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Crystal-Induced Arthritis

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Rheumatology for Primary Care Providers

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Abstract

Acute painful and swollen joints are a common complaint encountered by primary care physicians, hospitalists, orthopedic surgeons, and rheumatologists. Crystal-induced arthritis remains a common cause of monoarthritis, oligoarthritis, and polyarthritis. Gouty arthritis was one of the first crystal diseases to be recognized and described as a clinical entity. The earliest descriptions of podagra (acute gout in the first metatarsophalangeal joint) date back to 2640 B.C., and Hippocrates later described it as “the unwalkable disease” (Nugi, Simkin, A concise history of gout and hyperuricemia and their treatment. Arthritis Res TherArthritis Res Ther 8:S1–S5, 2006). History has made the association of an intemperate lifestyle with the development of gout, giving it the distinction as the “arthritis of the rich.” Centuries have passed, and modern medicine has delineated the biochemical pathways that lead to the formation of monosodium urate (MSU) crystals in the pathogenesis of gout and the discovery of other crystal-induced arthropathies such as “pseudogout” by McCarthy in the 1960s and other types of crystal-induced arthritis. Despite these changes, crystal diseases persist, in part based on inappropriate diagnosis, inadequate use of available medications, and poor follow-up of patients, transforming these arthropathies into a chronic and painful “unwalkable disease.” This concept further identifies similar clinical presentations of crystal-induced arthropathies and the need for diagnostic arthrocentesis and examination of the synovial fluid (SF) under compensated polarized light microscopy to identify MSU and CPP (calcium pyrophosphate dihydrate) crystals from other type(s) of crystals and institute proper therapeutic management of crystal-induced arthritis. The chapter summarizes the clinical features, natural history, and treatment of crystal-induced arthritis, and common clinical problems encountered by the primary care physician in the management of these arthropathies.

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Authors and Affiliations

  1. Division of Rheumatology, Roger William Medical Center, Brown University Alpert Medical School and Rhode Island Hospital, Providence, RI, USA

    Lewena Maher

  2. Department of Medicine, Brown University Alpert Medical School and Rhode Island Hospital, Providence, RI, USA

    John E. Oghene

  3. Division of Rheumatology, Brown University Alpert Medical School and Rhode Island Hospital, Providence, RI, USA

    Anthony M. Reginato

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  1. Lewena Maher
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  2. John E. Oghene
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  3. Anthony M. Reginato
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Correspondence to Anthony M. Reginato .

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Editors and Affiliations

  1. Mount Sinai Hospital, New York, NY, USA

    Yousaf Ali

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Maher, L., Oghene, J.E., Reginato, A.M. (2022). Crystal-Induced Arthritis. In: Ali, Y. (eds) Rheumatology for Primary Care Providers. Springer, Cham. https://doi.org/10.1007/978-3-030-80699-6_7

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