copyright information

© Springer-Verlag 1987

Authors and Affiliations

  • H. Ishikawa
    • 1
  • Y. Ueba
    • 1
  • T. Isobe
    • 1
  • K. Hirohata
    • 2
  1. 1.School of Allied Medical SciencesKobe UniversityKobeJapan
  2. 2.Department of Orthopaedic SurgeryKobe University, School of MedicineKobeJapan

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