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Identification of crystals in synovial fluids and joint tissues

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Abstract

The identification of crystals in synovial fluids and joint tissues is the most rapid and accurate method of diagnosing the common forms of crystal-associated arthritis. Although there are numerous methods available for identifying and characterizing crystals in biologic specimens including x-ray crystallography and Fourier transform infrared spectroscopy, in practice, polarizing light microscopy is used almost exclusively for articular crystals. Unfortunately, problems with reliability and reproducibility undercut the usefulness of this simple procedure. This article highlights recent developments in the field and discusses the importance of identifying synovial fluid crystals, proper handling of specimens, and the appropriate use of available technologies for crystal identification.

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References and Recommended Reading

  1. Schumacher HR Jr, Reginato AJ: Atlas of Synovial Fluid Analysis and Crystal Identification. Philadelphia: Lea & Febiger; 1991.

    Google Scholar 

  2. Fam AG: Gout in the elderly. Clinical presentation and treatment. Drugs Aging 1998, 13:229–243.

    Article  PubMed  CAS  Google Scholar 

  3. Ryan LM, McCarty DJ: Calcium pyrophosphate crystal deposition disease, pseudogout and articular chondrocalcinosis. In Arthritis and Allied Conditions, edn 13. Edited by Koopman WJ. Baltimore: Williams &Wilkins 1997, 2103–2126.

    Google Scholar 

  4. Claudepierre P, Rahmouni A, Bergamasco P, et al.: Misleading clinical aspects of hydroxyapatite deposits: a series of 15 cases. J Rheumatol 1997, 24:531–535. A paper demonstrating the importance of detecting basic calcium phosphate crystals in periarthritis.

    PubMed  CAS  Google Scholar 

  5. McGill NW, Swan A, Dieppe PA: Survival of calcium pyrophosphate crystals in stored synovial fluids. Ann Rheum Dis 1991, 50:939–941.

    PubMed  CAS  Google Scholar 

  6. Pascual E, Batlle-Gualda E, Marinez A, et al.: Synovial fluid analysis for diagnosis of intercritical gout. Ann Intern Med 1999, 131:756–759. An excellent paper reinforcing the importance of making a definite diagnosis of gout in patients who are seen after resolution of the acute attack.

    PubMed  CAS  Google Scholar 

  7. Darby AJ, Harness NF, Pritchard MS: Demonstration of urate crystals after formalin fixation. Histopathology 1998, 32:382–383.

    Article  PubMed  CAS  Google Scholar 

  8. Eulderink F, Postma T: Demonstration of urate in formalin fixative as support for the histopathological diagnosis of gout. Histopathology 1997, 30:195.

    Article  PubMed  CAS  Google Scholar 

  9. Mandel NS, Mandel GS: Structures of crystals that provoke inflammation. In Advances in Inflammation Research. Edited by Weissman G. New York: Raven Press; 1982:73–94.

    Google Scholar 

  10. Dieppe P, Swan A: Identification of crystals in synovial fluid. Ann Rheum Dis 1999, 58:261–263. An article summarizing the difficulties with the clinical use of the polarizing light microscope to identify crystals and urging the rheumatology community to address these issues.

    PubMed  CAS  Google Scholar 

  11. Von Essen R, Holtta AM, Pikkarainen R: Quality control of synovial fluid crystal identification. Ann Rheum Dis 1998, 57:107–109. A paper describing the systematic study of the accuracy and reliability of synovial fluid crystal identification in Finland and the discouraging results.

    Google Scholar 

  12. McGill NW, McGill VG: Quality assurance for synovial fluid examination for crystals: an improved method. Ann Rheum Dis 1997, 56:504–506.

    PubMed  CAS  Google Scholar 

  13. Ivorra J, Rosas J, Pascual E: Most calcium pyrophosphate crystals appear as non-birefringent. Ann Rheum Dis 1999, 58:582–584.

    Article  PubMed  CAS  Google Scholar 

  14. Gordon C, Swan A, Dieppe P: Detection of crystals in synovial fluids by light microscopy: sensitivity and reliability. Ann Rheum Dis 1989, 48:737–742.

    Article  PubMed  CAS  Google Scholar 

  15. Halverson PB, Cheung HS, McCarty DJ, et al.: "Milwaukee shoulder"-Association of microspheroids containing hydroxyapatite crystals, active collagenase, and neutral protease with rotator cuff defects. II. Synovial fluid studies. Arthritis Rheum 1981, 24:474–483.

    Article  PubMed  CAS  Google Scholar 

  16. Mandel G, Mandel N: Analysis of stones. In Kidney Stones: Medical and Surgical Management. Edited by Coe FL, Favus MJ, Pak CYC, et al. Philadelphia: Lippincott-Raven; 1986:323–335.

    Google Scholar 

  17. Derfus BA, Kurtin SM, Camacho NP, et al.: Comparison of matrix vesicles derived from normal and osteoarthritic human articular cartilage. Connect Tissue Res 1996, 35:337–342.

    PubMed  CAS  Google Scholar 

  18. Grignon B, Marchal L, Mainard D, et al.: Scanning electron microscopy and microcrystals in articular diseases. Bull Assoc Anat (Nancy) 1993, 77:13–17.

    CAS  Google Scholar 

  19. Blair JM, Sorenson LB, Arnsdorf MF, Lal R: The application of atomic force microscopy for the detection of microcrystals in synovial fluid from patients with recurrent synovitis. Semin Arthritis Rheum 1995, 24:359–369.

    Article  PubMed  CAS  Google Scholar 

  20. Beltran J, Marty-Delfaut E, Bencardino J, et al.: Chondrocalcinosis of the hyaline cartilage of the knee: MRI manifestations. Skeletal Radiol 1998, 27:369–374.

    Article  PubMed  CAS  Google Scholar 

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Rosenthal, A.K., Mandel, N. Identification of crystals in synovial fluids and joint tissues. Curr Rheumatol Rep 3, 11–16 (2001). https://doi.org/10.1007/s11926-001-0045-y

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  • DOI: https://doi.org/10.1007/s11926-001-0045-y

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