pyrophosphate and Arthritis

Once thought of as a biosynthetic waste product, over the last 2 decades PPi has become understood as an entity with a variety of biologic roles (see Table 1). Documented roles include participation in intracellular Ca++ traffic, mediation of nucleotide and iron transport, storage of molecules in cellular granules, modification of enzyme function, and modulation of mineralization. Much has been established regarding plasma, urine, and synovial fluid levels (see Fig. 1) and urinary excretion in health and disease. Derangements in intracellular PPi content of skin fibroblasts have been noted in patients with CPPD deposition arthropathy (see Table 2). Mechanisms by which elevated PPi concentration develops in synovial fluid from joints with CPPD deposition and related arthropathies have come under scrutiny. The chondrocyte is now recognized as the probable cellular source of intra-articular extracellular PPi (see Figs. 3 and 4). Special attention has been focused on two basic pathways by which chondrocytes could generate extracellular PPi (see Fig. 2). In the first mechanism, chondrocytes demonstrate a set of ectoenzymes which could work in concert to directly produce extracellular PPi. The second pathway involves the major reactions by which PPi is formed within the cell and how intracellular PPi thus formed could be transported into the extracellular space. Much future research is needed regarding these two pathways and their relative importance in the pathogenesis of CPPD crystal deposition and related arthropathies.

Topics: Animals; Arthritis; Calcium Pyrophosphate; Cartilage, Articular; Diphosphates; Extracellular Space; Fibroblasts; Humans; Synovial Fluid

CPPD deposition occurs in a wide variety of clinical settings, most commonly as an age-related phenomenon in the absence of other joint abnormality. Although our knowledge of CPPD and other intra-articular particles has increased in the last decade, the role of CPPD remains unclear. The paradox of asymptomatic deposition of phlogistic crystals, the wide spectrum of clinical presentation, and the lack of disease specificity, however, have challenged recognition of pyrophosphate arthropathy (PA) as a separate, distinct disease entity and led to reappraisal of earlier concepts of crystal deposition disease. In this article, clinical aspects of PA will first be presented; the validity of PA as a discrete arthropathy will then be discussed.

Topics: Arthritis; Calcinosis; Calcium Pyrophosphate; Chondrocalcinosis; Crystallization; Diphosphates; Humans; Joint Diseases

Varying combinations of acute inflammatory and/or chronic degenerative arthritis have been found to be associated with crystals of calcium pyrophosphate dihydrate (CPPD) and/or basic calcium phosphates (BCPs). Since the arthropathies associated with CPPDs and/or BCPs occur in older individuals, while diagnosis and treatment for monosodium urate monohydrate crystal deposition disease (gout) have become extremely precise and effective, joint problems associated with calcium crystals have become more common than those associated with monosodium urate monohydrate crystals. The classification, pathogenesis, clinical manifestations, and treatment of CPPD and BCP crystal deposition are discussed.

Topics: Aged; Anti-Inflammatory Agents; Arthritis; Calcium Phosphates; Calcium Pyrophosphate; Colchicine; Crystallization; Diphosphates; Female; Humans; Hyperplasia; Inflammation; Joint Diseases; Methods; Peptide Hydrolases; Radiography; Shoulder Joint; Syndrome; Synovial Membrane

Topics: Aged; Arthritis; Bone and Bones; Calcium Pyrophosphate; Chondrocalcinosis; Crystallization; Diphosphates; Durapatite; Female; Gout; Humans; Hydroxyapatites; Male; Osteoarthritis

Topics: Aged; Arthritis; Arthritis, Rheumatoid; Calcium Pyrophosphate; Chondrocalcinosis; Crystallization; Diagnosis, Differential; Diphosphates; Humans; Knee Joint; Middle Aged

Topics: Adult; Aged; Arthritis; Calcinosis; Diphosphates; Female; Gout; Humans; Joint Diseases; Male; Middle Aged; Phagocytosis; Synovial Fluid; Synovitis; Terminology as Topic; Uric Acid

Topics: Arthritis; Calcinosis; Calcium; Cartilage, Articular; Chemical Phenomena; Chemistry; Chondrocalcinosis; Diagnosis, Differential; Diphosphates; Geriatrics; Gout; Humans; Joint Diseases; Radiography; X-Ray Diffraction

Fifteen patients with bilateral, symmetrical, chronic pyrophosphate arthropathy of the knee were given intra-articular injections of yttrium-90 (5 mCi) plus steroid (triamcinolone hexacetonide, 20 mg) into one knee, and saline plus steroid into the other (control) knee. Allocation of the 90Y injection was random and double blind. After 6 months there was significantly less pain, inactivity stiffness, joint-line tenderness, and effusion in the 90Y-injected knees than in the controls (p less than 0.01). There were also significant differences between 90Y-injected and control knees in the changes in range of movement (p less than 0.01) and joint circumference (p less than 0.05) caused partly by progression of disease in the control knees. No significant differences in joint deformity, instability, X-ray appearance, or synovial-fluid analysis were seen. In all cases patient and observer assessment favoured the treated side (p less than 0.01). These findings indicate that intra-articular 90Y may be of benefit in chronic pyrophosphate arthropathy, a disease for which there is no treatment. The predilection of this condition to affect the knees of the elderly makes such treatment highly suitable because the joint lends itself readily to injection and the procedure carries very few actual or potential risks in this age group.

Topics: Aged; Arthritis; Chronic Disease; Clinical Trials as Topic; Diphosphates; Double-Blind Method; Female; Humans; Injections, Intra-Articular; Knee; Male; Middle Aged; Random Allocation; Triamcinolone Acetonide; Yttrium Radioisotopes

Direct selective and sensitive sensing of pyrophosphate ion (PPi) in synovial fluid of arthritis patients is of great importance because of its crucial roles in the diagnosis and therapy of arthritic diseases. In this study, we demonstrate a sensitive and selective method for PPi sensing in synovial fluid of arthritis patients with gold nanoparticles (Au-NPs) as the signal readout based on the competitive coordination chemistry of Cu(2+) between cysteine and PPi. Initially, Au-NPs stabilized with cysteine are red in color and exhibit absorption at 519 nm in the UV-vis spectrum. The addition of an aqueous solution of Cu(2+) to the Au-NPs dispersion containing cysteine causes the aggregation of Au-NPs, resulting in the wine red-to-blue color change and the appearance of a new absorption at 650 nm in the UV-vis spectrum of the Au-NPs dispersion. The subsequent addition of PPi to the Au-NPs aggregation well solubilizes the aggregated Au-NPs with the changes in both the color and the UV-vis spectrum of the Au-NPs dispersion. These changes are ascribed to the higher coordination reactivity between Cu(2+) and PPi than that between Cu(2+) and cysteine. On the basis of this, the concentration of PPi can be visualized with the naked eyes through the blue-to-wine red color change of the Au-NPs dispersion and quantitatively determined by UV-vis spectroscopy. Under the optimized conditions, the ratio of the absorbance at 650 nm (A(650)) to that at 519 nm (A(519)) shows a linear relationship with PPi concentration within a concentration range from 130 nM to 1.3 mM. The method demonstrated here is highly sensitive, free from the interference from other species in the synovial fluid, and is thus particularly useful for fast and simple clinic diagnosis of arthritic diseases.

Topics: Arthritis; Copper; Cysteine; Diphosphates; Gold; Humans; Ions; Metal Nanoparticles; Spectrophotometry, Ultraviolet; Synovial Fluid

We describe the pattern of early childhood seizures within a family with autosomal dominant chondrocalcinosis (CCAL, which causes adult-onset arthritis). All affected family members with CCAL experienced seizures in early childhood, usually, but not always, associated with fever. Similarities exist to the syndrome of generalized epilepsy with febrile seizures plus (GEFS+). A mutation within the ANKH gene on chromosome 5p has been found previously in this family; other patients with familial CCAL (but without seizures) have mutations in the same gene. ANKH codes for a transmembrane protein involved in the regulation of extracellular pyrophosphate ion levels, although its precise mechanism of action remains unclear. It is highly expressed in the brain, and its expression may be influenced by seizure activity. The mutation within this family creates a premature initiation codon, adding four amino acids to the N-terminus of the protein. We postulate that this may lead to a gain of function, causing seizure susceptibility as well as chondrocalcinosis. Mutations within this gene may underlie other forms of genetic epilepsy and febrile seizures.

Topics: Arthritis; Child, Preschool; Chondrocalcinosis; Codon, Initiator; Diphosphates; Epilepsy, Generalized; Female; Gene Expression; Genetic Predisposition to Disease; Humans; Infant; Male; Membrane Proteins; Mutation; Pedigree; Phosphate Transport Proteins; Seizures; Seizures, Febrile

Mutation at the mouse progressive ankylosis (ank) locus causes a generalized, progressive form of arthritis accompanied by mineral deposition, formation of bony outgrowths, and joint destruction. Here, we show that the ank locus encodes a multipass transmembrane protein (ANK) that is expressed in joints and other tissues and controls pyrophosphate levels in cultured cells. A highly conserved gene is present in humans and other vertebrates. These results identify ANK-mediated control of pyrophosphate levels as a possible mechanism regulating tissue calcification and susceptibility to arthritis in higher animals.

Topics: Animals; Arthritis; Base Sequence; Biological Transport; Calcinosis; Chromosome Mapping; Cloning, Molecular; COS Cells; Diphosphates; DNA; Durapatite; Gene Expression; Genetic Complementation Test; Humans; Membrane Proteins; Mice; Mice, Transgenic; Molecular Sequence Data; Mutation; Phenotype; Phosphate Transport Proteins; Physical Chromosome Mapping; Sequence Homology, Nucleic Acid; Tissue Distribution

A new study on page 265 of this issue suggests that a genetic defect in mice causes the joint's cartilage cells to pump insufficient amounts of pyrophosphate--a natural water softener--into the joint cleft, and this in turn leads to the formation of bony spurs that eventually stiffen the joints completely. Because humans have an almost identical gene, and disorders such as osteoarthritis also feature an abnormal outgrowth of bones, some arthritis researchers are hopeful that these new findings may point the way toward a new class of pyrophosphate-based drugs similar to the antiscaling chemicals in washing powders and toothpaste. But, as many of the researchers point out, the numerous roads that lead to human joint degradation make a single cure-all unlikely.

Topics: Animals; Arthritis; Cartilage; Diphosphates; Humans; Joints; Membrane Proteins; Mice; Mice, Mutant Strains; Mutation; Osteoarthritis; Phosphate Transport Proteins

In order to evaluate the effect of calcium pyrophosphate dihydrate (CPPD) deposition on articular cartilage catabolism, the proteoglycans released into normal synovial fluid were compared with those in synovial fluid obtained from patients with osteoarthritis (OA), chronic pyrophosphate arthropathy (CPA) and acute pyrophosphate arthropathy (APA). Keratan sulphate (KS) was measured by the modified 1,9-dimethylmethylene blue (DMB) assay in synovial fluids treated with chondroitin ABC lyase. This enzyme was found to eliminate all of the sulphated glycosaminoglycans in synovial fluid except KS. In OA, CPA and APA the concentrations of KS were found to be significantly higher than in normal synovial fluid (NSF) (P less than 0.01). Similar KS concentrations were observed in CPA and APA. In CPA they were significantly higher than in OA (P less than 0.02). The size distribution of proteoglycan fragments varied between different patients with the same disease, but only minor differences were observed in patients with OA and CPA who were matched for age, sex and disease severity. Furthermore, the size distribution of proteoglycan fragments in the acute and chronic phases of pyrophosphate arthritis was similar. Thus although in pyrophosphate arthritis the rate at which proteoglycans are released from the cartilage may be greater than in OA or normal joints, the fundamental processes governing the release of these macromolecules may be the same.

Topics: Adult; Aged; Aged, 80 and over; Arthritis; Calcium Pyrophosphate; Chromatography, Gel; Diphosphates; Female; Humans; Keratan Sulfate; Male; Middle Aged; Osteoarthritis; Proteoglycans; Synovial Fluid

Deposition of intra-articular calcium pyrophosphate is associated with both aging and arthropathy; increased concentrations of free pyrophosphate (PPi) may contribute to such deposition. Free pyrophosphate and nucleoside triphosphate pyrophosphatase (NTPase) were estimated in synovial fluids from 50 subjects with normal knees and from 44 patients with rheumatoid arthritis, 61 with pyrophosphate arthropathy, and 59 with osteoarthritis. For arthropathic knees clinically assessed inflammation was classified as active or inactive using a summated score of six clinical features. The order of PPi (mumol/l) and NTPase (mumol PPi/30 min/mg protein) was pyrophosphate arthropathy greater than osteoarthritis greater than rheumatoid arthritis (median PPi, NTPase respectively: for pyrophosphate arthropathy 15.9, 0.45; for osteoarthritis 9.3, 0.25; for rheumatoid arthritis 4.4, 0.18), with significant differences between all groups. In pyrophosphate arthropathy both PPi (mumol/l) and NTPase (mumol PPi/30 min/mg protein) were higher than normal (15.9, 0.45 v 8.6, 0.2 respectively), but findings in osteoarthritis did not differ from normal. The inflammatory state of the knee had a distinct but variable effect on synovial fluid findings in rheumatoid arthritis and pyrophosphate arthropathy, but not in osteoarthritis. There was no correlation of either PPi or NTPase with age, or between PPi and NTPase in any group. This study provides in vivo data for synovial fluid PPi and NTPase. It suggests that factors other than PPi need to be considered in a study of crystal associated arthropathy. Clinical inflammation, as well as diagnosis, is important in synovial fluid studies.

Topics: Adult; Aged; Aged, 80 and over; Arthritis; Arthritis, Rheumatoid; Calcium Pyrophosphate; Diphosphates; Female; Humans; Joint Diseases; Knee Joint; Male; Middle Aged; Osteoarthritis; Pyrophosphatases; Synovial Fluid

Three thousand synovial fluids (1312 patients: chronic pyrophosphate arthropathy (CPA), 41%; osteoarthritis (OA), 12%; rheumatoid arthritis (RA), 16%) were examined for crystals, including calcium pyrophosphate dihydrate (CPPD), by polarized microscopy (score 0-3); calcific particles, by alizarin red positivity (ARP; 0-3); and total cell count. For 1150 fluids, local joint inflammation was assessed as 'active' or 'inactive' using a summated score of six clinical variables. CPPD and ARP scores did not correlate, but each showed positive correlation with age (P less than 0.01, P less than 0.02 respectively). Pseudogout had the highest mean CPPD score (P less than 0.001); intermittent CPPD positivity (range 8-100%) was seen in serially aspirated CPA joints, and there was no difference in CPPD positivity or score between active and inactive CPA. ARP was most frequent in OA subsets (72% of CPA, 46% of OA, 31% of RA; P less than 0.001). ARP was more frequent in active than inactive OA (P less than 0.05) but showed no association with inflammation in CPA or RA. Cell counts were higher in RA and pseudogout compared to OA and CPA, and in active compared to inactive RA. No correlation was found between ARP or CPPD scores and cell count. Cholesterol crystals were uncommon (0.2%) and showed no disease or joint predilection. In arthritic joints, CPPD and calcific particles particularly associate with the OA process and ageing. CPPD may contribute to acute and other calcific particles to chronic inflammation in OA.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anthraquinones; Arthritis; Arthritis, Rheumatoid; Calcium Pyrophosphate; Child; Chondrocalcinosis; Coloring Agents; Crystallography; Diphosphates; Female; Humans; Male; Middle Aged; Osteoarthritis; Synovial Fluid

Topics: Arthritis; Calcium Phosphates; Calcium Pyrophosphate; Diphosphates; Humans; Osteoarthritis; Synovial Fluid

We studied the effects of joint movement and immobilization on acute and chronic calcium pyrophosphate dihydrate (CPPD) crystal induced arthritis in lapine knee joints. Exercised CPPD injected joints, in both acute (single 10 mg CPPD intraarticular (IA), duration: 5 h) and chronic (repeated 10 mg CPPD IA, duration: 20 and 42 days) experiments, demonstrated a more intense histologic synovitis compared to cast immobilized knees (p = 0.0001). In chronic experiments, both CPPD injected and noninjected immobilized knees showed greater cartilage histopathologic-histochemical abnormalities (p less than 0.004) and significant reduction in cartilage hexosamine content (p less than 0.005), compared to exercised joints. CPPD injected knees, both exercised and immobilized, demonstrated an initial phase of increased cartilage biosynthetic activity (35S incorporation) at 20 days, compared to noninjected knees (p = 0.02), followed by a decline at 42 days (p less than 0.005). Our data indicate that joint movement enhances acute and chronic experimental CPPD crystal induced synovitis. Articular cartilage is more adversely affected by joint immobilization than by chronic crystalline inflammation. An optimum balance between exercise and rest seems necessary for patients with arthritis so that cartilage can be preserved but pain from active inflammation also controlled.

Topics: Animals; Arthritis; Calcium Pyrophosphate; Cartilage, Articular; Crystallization; Diphosphates; Histocytochemistry; Immobilization; Joints; Male; Rabbits; Synovial Fluid; Synovial Membrane; Time Factors

The authors presented the results of clinical, x-ray and osteoscintigraphic investigations of 133 psoriatic arthritis patients and 72 patients with common psoriasis. Osteoscintigraphy was performed using a routine method with 99mTc-pyrophos (USSR) and 99mTc-phosphone (Hungary) on gamma-camera LFOV (Nuclear-Chicago, USA). X-ray signs of the involvement of the osteoarticular system were noted in 69 (51%) patients with psoriatic arthritis and in 16 (22%) patients with common psoriasis. The method permitted the detection of the foci of RP hyperfixation in 129 (97%) patients with psoriatic arthritis and in 51 (70.8%) patients with common psoriasis. They were observed mostly in large and small limb joints, less frequently--in the vertebral column, cranial bones, thorax, and ribs. Thus, osteoscintigraphy is a highly sensitive method for the detection of active inflammatory foci of the osteoarticular system in psoriasis at all stages of arthritis development. It makes it possible to detect the spreading of arthritis and its preclinical forms.

Topics: Arthritis; Bone and Bones; Chronic Disease; Diphosphates; Evaluation Studies as Topic; Humans; Psoriasis; Radiography; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Authors describe the case of a 43 years old male patient with complaints and restriction of motions since years, localized on the talocrural joint. In the background of the disease, responding inadequately to the therapy, calcium pyrophosphate depositions were found in the joint tissues. As the pathomechanism of the disease is even presently not cleared authors summarize our present knowledge referring to this problem.

Topics: Adult; Ankle Joint; Arthritis; Calcium Pyrophosphate; Chondrocalcinosis; Diphosphates; Humans; Male; Synovial Fluid

C3 degradation products (C3dg/d) were estimated in 288 synovial fluid (SF) samples (rheumatoid arthritis (RA) 93, osteoarthritis (OA) 68, chronic pyrophosphate arthropathy 80, acute pseudogout 20, others 27) from knees of 138 patients (bilateral 67, serial sampling on two to six occasions 40). At each aspiration knees were defined as 'active' or 'inactive' by single observer global assessment using six clinical parameters of inflammation. Lack of correlation between paired SF and plasma C3dg/d implied local C3 activation within joints. Raised SF C3d levels were found in active compared with inactive RA joints (mean (range) 51 (15-105) and 6 (0-15) units/ml respectively). Low SF C3dg/d levels were found in OA (mean (range) 0.8 (0-7) units/ml) and chronic pyrophosphate arthropathy (mean (range) 4 (0-16) units/ml), irrespective of clinical activity. In contrast, very high levels (mean (range) 61 (16-126) units/ml) were present in all cases of pseudogout. These differences remained after correction for SF C3 or albumin. This study is the first to show a positive correlation between SF C3dg/d and local inflammation in RA joints. It further suggests that C3 activation is a constant feature of pseudogout but not an accompaniment of inflammation associated with chronic crystal associated synovitis or OA.

Topics: Adult; Aged; Aged, 80 and over; Arthritis; Arthritis, Rheumatoid; Chondrocalcinosis; Complement C3; Complement C3b; Complement C3d; Diphosphates; Female; Gout; Humans; Knee Joint; Male; Middle Aged; Osteoarthritis; Peptide Fragments; Synovial Fluid

We studied synovial fluid (SF) collagenase in 10 women with severe rheumatoid arthritis (RA), 10 with pyrophosphate arthropathy, and 10 with idiopathic destructive disease of the shoulder conforming to a pattern recently described. SF cell counts were highest in the RA group. Particles were detected by polarized light microscopy and alizarin red staining. Crystals were seen in fluids from all 3 groups; pyrophosphate predominated in the pyrophosphate arthropathy group and alizarin red-positive particles in the idiopathic disease group. Collagenase and tissue inhibitor of metalloproteinase levels were estimated in SF after gel filtration. Tissue inhibitor of metalloproteinase activity was detected in all fluids, but tended to be highest in the RA group. Collagenase activity was detected in 3 RA fluids only. In no sample was collagenase found in an active form. These findings support the clinical concept of an aggressive destructive process which sometimes occurs in the shoulder joints of elderly women. Because we were not able to detect free collagenase in SF from any of the patients with idiopathic shoulder disease, the data suggest that high levels of active collagenase are not characteristic of this group of patients.

Topics: Apatites; Arthritis; Arthritis, Rheumatoid; Crystallization; Diphosphates; Enzyme Inhibitors; Female; Humans; Microbial Collagenase; Radiography; Shoulder Joint; Synovial Fluid; Tissue Inhibitor of Metalloproteinases

Topics: Arthritis; Diphosphates; Humans; Joints; Psoriasis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Arthritis; Diphosphates; Humans; Joints; Psoriasis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Technetium Tc 99m Pyrophosphate

A 49 year old man is described with a polyarticular arthritis. Synovial fluid aspirated from the knee joint showed monosodium urate monohydrate and calcium pyrophosphate dihydrate by polarised light microscopy. Additionally, diphosphonate binding and scanning electron microscopy with energy dispersive analysis showed that basic calcium phosphate crystals were also present. This appears to be the first report of three crystals occurring simultaneously in a single joint.

Topics: Arthritis; Calcium Phosphates; Calcium Pyrophosphate; Crystallization; Diphosphates; Humans; Knee Joint; Male; Middle Aged; Uric Acid

In a series of 28 long-term dialysis patients with musculoskeletal complaints, the radiologic findings in six cases resembled those occurring in the arthropathy of idiopathic calcium pyrophosphate dihydrate deposition (CPPD) disease. These findings included osteophytes, subchondral cysts, and cartilage loss in the metacarpophalangeal joints, patellofemoral joints, wrists, and shoulders. Chondrocalcinosis was present in three of the six cases. There were no significant differences in renal function or levels of serum calcium, phosphorus, iron, ferritin, aluminum, or parathormone between these patients and a control group matched for sex and age. Long-term dialysis may be associated with a metabolic arthritis similar to the arthritis which occurs in CPPD deposition disease. The etiology may include deposition of CPPD crystals, hydroxyapatite, or other calcium-containing substances in joints, or it may be related to a number of dialysis-induced metabolic abnormalities.

Topics: Arthritis; Arthrography; Calcinosis; Calcium Pyrophosphate; Cartilage, Articular; Cysts; Diphosphates; Hemochromatosis; Humans; Hyperparathyroidism, Secondary; Iron; Kidney Failure, Chronic; Renal Dialysis

Six women and three males, who initially had seronegative monarticular arthritis of the manubriosternal joint (MSJ) were followed for a mean period of 7.1 years (range 0.8-17 years). Rather severe, progressive disease occurred in five patients, three of whom had pustulosis palmoplantaris (PPP) and one acne vulgaris. The course was milder in four patients who had either psoriasis vulgaris, psoriasis in the family or HLA-B27, and the disease remained localized to the MSJ in these patients. None of the patients developed sacroiliitis or peripheral erosive joint changes, but one patient with PPP developed paravertebral ossification.

Topics: Adult; Arthritis; Diphosphates; Female; Follow-Up Studies; Humans; Male; Manubrium; Middle Aged; Radiography; Radionuclide Imaging; Skin Diseases; Sternum; Technetium; Technetium Tc 99m Pyrophosphate

The polyetiology, the discrepancies in the initial manifestations, polymorphism in the course and the possibility of the ephemerality or absence of ocular, uro-genital and skin-mucosal manifestations create jointly the preconditions for a frequent diagnostic error in Reiter syndrome. The study confirmed the thesis that the diagnostic characteristics including the articular symptomatics are among the most striking ones. Synovial-arthritis and the involvement of the soft tissues are accompanied by disorders in the immune system with increased number of early T-lymphocytes, of Fc Gd and complement (C3b)-receptor lymphocytes and of spontaneously blast-transformed cells. The rheumatological process is characterized by proportionately accumulation of 99m Tc-pertechnetate and 99m Tc-pyrophosphate in the affected articular structures, with asymmetry of affection, with predilection and maximal capture of the radiopharmaceutical in the feet. The radioisotope information is on scanty alterations in the spine and sacroiliac joints. The complex study facilitates the timely diagnosis of the disease.

Topics: Adolescent; Adult; Arthritis; Arthritis, Reactive; Arthrography; Diphosphates; Female; Humans; Immunologic Tests; Male; Sodium Pertechnetate Tc 99m; Technetium; Technetium Tc 99m Pyrophosphate

A juxtaposition between the clinical-laboratory, immunologic and radionucleotide articular parameters was performed in 50 patients with psoriatic arthropathy, distributed according to the incidence of X-ray manifestations. The late and moderate changes in ESK, leukocytes, fibrinogen, DPA and phosphatasemia do not characterize the severity of the disease. A tendency to hyperuricemia and hypercalcemia is established in the period of arthralgia before the X-ray image for bone-tissue damage. The genetic HLA-B27 predetermination plays a certain role for the more frequent involvement of the spine and sacroiliac joints in the pathological process. The disturbances in the immune system are manifested with increased number of early T-lymphocytes, FcG-receptor lymphocytes, complement (C3b)--receptor lymphocytes and spontaneously blast-transformed cells. The increasing IgG content correlates with the accumulation of macromorphological X-ray images and with the index of mineral metabolism from the articular study with 99MTc-pyrophosphate. The changes in the pertechnetium index for articular vascularization are quantitatively insignificant and do not allow the joining of the psoriatic arthropathy to the group of primary synoviarthritis. The accumulation of technetium pyrophosphate in the articular structures is asymmetric, focal and precedes the changes in the X-ray image.

Topics: Adult; Alkaline Phosphatase; Arthritis; Blood Proteins; Blood Sedimentation; Calcium; Diphosphates; Female; Fibrinogen; Humans; Leukocyte Count; Male; Middle Aged; Psoriasis; Sodium Pertechnetate Tc 99m; T-Lymphocytes; Technetium; Technetium Tc 99m Pyrophosphate; Uric Acid

Topics: Arthritis; Calcium Pyrophosphate; Diphosphates; Electron Probe Microanalysis; Humans; Male; Microscopy, Electron; Middle Aged; Monocytes; Neutrophils; Synovial Fluid

Synovial fluid from 16 normal subjects was compared with that from 149 patients with a variety of rheumatic disorders. Normal fluid had fewer cells and a lower content of beta-glucuronidase than osteoarthritic samples. Particles, including occasional birefringent crystals, were seen in normal fluids as well as pathological samples. Alizarin red staining particles (presumed to contain apatite) were seen in all diagnostic groups; their numbers showed some correlation with radiological calcification in and around the joints and with a hypertrophic subchondral bone response. Lactate levels were highest in septic arthritis. No assay showed disease specificity.

Topics: Adult; Anthraquinones; Arthritis; Arthritis, Infectious; Arthritis, Rheumatoid; Cell Count; Diphosphates; Female; Glucuronidase; Humans; Knee Joint; Male; Microscopy, Polarization; Middle Aged; Osteoarthritis; Physical Exertion; Radiography; Staining and Labeling; Synovial Fluid; Viscosity

The paper is concerned with some comparative data on the frequency of the detection of sacroileitis using clinicoroentgenological and scintigraphic studies in 57 patients with chronic monarthritis of the knee joint of different genesis. On clinical examination 14 patients (24.7%) only had indirect signs of the affected sacroiliac joints, in 30 patients (52.6%) sacroileitis was diagnosed by x-ray. Scintigraphy with 99mTc-pyrophosphate proved to be most effective for the detection of early signs of sacroileitis because lesions in the sacroiliac joints were found in 35 patients (61.4%).

Topics: Adolescent; Adult; Arthritis; Diphosphates; Female; Humans; Male; Middle Aged; Radiography; Radionuclide Imaging; Sacroiliac Joint; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Adult; Aged; Arthritis; Diphosphates; Female; Humans; Male; Middle Aged; Psoriasis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

A model for the deposition of calcium pyrophosphate dihydrate (CPPD) crystals in cartilage observed in human CPPD crystal deposition disease has been developed using diffusion of calcium and pyrophosphate ions through a denatured collagen matrix environment at physiologic pH. This model system uses biological grade gelatin and has allowed for the study of crystal deposition over a wide range of calcium and pyrophosphate concentrations, including physiologic levels. The model has reproducibly formed the two crystallographic dimorphs observed clinically: triclinic and monoclinic calcium pyrophosphate dihydrate. In addition, amorphous calcium pyrophosphate has been identified, and is the first species to form in the crystallization process and transforms to orthorhombic calcium pyrophosphate tetrahydrate. This in turn dissolves with a very localized increase in available pyrophosphate leading to the formation of triclinic and monoclinic calcium pyrophosphate dihydrate. The denatured collagen matrix has allowed for the formation of the two in vivo crystals at pyrophosphate concentrations lower than previously reported in solution studies.

Topics: Arthritis; Calcium Pyrophosphate; Collagen; Crystallization; Diphosphates; Humans; Hydrogen-Ion Concentration; In Vitro Techniques; Microscopy, Electron, Scanning; Models, Biological

Five elderly patients with chronic pyrophosphate arthropathy developed stress fractures of the tibia. All patients had deformed, painful knees with the result that their increasing symptoms were not readily attributed to a stress fracture. Such a possibility should be considered in patients with chronic pyrophosphate arthropathy since early recognition makes management of the stress fracture easier.

Topics: Aged; Arthritis; Calcium Pyrophosphate; Cartilage, Articular; Diphosphates; Female; Fractures, Spontaneous; Humans; Knee Joint; Radiography; Tibia; Tibial Fractures

Radionuclide joint imaging with the technetium-99m-labeled phosphates is a sensitive technique for the detection of inflammatory articular disease, although it is nonspecific as to the cause of the increased uptake and offers poor resolution in comparison to conventional radiography. There does not appear to be any place for the routine use of joint imaging of the peripheral joints, as there is little evidence that it benefits patient management. Scintigraphy is of benefit in the detection of osteomyelitis, Legg-Perthes' disease, and osteonecrosis, where changes may antedate roentgenologic abnormalities. Technetium-99m-phosphates may have an increasing role in the evaluation of knee and hip prosthetic joint loosening and infection, especially regarding the femoral components. Scintigraphy may be useful in excluding synovitis and allaying concern in selected patients with chronic articular pain in whom a conventional diagnostic evaluation is unrewarding. Attempts have been made to use radionuclide joint imaging to quantitate the degree of synovitis present in individual joints, particularly the sacroiliac joints. To date, reliable methods that distinguish normal from abnormal joints have not been established, although this remains an area of potential usefulness and active research. Scintigraphy with 99mTc-phosphates is useful in the detection of spinal fracture and pseudoarthrosis in individuals with ankylosing spondylitis.

Topics: Adult; Arthritis; Bone Neoplasms; Child; Diphosphates; Diphosphonates; Female; Gallium Radioisotopes; Humans; Joint Diseases; Legg-Calve-Perthes Disease; Male; Middle Aged; Osteoarthritis; Osteomyelitis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Spondylitis, Ankylosing; Synovitis; Technetium; Technetium Compounds; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

Topics: Aged; Arthritis; Calcium Pyrophosphate; Chondrocalcinosis; Crystallization; Diagnosis, Differential; Diphosphates; Female; Humans; Radiography

A clinical and radiographic survey of 110 members of 2 families with hereditary pyrophosphate arthropathy was performed. The mode of inheritance was autosomal, dominant with a variable penetrance. Twenty-two percent of the family members had joint involvement related to pyrophosphate arthropathy, 47% of those over 50 years of age had experienced acute attacks of arthritis and/or had joint calcifications. The majority of individuals with both arthritis and joint calcifications suffered from chronic pain that resulted in early retirement. A high frequency of back pain was observed, but no ankylosis or deformity. Surgery was performed for parathyroid hyperplasia on the propositus in 1 family, and several members of her family suffered from symptoms that suggested a disturbance of calcium phosphate metabolism. There were several differences between our patients and 50 cases of sporadic pyrophosphate arthropathy from the same area of Sweden. Familial cases had an earlier onset, a greater number of involved joints, and peripheral joint involvement more often. Back pain was more frequent, and calcifications of intervertebral discs were found only in the hereditary cases.

Topics: Adult; Age Factors; Aged; Arthritis; Calcium Pyrophosphate; Chondrocalcinosis; Diphosphates; Female; Genes, Dominant; Humans; Male; Middle Aged; Pedigree; Prognosis; Radiography; Sweden

Topics: Acute Disease; Arthritis; Bruxism; Calcium Metabolism Disorders; Calcium Pyrophosphate; Diphosphates; Humans; Male; Middle Aged; Temporomandibular Joint Disorders; Wrist Joint

The association of hypophosphatasia and pyrophosphate arthropathy in an adult patient has been described on 1 previous occasion. We report a further 2 patients with this disease combination. One patient suffers from the type of hypophosphatasia that presents in adult life, with fractures that are either spontaneous or the result of minimal trauma. The other patient suffered from the severe type of hypophosphatasia that presents in infancy but survived longer than is usual; the necropsy findings on this patient are reported.

Topics: Arthritis; Bone and Bones; Calcium Pyrophosphate; Cartilage, Articular; Child, Preschool; Chondrocalcinosis; Diphosphates; Female; Fractures, Spontaneous; Humans; Hypophosphatasia; Male; Middle Aged

An animal model of arthritis in the rabbit was employed to assess the radioactivity contribution of joint tissues to externally monitored scintigram positivity. Bone contained the greatest total amount of radioactivity whether the imaging agent was technetium pertechnetate or pyrophosphate, although the greatest percent increase in the arthritis joints over control joints was seen in synovium. Mid-shaft bone in the same region as the arthritic joint also showed increased radioactivity compared with control.

Topics: Animals; Arthritis; Diphosphates; Disease Models, Animal; Evaluation Studies as Topic; Femur; Injections, Intra-Articular; Knee Joint; Rabbits; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Synovial Fluid; Synovial Membrane; Technetium; Technetium Tc 99m Pyrophosphate; Tissue Distribution

Topics: Aged; Arthritis; Calcium Pyrophosphate; Diagnosis, Differential; Diphosphates; Female; Humans; Male; Middle Aged; Synovial Fluid

Soluble pyrophosphate was measured in the plasma and synovial fluid of various groups of patients and in the plasma of two control groups. The two control groups consisted of 13 healthy subjects and 19 patients suffering from benign lumbar back pain. The other group of patients had rheumatoid arthritis (RA) (14 plasma and 19 synovial fluid examinations), osteoarthrosis (OA) (19 plasma and 26 synovial fluids) and articular chondrocalcinosis (ACC) (27 plasma and 43 synovial fluids). The level of soluble pyrophosphate in the plasma was 3.5 mumol/l in healthy subjects, 4.0 mumol/l in patients with lumbar back pain, 4.1 mumol/l in individuals having OA and 3.5 mumol/l in the group suffering from RA as well as for those with ACC. The differences between these values are not significant statistically. In the synovial fluid the values were 4.6 mumol/l for the group with RA, 12.7 mumol/l for those with OA and 34.2 mumol/l in the group having ACC. If a normal distribution of these values is assumed and the average values and standard deviations recalculated for each group after elimination of cases more than 3 standard deviations above the mean, then we obtain 9.8 mumol/l for the group with OA and 23.8 mumol/l for those with ACC. The difference between the group with RA and that with OA is highly significant (p greater than 0.0001). Even more significant is the difference between the group with RA and ACC (p less than 0.0005). The difference between the OA and the ACC is also highly significant (p less than 0.001). On the basis of these observations various mechanisms leading to the pyrophosphage crystal deposition disease are discussed.

Topics: Arthritis; Arthritis, Rheumatoid; Back Pain; Chondrocalcinosis; Diphosphates; Humans; Osteoarthritis; Solubility; Synovial Fluid

Ten patients with Crohn's disease and recurrent pain in the knee joints were subjected to arthroscopy. Biopsies obtained from the synovial membrane were examined under polarizing light microscopy. The arthroscopy revealed crystalline deposits in 7 patients and the microscopic examination of the synovial membrane demonstrated positively birefringent crystals in 4 patients. The crystals with positive birefringence had the rod or rhomboid shape typical of pyrophosphate crystals. As arthroscopy crystals in 7 patients and polarizing microscopy revealed crystals in one further patient, crystal deposits were thus found in 8 patients altogether. All patients had normal serum uric acid values. The crystal deposits were interpreted as pyrophosphate and their possible connection with the recurrent arthralgia in Crohn's disease is discussed.

Topics: Adult; Aged; Arthritis; Arthroscopy; Biopsy; Crohn Disease; Diphosphates; Female; Humans; Knee Joint; Male; Middle Aged; Pain; Recurrence; Synovial Membrane

Hydroxyapatite crystals are a common cause of periarticular disease, but recent studies have shown that they may also be deposited intra-articularly, either as a primary phenomenon or secondary to another disease. A continuum of abnormalities from monoarticular periarthritis to polyarticular disease and finally joint destruction may occur.

Topics: Adult; Aged; Arthritis; Calcinosis; Diphosphates; Female; Finger Joint; Humans; Hydroxyapatites; Knee Joint; Male; Middle Aged; Periarthritis; Radiography; Uric Acid

Degenerative arthritis in the aged includes two major disease categories--osteoarthritis and the crystal-associated arthropathics. The crystals chiefly involved are monosodium urate (gout) and calcium pyrophosphate dihydrate (CPPD), although several others (e.g., cholesterol, brushite and apatite) have been implicated. This report illustrates how the newer diagnostic techniques such as polarized-light microscopy, analytical electron microscopy and x-ray microdiffraction have augmented knowledge concerning diseases associated with articular crystal deposition. For example, diffraction techniques are required for accurate identification of the apatite crystals found in synovial fluid effusions and in the matrix vesicles of degenerate cartilage. According to ultrastructural studies, monosodium urate crystals found in tophi, joint surfaces and effusions show a distinct morphology. Present in inactive joints, the crystal surfaces are bare; in acute gout, the crystals are covered with mucin, confirming the observation that protein binding to crystals is necessary for inflammation to proceed. CPPD disease is by far the most common crystal-associated arthropathy affeting the aged. The incidence of CPPD deposits in articular tissues increases with age but, in contrast to gout, affects both men and women. The pathogenesis of CPPD disease is a mystery, but factors under investigation include matrix abnormalities, ionic imbalances, and enzyme disorders.

Topics: Aged; Arthritis; Calcium Pyrophosphate; Crystallization; Diagnosis, Differential; Diphosphates; Electron Probe Microanalysis; Female; Gout; Humans; Male; Microscopy, Electron; Synovial Fluid

Topics: Apatites; Arthritis; Crystallization; Diphosphates; Humans

Synthetic triclinic calcium pyrophosphate dihydrate crystals were uniformly trace-labeled with Ytterbium-169 (169Yb), a pure gamma-emitting isotope with a halflife of 31 days. The solubility of the labeled crystals was similar to that of cold synthetic crystals. The clearance rate of labeled sterile crystals, sieved to obtain the desired size, was determined after injection of microgram quantities into 4 arthritic huuman and 3 normal adult rabbit joints and corrected by the observed rate of clearance of free 169Yb. The derived rate constants were then used to calculate the time required for half of the injected dose of CPPD to be cleared from the joint. Crystal clearance was found in all instances. Crystal removal from normal rabbit joints was much more rapid than from the much larger human arthritic joints and was inversely proportional to the size of the crystals injected.

Topics: Animals; Arthritis; Calcium Pyrophosphate; Diphosphates; Humans; Injections, Intra-Articular; Knee Joint; Rabbits; Radioisotopes; Synovial Membrane; Time Factors; Tissue Distribution; Ytterbium

Topics: Arthritis; Calcium Pyrophosphate; Cartilage, Articular; Chondrocalcinosis; Crystallization; Diphosphates; Electron Probe Microanalysis; Humans; Microscopy, Electron; Microscopy, Electron, Scanning; X-Ray Diffraction

A material of 15 cases of histologically examined pyrophosphate arthritis (hip-joint: 7 cases, knee joint: 8 cases) is presented. Amyloid deposits were found in 14 cases and chondromatosis in the subsynovial connective tissue of all the cases. The significance of this high, not previously reported, coincidence is discussed, together with various pathogenetic possibilities, as related to the theories of the genesis of amyloid substance.

Topics: Aged; Amyloid; Amyloidosis; Arthritis; Calcium Pyrophosphate; Connective Tissue; Crystallization; Diphosphates; Female; Hip Joint; Humans; Knee Joint; Male; Microscopy, Polarization; Middle Aged; Synovial Membrane

After description of etiopathogenetic, anatomopathological and clinical aspects of the disease, the authors relate about a case of ochronotic arthropathy, lining on its typical radiological patterns. Scintigraphic study with 99mTc-pertechnetate and with 99mTc-pyrophosphate, excluding any phlogistic component, agree with dysmetabolic and degenerative nature of this arthropathy.

Topics: Arthritis; Diagnosis, Differential; Diphosphates; Humans; Joint Diseases; Ochronosis; Radiography; Radionuclide Imaging; Technetium

Topics: Adult; Aged; Arthritis; Calcium Pyrophosphate; Chondrocalcinosis; Crystallization; Diphosphates; Female; Humans; Male; Middle Aged; Radiography; Synovial Fluid

Topics: Aged; Arthritis; Cartilage, Articular; Chondrocalcinosis; Diagnosis, Differential; Diphosphates; Elasticity; Female; Humans; Male; Middle Aged

Topics: Arthritis; Calcium Pyrophosphate; Diagnosis, Differential; Diphosphates; Humans; Synovitis

The acute inflammatory response to calcium pyrophosphate dihydrate crystals follows the meeting of neutrophils and crystals. The ensuing phagocytosis leads to the generation of a glycoprotein chemotactically active for neutrophils and to the release of lysosomal enzymes. Indomethacin and phenylbutazone, at therapeutic concentrations, impaired phagocytosis of the crystals and generation of chemotactic factor activity. Colchicine had no effect upon phagocytosis but significantly impaired the appearance of chemotactic factor activity.

Topics: Arthritis; Calcium; Chemotaxis, Leukocyte; Colchicine; Diphosphates; Galactosidases; Glucuronidase; Humans; In Vitro Techniques; Indomethacin; L-Lactate Dehydrogenase; Neutrophils; Phagocytosis; Phenylbutazone

Topics: Aged; Arthritis; Crystallization; Diagnosis, Differential; Diphosphates; Humans; Male; Middle Aged

Bone-to-bone, iliosacral joint-to-os sacrum and joint-to-joint ratios were computed using the region-of-interest technique 2 to 3 hrs. after injection of 99mTc Sn-methylene-diphosphonate or 99mTc Sn-pyrophosphate in 139 patients with skeletal diseases (bone tumours, degenerative changes of the spine and joints, inflammatory changes of joints) as well as in 123 patients with normal skeletal states. In the latter group, iliosacral joint-to-os sacrum ratios decreased with increasing age of the patients. In patients with osseous metastases of the spine ratios of 0.80 to 4.0 occurred ( reference area second vertebra below or above the affected vertebra). In degenerative changes of the spine values of 0.80 to 1.69 were computed. These results show, that 74% of the spine metastases could not be differentiated from benign changes of the spine by determining their relative amounts of bone uptake. In bone tumours of the extremities and in rheumatoid or gouty arthritis of the small joints (hands and feet) the highest ratios, i.e. contrasts, occurred referring to a contralateral reference area. Osteoarthritic and inflammatory alterations of the big joints could not be differentiated because of percentual distribution of the increased joint-to-joint ratios turned out to be nearly identical.

Topics: Adult; Aged; Arthritis; Arthritis, Rheumatoid; Bone Diseases; Bone Neoplasms; Colonic Neoplasms; Diphosphates; Diphosphonates; Extremities; Femur; Gout; Hemangiosarcoma; Humans; Hypertrophy; Lumbar Vertebrae; Melanoma; Middle Aged; Neoplasm Metastasis; Osteoarthritis; Radionuclide Imaging; Spinal Neoplasms; Spinal Osteophytosis; Spondylolisthesis; Technetium

Five cases of hemochromatosis arthropathy are presented and the distinctive radiological features of the disease are described. Although the condition is typically degenerative, showing subchondral cyst formation, sclerosis, and thinning of cartilage, its distribution is characteristic. Selective degenerative changes of the second and third metacarpophalangeal joints are striking, particularly in the hands, while abnormalities in the intercarpal joints are variable and the interphalangeal joints are spared. Chondrocalcinosis involving both fibrous and hyaline cartilage is frequently seen as well, particularly in the large joints. The calcification is due to deposition of calcium pyrophosphate crystals, perhaps resulting from iron inhibition of pyrophosphatase.

Topics: Adult; Aged; Arthritis; Arthritis, Rheumatoid; Calcium Phosphates; Chondrocalcinosis; Diagnosis, Differential; Diphosphates; Elbow Joint; Finger Joint; Hemochromatosis; Hip Joint; Humans; Joint Diseases; Knee Joint; Male; Middle Aged; Osteoarthritis; Radiography; Shoulder Joint; Spine; Synovial Membrane; Wrist Joint

The pleural cavity of rats and guinea-pigs has been utilized to study the inflammatory response to immediate hypersensitivity, delayed hypersensitivity, calcium pyrophosphate and carrageenan. The mediators will be described and their possible interaction with cyclic AMP. Finally the effect of some anti-inflammatory agents on these models will be discussed.

Topics: Animals; Arthritis; Arthus Reaction; Carrageenan; Cyclic AMP; Diphosphates; Disease Models, Animal; Guinea Pigs; Humans; Hypersensitivity, Delayed; Hypersensitivity, Immediate; Inflammation; Lung; Pleura; Rats; Synovial Fluid

Recent studies have shown elevated inorganic pyrophosphate (PPi) levels in most knee joint fluid supernates from patients with pseudogout (PG) or osteoarthritis (OA) and more modestly elevated levels in some supernates from patients with gout or rheumatoid arthritis (RA) relative to PPi levels found in the venous blood plasma of normal or arthritic subjects. We measured the intraarticular PPi pool and its rate of turnover to better understand the significance of the joint fluid-plasma PPi gradient. Preliminary studies in rabbits showed that (32-P)PPi passed from joint space to blood and vice versa without detectable hydrolysis. Incubation of natural or synthetic calcium pyrophosphate dihydrate (CPPD) microcrystals with synovial fluid in vitro in the presence of (32P)PPi tracer showed no change in PPi specific activity in the supernate over a 19-h period so that exchange of PPi in solution with that in CPPD microcrystals could be ignored. Clearance rates of (32P)PPi and of (33P)Pi, as determined by serially sampling the catheterized knee joints of volunteers with various types of arthritis over a 3-h period, were nearly identical. The (32P)PPi/(32P)Pi was determined in each sample. A mixture of a large excess of cold PPi did not influence the clearance rate of either nuclide. The quantity of PPi turned over per hous was calculated from the pool size as determined by isotope dilution and the turnover rate. The residual joint fluid nuclide was shown to be (32P)PPi. The PPi pool was generally smaller and the rate of turnover was greater in clinically inflamed joints. The mean plus or minus SEM pool size (mu-moles) and turnover rate (percent/hour) in PG knees was 0.23 plus or minus 0.07 and 117 plus or minus 11.9, hydrolysis rate (%/h) to Pi was 27.7 plus or minus 13.2; in OA knees: 0.45 plus or minus 0.26 and 72 plus or minus 9.2, hydrolysis 6.9 plus or minus 0.9; in gouty knees: 0.8 plus or minus 0.41 and 50 plus or minus 11.6, hydrolysis 9.8 plus or minus 2.8; and in RA knees: 0.14 plus or minus 0.14 and 114 plus or minus 35.8, hydrolysis 236 plus or minus 116. PPi turnover (mumoles/hour) correlated with the degree of OA change present in the joint as graded by radiologic criteria irrespective of the clinical diagnosis. Mean PPi turnover in joints with advanced OA was greater than in those with mild or moderate changes (P smaller than 0.001), but the mild and moderate groups showed no significant difference. We conclude that synovial PPi turnover and elevat

Topics: Adult; Aged; Arthritis; Chondrocalcinosis; Diphosphates; Female; Humans; Knee Joint; Male; Middle Aged; Osteoarthritis; Phosphorus Radioisotopes; Pyrophosphatases; Synovial Fluid

The anatomy and pathology of the radiocarpal compartment of the adult wrist are described in a study of human cadavers and 50 consecutive patients with radiocarpal joint abnormalities. The most frequently encountered diseases were adult onset rheumatoid arthritis (42) and calcium pyrophosphate deposition disease (22%). Features allowing radiographic diagnosis included the degree of symmetry and the presence of demineralization, sclerosis, joint space narrowing, subchondral cysts and erosions. Evaluation of abnormalities in other compartments of the wrist and the ulnar styloid is mandatory.

Topics: Adult; Aged; Arthritis; Arthritis, Juvenile; Arthritis, Rheumatoid; Carpal Bones; Diphosphates; Female; Gout; Humans; Male; Middle Aged; Psoriasis; Radiography; Radius; Spondylitis, Ankylosing; Wrist Joint

Topics: Animals; Arthritis; Arthus Reaction; Calcium; Carrageenan; Chondrocalcinosis; Diphosphates; Disease Models, Animal; Guinea Pigs; Immunity, Cellular; Kinetics; Macrophages; Phosphorus; Pleurisy; Rats

Topics: Arthritis; Chondrocalcinosis; Diphosphates; Humans

Topics: Adult; Arthritis; Arthroplasty; Calcium Phosphates; Chondrocalcinosis; Chronic Disease; Diphosphates; Female; Humans; Knee; Middle Aged; Radiography; Syndrome; Synovial Fluid

Topics: Adult; Arthritis; Bone Diseases; Diphosphates; Female; Humans; Male; Middle Aged; Phosphates; Radionuclide Imaging; Sacroiliac Joint; Spine; Spondylitis, Ankylosing; Sternoclavicular Joint; Sternum; Strontium Radioisotopes; Technetium; Tomography, X-Ray; Zinc

Topics: Arthritis; Bone Diseases; Bone Neoplasms; Diagnosis, Differential; Diphosphates; Hodgkin Disease; Humans; Multiple Myeloma; Neoplasm Metastasis; Osteitis Deformans; Osteoarthritis; Osteolysis; Osteomalacia; Osteoporosis; Radionuclide Imaging; Reflex Sympathetic Dystrophy; Rheumatic Diseases; Technetium; Tin

Topics: Aged; Arthritis; Chondrocalcinosis; Diagnosis, Differential; Diphosphates; Gout; Humans; Knee Joint; Leukocytes; Male; Middle Aged; Radiography; Suppuration; Synovial Fluid

Topics: Adult; Aged; Arthritis; Calcium; Chondrocalcinosis; Crystallization; Diabetes Complications; Diet Therapy; Diphosphates; Female; Gout; Humans; Hyperparathyroidism; Knee Joint; Leukocytes; Male; Middle Aged; Physical Therapy Modalities; Radiography; Synovial Fluid; Synovitis; Uric Acid

Topics: Animals; Arthritis; Chickens; Colchicine; Diphosphates; Dose-Response Relationship, Drug; Talc; Uric Acid

Topics: Aminocaproates; Animals; Aprotinin; Arthritis; Complement Inactivator Proteins; Crystallization; Diphosphates; Inflammation; Injections, Intra-Articular; Injections, Subcutaneous; Leukocytes; Lysosomes; Protease Inhibitors; Rabbits; Skin Diseases; Synovial Membrane; Trypsin Inhibitors; Venoms; Vinblastine

Topics: Allopurinol; Arthritis; Calcium Phosphates; Cartilage, Articular; Chondrocalcinosis; Crystallization; Diphosphates; Gout; Humans; Kidney Diseases; Kidney Tubules; Leukocytes; Macrophages; Myeloproliferative Disorders; Synovial Fluid; Uric Acid

Topics: Age Factors; Aged; Arthritis; Arthrography; Calcium; Calcium Phosphates; Chondrocalcinosis; Crystallization; Diphosphates; Drainage; Exercise Therapy; Humans; Leukocytes; Middle Aged; Phenylbutazone; Synovial Fluid; Synovitis

Topics: Adult; Age Factors; Aged; Arthritis; Calcium Phosphates; Chondrocalcinosis; Diphosphates; Female; Fever; Hemarthrosis; Hemostasis; Humans; Joint Diseases; Male; Middle Aged; Osteoarthritis; Osteochondritis; Sex Factors; Synovial Fluid; Synovial Membrane

Topics: Arthritis; Calcium; Cesium; Cholesterol; Colchicine; Diphosphates; Humans; Leukocytes; Phagocytosis; Potassium; Quaternary Ammonium Compounds; Sodium; Thallium; Uric Acid

Topics: Adolescent; Adult; Aged; Alkaline Phosphatase; Arthritis; Calcinosis; Calcium; Chromatography, Ion Exchange; Crystallization; Diphosphates; Electrophoresis; Female; Humans; Hydrolysis; Ion Exchange; Joint Diseases; Male; Middle Aged; Phosphates; Phosphorus Isotopes; Radioisotope Dilution Technique; Solubility; Synovial Fluid

Topics: Arthritis; Diphosphates; Humans; Synovitis

Topics: Arthritis; Calculi; Cartilage Diseases; Colchicine; Crystallization; Diphosphates; Female; Humans; Joint Diseases; Kidney Failure, Chronic; Knee; Male; Periarthritis; Radiography; Shoulder; Synovial Fluid; Synovitis; Wrist

Topics: Acetates; Arthritis; Arthritis, Rheumatoid; Betamethasone; Diagnosis, Differential; Diphosphates; Glucocorticoids; Gout; Humans; Injections, Intra-Articular; Methylprednisolone; Microscopy, Electron; Microscopy, Polarization; Synovial Fluid; Triamcinolone Acetonide; Uric Acid

Topics: Arthritis; Crystallization; Diphosphates; Drainage; Gout; Humans; Synovial Fluid; Synovitis

Injection of sodium urate or calcium pyrophosphate crystals into the stifle joints of anesthetized dogs almost invariably induced an acute exudative response. This response was quantified by serial measurements of intra-articular pressure, pH and leukocyte concentration. Pressure rose progressively and reflected intra-articular volume increase. The hydrogen ion concentration increased as the reaction progressed and correlated in a given exudate with the leukocyte concentration. Analysis of sequential physiologic and biochemical changes occurring in this model of crystal-induced inflammation may provide insight into the mechanisms of acute gouty arthritis in man.

Topics: Animals; Arthritis; Calcium Phosphates; Diphosphates; Dogs; Injections, Intra-Articular; Synovitis; Uric Acid

Topics: Arthritis; Calcinosis; Calcium; Cartilage, Articular; Chondrocalcinosis; Diagnosis, Differential; Diphosphates; Gout; Humans; Hyaline Cartilage; Joint Diseases; Knee Joint

Topics: Arthritis; Arthritis, Rheumatoid; Calcinosis; Calcium Phosphates; Cartilage; Cartilage, Articular; Chondrocalcinosis; Classification; Diagnosis, Differential; Diphosphates; Geriatrics; Gout; Humans; Joint Diseases; Knee; Lupus Erythematosus, Systemic; Pathology; Radiography; Rheumatic Diseases; Synovial Fluid

Topics: Arthritis; Calcinosis; Chondrocalcinosis; Diphosphates; Humans; Rheumatic Diseases; Synovitis