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Harrison's Principles of Internal Medicine, 18e
| Part 15. Disorders of the Joints and Adjacent Tissues > Section 3. Disorders of the Joints and Adjacent Tissues > |
Chapter 333. Gout and Other Crystal-Associated Arthropathies
Sections: Gout and Other Crystal-Associated Arthropathies: Introduction, Gout, CPPD Deposition Disease, Calcium Apatite Deposition Disease, CaOx Deposition Disease, Acknowledgment, Further Readings.
Topics Discussed: crystal arthropathy; gout.
Excerpt:"The use of polarizing light microscopy during synovial fluid analysis in 1961 by McCarty and Hollander and the subsequent application of other crystallographic techniques, such as electron microscopy, energy-dispersive elemental analysis, and x-ray diffraction, have allowed investigators to identify the roles of different microcrystals, including monosodium urate (MSU), calcium pyrophosphate dihydrate (CPPD), calcium apatite (apatite), and calcium oxalate (CaOx), in inducing acute or chronic arthritis or periarthritis. The clinical events that result from deposition of MSU, CPPD, apatite, and CaOx have many similarities but also have important differences. Before the use of crystallographic techniques in rheumatology, much of what was considered to be gouty arthritis in fact was not. Because of often similar clinical presentations, the need to perform synovial fluid analysis to distinguish the type of crystal involved must be emphasized. Polarized light microscopy alone can identify most typical crystals; apatite, however, is an exception. Aspiration and analysis of effusions are also important to assess the possibility of infection. Apart from the identification of specific microcrystalline materials or organisms, synovial fluid characteristics in crystal-associated diseases are nonspecific,..."
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