pyrophosphate and Gout

Paget's disease of bone affects 10% of those surviving to the eighth decade of life. Relatively easy to diagnose, treatment decisions are more complex. Surgery and immobilization present unique challenges often requiring prophylaxis to prevent activation/exacerbation of the disease.

Topics: Aged; Aged, 80 and over; Calcitonin; Diphosphates; Female; Gout; Humans; Male; Osteitis Deformans; Pain

Topics: Arthrography; Chondrocalcinosis; Diphosphates; Global Health; Gout; Humans; Pedigree; Rheumatic Diseases

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

Topics: Aged; Arthritis, Rheumatoid; Chondrocalcinosis; Colchicine; Crystallization; Diphosphates; Female; Gout; Humans; Indomethacin; Joint Diseases; Male; Phenylbutazone; Probenecid; Sulfinpyrazone; Synovial Fluid; Uric Acid; X-Ray Diffraction

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

Topics: Adenosine Monophosphate; Adenosine Triphosphate; Culture Techniques; Diphosphates; Fibroblasts; Glutamine; Gout; Guanine Nucleotides; Humans; Pentosyltransferases; Purines; Ribose; Uric Acid

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

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

The kinetics of calcium pyrophosphate dihydrate (CPPD) crystal growth was studied by allowing calcium and pyrophosphate (PPi-4) ions to diffuse through a denatured collagen matrix (biological grade gelatin) in the presence of either monosodium urate monohydrate (MSU) or hydroxyapatite (HA) crystals. In this in vitro model system, MSU crystals significantly altered the kinetics of PPi-4 ionic diffusion through the gelatin matrix by allowing the [PPi-4] gradient to fall off much more rapidly, suggesting an increased level of scavenging of PPi-4 ions into crystalline materials. Even more significantly, the presence of MSU crystals markedly influenced the crystal growth morphology of triclinic CPPD, producing that observed in vivo. A large number of epitaxially dimensional matches between MSU and triclinic (t) and monoclinic (m) CPPD were identified, suggesting that MSU crystals can epitaxially induce CPPD crystal growth. This finding supports the hypothesis that the association of urate gout and CPPD crystal deposition disease is based on the nucleating potential of MSU crystals for CPPD crystal growth. In contrast, the HA crystal structure did not appear to serve as a nucleating agent for CPPD crystals. However, HA crystals did serve as effective traps for PPi-4 ions and their presence led to more stable CPPD crystal growth.

Topics: Apatites; Calcium Pyrophosphate; Diphosphates; Gelatin; Gout; Humans; Microscopy, Electron, Scanning; Models, Biological; Uric Acid

Monosodium urate crystals are clearly related to acute attacks of gout and to the hard tissue destruction of chronic tophaceous gout. Fortunately, the acute attacks are readily treated with anti-inflammatory drugs, and destructive changes due to tophi may be prevented or reversed, at least in part, by the intelligent control of serum urate levels. Control of gout is one of the premier success stories of modern medicine. In contrast, the number of patients who have arthritis associated with crystals that contain calcium appears to be rising--perhaps a function of better recognition, perhaps related to the aging of the population. CPPD and BCP crystals can be associated with acute or subacute inflammation, but as in acute gout, it is easily controlled with anti-inflammatory drugs or by local injections of corticosteroids. A direct relationship of BCP and CPPD crystals to the associated destructive arthropathies has been hypothesized and is supported by clinical observations, animal studies, and in vivo experiments. Unlike gout, which is usually associated with a systemic metabolic abnormality (i.e., hyperuricemia), calcium crystals deposition seem to be a localized phenomenon, although numerous local sites in several joints are often involved in a given patient. Tissue degeneration in gout clearly follows (tophaceous) crystal deposition. Calcium crystal deposition may follow, rather than precede, destructive joint changes. Alternatively, both destructive changes and crystal deposition may derive independently from a common, still obscure, biochemical abnormality of joint tissues. P. A. Dieppe and colleagues believe that calcium crystal deposition follows either primary or secondary tissue degeneration but that the crystals exert a positive feedback effect (amplification loop) that accelerates degeneration. Each of those formulations of a pathogenetic role for crystals may be true in a given case, analogous to the etiology of primary and secondary forms of hyperuricemia and to sodium urate crystal deposition coexistent with osteoarthritis (tophus formation in Heberden's nodes). Conclusive proof of a significant role for BCP or CPPD crystals in the pathogenesis of human joint tissue damage depends on interrupting the postulated disease mechanism and showing that this prevents joint deterioration and leads to significant repair of existing damage. Our current position is somewhat analogous to that of our colleagues who had to contend with management of gouty a

Topics: Aged; Arthritis, Rheumatoid; Calcium Phosphates; Calcium Pyrophosphate; Crystallization; Diphosphates; Gout; Humans; Male; Middle Aged

Topics: Aged; Arthritis, Infectious; Calcium Pyrophosphate; Cartilage Diseases; Diphosphates; Gout; Humans; Male

We found previously that crystals of sodium urate and silicon dioxide (silica) can stimulate the production of endogenous pyrogen (EP), now called interleukin-1 (IL-1), the polypeptide mediator of fever and other aspects of inflammation. We have confirmed and extended the work with urate crystals and have examined 2 other crystals associated with joint problems, hydroxyapatite (HA) and calcium pyrophosphate dihydrate (CPPD). The crystals were added to suspensions of human blood leukocytes (2.5 X 10(6) monocytes/dose, with 10% fresh autologous plasma); after 18 hours of incubation, the EP content of the supernatants was assayed in the rabbit pyrogen test. HA and CPPD crystals neither induced EP production nor reduced the amount of staphylococci-induced EP. Presized (10 - 40 micron) urate crystals were pyrogenic, but less so than the unsized and aggregated urate crystals investigated previously and reexamined here. On ultrasonication, the aggregated urate crystals became first more pyrogenic and then less so as the crystals were dispersed and broken down. Ultrasound did not impart pyrogenicity to HA or CPPD crystals: their failure to stimulate EP/IL-1 production from leukocytes in vitro indicates a difference in their phlogistic properties, compared with crystals of urate or silica. The results with urate crystals have pathogenetic implications in a number of areas of gouty inflammation: initiation of the acute attack, other aspects of the acute-phase response, polyarticular involvement, and the inflammatory consequences of chronic stimulation by tophaceous material.

Topics: Calcium Pyrophosphate; Crystallization; Diphosphates; Durapatite; Gout; Humans; Hydroxyapatites; Interleukin-1; Leukocytes; Monocytes; Sonication; Uric Acid

Topics: Adolescent; Adult; Aged; Autopsy; Biopsy, Needle; Calcium Pyrophosphate; Crystallization; Diphosphates; Female; Gout; Humans; Male; Metatarsophalangeal Joint; Middle Aged; Synovial Fluid; Toe Joint; Uric Acid

The initial rates of oxygen consumption and of glucose oxidation via the hexose monophosphate shunt were measured during the phagocytosis of sodium urate and calcium pyrophosphate microcrystals. By applying the kinetics of an enzyme-catalyzed reaction, the affinity of the polymorphonuclear leukocytes for crystals, Km, and the maximum rate, Vmax, were determined. When the comparisons are made between the two kinds of crystals, the differences in Vmax are always significant (p less than 0.02). The lesser phlogistic properties of pyrophosphate crystals stem probably in part from different crystal-protein interactions. The influence of the donor is less marked. Part of the weakly depressed phagocytic activity observed with pseudogouty PMN may be attributed to antiinflammatory drugs.

Topics: Adult; Aged; Calcium Pyrophosphate; Chondrocalcinosis; Crystallization; Diphosphates; Glucose; Gout; Humans; Middle Aged; Neutrophils; Oxidation-Reduction; Oxygen Consumption; Phagocytosis; Uric Acid

The inflammatory response to intradermal injections of urate, pyrophosphate and hydroxyapatite crystals in human forearm skin is described. Patients with rheumatoid arthritis responded normally to urate crystals, and patients with osteoarthritis or pyrophosphate arthropathy responded normally to hydroxyapatite and pyrophosphate crystals respectively. These results suggest that variation in host response to crystals cannot explain the different patterns of crystal-induced disease seen in man. The model, however, is recommended as a safe, simple ethical and reproducible test of inflammation in human subjects.

Topics: Arthritis, Rheumatoid; Calcium Pyrophosphate; Diphosphates; Gout; Humans; Hydroxyapatites; Intradermal Tests; Osteoarthritis; Skin; 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

An erroneous identification of sodium urate and calcium pyrophosphate crystals in synovial fluid may occur when utilizing compensated polarized microscopy with a dual-viewing-head teaching microscope. This is due to alteration of the observed image orientation with respect to the actual orientation of the crystal in space. By viewing a simple geometric figure through each microscope head, two basic types of image alterations are identified: a 180-degree rotation and a mirror-image transformation. Combinations of these two may also occur. This problem is clarified and illustrated and suggestions are offered to avoid erroneous crystal identification.

Topics: Calcium Pyrophosphate; Chondrocalcinosis; Crystallization; Diagnosis, Differential; Diphosphates; Gout; Humans; Microscopy, Polarization; Synovial Fluid; Uric Acid

Aspiration of inflamed periarticular tissues in seven patients suspected of having gout on clinical examination revealed positively birefringent calcium pyrophosphate crystals. The identification of calcium pyrophosphate crystals within articular structures and in the surrounding soft tissues and radiologic findings of chondrocalcinosis, in the absence of identifiable uric acid crystals, emphasize the importance of crystal identification in all cases of probable gout and stress the diagnostic role of soft-tissue aspiration in cases of soft-tissue inflammation, especially when arthrocentesis is unsuccessful.

Topics: Adult; Aged; Biopsy, Needle; Birefringence; Calcium Pyrophosphate; Chondrocalcinosis; Crystallization; Diagnosis, Differential; Diphosphates; Gout; Humans; Joints; Male; Middle Aged; Synovial Fluid

Topics: Calcium Pyrophosphate; Diphosphates; Gout; Humans; Metatarsophalangeal Joint; Toe Joint

Topics: Arthritis, Rheumatoid; Crystallization; Diphosphates; Gout; Humans; Hydroxyapatites; Joint Diseases; Leukocyte Count; Microscopy, Electron; Microscopy, Polarization; Osteoarthritis; Phagocytosis; Synovial Fluid

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

Radiological and morphological findings in advanced arthritis urica and pyrophosphate arthropathy are well known. In contrast, the early changes of synovial membrane in these disturbances of metabolism pose diagnostic problems. With the assistance of various cytological techniques and polarizing microscopical as well as electron microscopical investigation it was examined to what extent needle biopsies can be helpful in the differential diagnosis of gout and pseudogout.. In 8 patients with gout and 11 patients with pseudogout synovial fluid and small tissue specimens could be obtained with the aid of the Parker-Pearson needle. Both fluid and tissue specimens were investigated light and electron microscopically. Cell counts were evaluated in a Rosenthal chamber. The differentiation of the cells in stained smears was done by counting 200-600 cells per case. Crystals were identified by polarizing microscopy in wet preparations of freshly aspirated synovial fluid.. Polarizing microscopy of synovial fluid detected intra- as well as extracellular urate and pyrophosphate crystals. The wedge-shaped urate crystals and the larger partly polygonal pyrophosphate crystals showed different polarizing microscopical properties and a negative birefringence. The absolute cell counts in gout were higher than those in pseudogout. The relative cell counts of the different cell types in synovial fluid showed more variation in gout than in pseudogout. Cases with acute gout developed a relative leukocytosis in contrast to a relative lymphocytosis in chronic gout. A relative leukocytosis was constant in all patients with pseudogout. Sclerosed areas with scarce and plump villi as well as sometimes hyperplastic and polymorphous synovial cell layers could be demonstrated histologically in the tissue specimens of the needle biopsies in cases with gout. Urate crystals were less frequent in specimens fixed in formalin. The histological alterations in pseudogout were uniform, 2-4 rows of slightly pleomorphic synovial cells lined the inner surface of the joint capsule, sclerosing alterations were less frequent. Pyrophosphate crystals and calcified particles were seen within the synovial lining cells, the connective tissue and the enodthelial cells of the blood vessels in pseudogout specimens. Intra- as well as extracellular crystals could also be demonstrated with the aid of scanning electron microscopy in sediments of synovial fluid in gout and pseudogout. Transmission electron microscopical investigations of synovial tissue specimens detected proliferated and pleomorphic synovial lining cells in gout in contrast to a more monomorphic appearance of these cells in pseudogout. The crystals were washed out during the preparation techniques for transmission electron microscopy so that needle-like empty spaces resulted within cytoplasm of the phagocytic cells. These clefts were surrounded by phagosomal structures and densified cytoplasmic ground substance; sometimes they were also lined by membranes...

Topics: Aged; Biopsy, Needle; Chondrocalcinosis; Diagnosis, Differential; Diphosphates; Female; Gout; Humans; Leukocyte Count; Male; Microscopy, Electron, Scanning; Microscopy, Polarization; Middle Aged; Phagocytes; Synovial Fluid; Synovial Membrane; Uric Acid

The solubility of triclinic calcium pyrophosphate dihydrate (CPPD) crystals was measured under varying conditions using 45Ca-labeled crystals, expressing solubility as micromoles per liter of 45Ca in solution. In a 0.1-M Tris-HC1 buffer pH 7.4, the solubility of accurately sized CPPD crystals (37-20mum) was 60muM with maximal solubility being attained after about 8 h incubation at 37degreeC. Reduction in crystal size, decrease in pH, increase in ionic strength, Mg++, citrate, and albumin all increased solubility. The most marked effects on solubility occurred when changing the calcium concentration or by enzymatic hydrolysis of inoganic pyrophosphate to orthophosphate. It was found that decreasing the ionized calcium level below 5 mg/100 ml resulted in a progressive enhancement of solubility. The observed solubility-enhancing effects of albumin could be explained solely on its calcium-binding ability and thereby, altered ionized calcium level. Diffusible calcium in synovial fluid was only 40% of the total calcium concentration, which means most joint fluids are normally near the critical concentration of 5 mg/100 ml of ionized calcium, below which solubility is enhanced. During surgery, especially parathyroidectomy, calcium levels fall, favoring dissolution of CPPD crystals. We speculate that the slight decrease in crystal size during dissolution frees them from their cartilaginous mold, resulting in a dose-dependent inflammatory reaction as they are "shed" into the joint space. Crystal shedding may be reinforced by the modest fall in joint fluid pH accompanying the inflammatory response.

Topics: Arthritis, Rheumatoid; Calcium; Chondrocalcinosis; Citrates; Diphosphates; Gout; Humans; Hydrogen-Ion Concentration; Hydrolysis; Joint Diseases; Joints; Magnesium; Osteoarthritis; Pyrophosphatases; Serum Albumin; Solubility; Synovial Fluid

Crystal identification is made with a polarizing, color-compensated light microscope. Most microscopes can be easily and inexpensively adapted for crystal identification. The color compensator allows differentiation between the monosodium urate crystals of gout and the crystals of pseudogout, or calcium pyrophosphate deposition disease. All synovial fluid specimens should be examined. The observation of phagocytosis of crystals establishes that they are the etiologic agent responsible for an ongoing acute attack of arthritis.

Topics: Betamethasone; Calcium Phosphates; Cholesterol; Chondrocalcinosis; Color; Crystallography; Diphosphates; Edetic Acid; Gout; Humans; Light; Lipids; Microscopy; Microscopy, Polarization; Oxalates; Physical Phenomena; Physics; Synovial Fluid; Uric Acid

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: Acromegaly; Acute Disease; Aged; Arthritis, Rheumatoid; Bursitis; Calcium Phosphates; Chondrocalcinosis; Chronic Disease; Colitis, Ulcerative; Crystallization; Diphosphates; Female; Gout; Humans; Knee Joint; Male; Middle Aged; Osteoarthritis; Pyrophosphatases; Radioisotope Dilution Technique; Synovial Fluid

Topics: Adult; Calcinosis; Collagen; Diagnosis, Differential; Diphosphates; Gout; Hand; Humans; Knee; Male; Middle Aged; Radiography; Uric Acid

Topics: Calcium Phosphates; Chondrocalcinosis; Crystallization; Diphosphates; Gout; Humans; Joint Diseases; Uric Acid

Topics: Arm; Bursitis; Calcinosis; Calcium; Chondrocalcinosis; Collagen Diseases; Diphosphates; Epidermolysis Bullosa; Gout; Humans; Joint Diseases; Leg; Lipodystrophy; Periarthritis; Radiography; Rupture; Synovial Cyst; Synovial Membrane; Tendon Injuries

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

Topics: Animals; Calcium; Complement System Proteins; Diphosphates; Erythrocytes; Factor XII; Gout; Hemolysis; Hot Temperature; Humans; Hydrogen-Ion Concentration; Hypoxanthines; Immune Adherence Reaction; Immunoglobulins; Magnesium; Orotic Acid; Properdin; Sheep; Time Factors; Uric Acid

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: Acid Phosphatase; Chondrocalcinosis; Diphosphates; Female; Gout; Hemolysis; Humans; Inflammation; Leukocytes; Lysosomes; Male; Membranes; Phagocytosis; Sex Factors; Silicon Dioxide; Uric Acid

Topics: Adult; Allopurinol; Child; Child, Preschool; Diphosphates; Erythrocytes; Female; Gout; Humans; Infant; Kidney Calculi; Male; Metabolism, Inborn Errors; Phosphotransferases; Purines; Uric Acid

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: Antibodies, Antinuclear; Arthritis, Rheumatoid; Biopsy; Connective Tissue; Dermatomyositis; Diphosphates; Gout; Humans; Hyperparathyroidism; Inflammation; Joint Diseases; Lupus Erythematosus, Systemic; Neutrophils; Polyarteritis Nodosa; Psoriasis; Rheumatoid Factor; Salicylates; Sarcoidosis; Spondylitis, Ankylosing; Synovial Fluid; Synovial Membrane; Uric Acid

Topics: Adult; Allopurinol; Diphosphates; Erythrocytes; Gout; Guanine; Humans; Hypoxanthines; Male; Nucleotides; Pentosephosphates; Pentosyltransferases; Purines; Ribose; Uric Acid

Topics: Antibodies, Antinuclear; Arthritis, Rheumatoid; Color; Complement System Proteins; Diphosphates; Erythrocytes; Glucose; Gout; Hemophilia A; Humans; Hyaluronic Acid; Immunoglobulins; Joint Diseases; Joints; Leukocytes; Lipids; Proteins; Rheumatoid Factor; Synovial Fluid; Viscosity

Microcrystals of sodium urate produced direct lysis of erythrocyte membranes, as had been described previously for silica. Calcium pyrophosphate crystals induced modest erythrocyte hemolysis, also, and time-course experiments showed a markedly different reaction curve from those produced by silica and urate. Polyvinylpyridine-N-oxide, a strong hydrogen acceptor, was bound from solution to urate and silica, but not to calcium pyrophosphate crystals; this compound effectively blocked urate and silica, but not calcium pyrophosphate or control hemolysis. Dextran and heparin inhibited urate-but not silica-induced hemolysis. If erythrocyte and lysosome membranes react similarly to these particles, then the absence of phagosomes in gouty synovial fluid leukocytes, and the presence of these structures in pseudogout, may be explained.

Topics: Cell Membrane; Crystallization; Diphosphates; Erythrocytes; Gout; Hemolysis; Humans; Surface Properties; Uric Acid

Topics: Adenosine Diphosphate; Allopurinol; Diphosphates; Erythrocytes; Feedback; Female; Glycerophosphates; Gout; Guanine Nucleotides; Humans; Male; Middle Aged; Pentosephosphates; Phosphoric Acids; Purines; Transferases; Uric Acid

Topics: Aged; Chondrocalcinosis; Crystallization; Diagnosis, Differential; Diphosphates; Female; Gout; Humans; Indomethacin; Middle Aged; Synovitis; Uric Acid

Topics: Aged; Calcinosis; Calcium Phosphates; Diagnosis, Differential; Diphosphates; Female; Gout; Humans; Joint Diseases; Knee Joint; Male; Middle Aged; Synovial Fluid; Synovitis

Topics: Aged; Diphosphates; Gout; Humans; Male; Synovial Fluid

Topics: Administration, Oral; Adult; Allopurinol; Diphosphates; Erythrocytes; Female; Gout; Hemolysis; Humans; In Vitro Techniques; Male; Middle Aged; Nucleotides; Purines; Pyrazoles; Pyrimidines; Ribose; Uric Acid; Xanthine Oxidase

Topics: Allopurinol; Diphosphates; Erythrocytes; Gout; Humans; Purine-Pyrimidine Metabolism, Inborn Errors; Purines; Ribose; Transferases; Uric Acid

Topics: Acromegaly; Adult; Calcinosis; Calcium Phosphates; Cartilage Diseases; Diagnosis, Differential; Diphosphates; Gout; Hemochromatosis; Humans; Hyperparathyroidism; Joints; Male; Microscopy, Polarization; Middle Aged; Radiography; Terminology as Topic

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: Aged; Arthritis, Rheumatoid; Calcium; Chondrocalcinosis; Crystallization; Diphosphates; Gout; Humans; Male; Methods; Microscopy, Fluorescence; Microscopy, Polarization; Synovial Fluid; Uric Acid

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

Topics: Adenoma; Aged; Calcinosis; Calcium; Carpal Tunnel Syndrome; Diphosphates; Gout; Humans; Hyperparathyroidism; Male; Mediastinal Neoplasms; Parathyroid Neoplasms; Photomicrography; Synovial Fluid; Tendons; Ulna; Wrist

Topics: Calcinosis; Cartilage; Diagnosis, Differential; Diphosphates; Gout; Humans; Radiography; Technology, Radiologic

Topics: Adult; Diphosphates; Erythrocytes; Glucosyltransferases; Gout; Guanine; Hot Temperature; Humans; Hypoxanthines; In Vitro Techniques; Leukocytes; Male; Middle Aged; Molecular Biology; Mutation; Purine-Pyrimidine Metabolism, Inborn Errors; 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: Adrenal Cortex Hormones; Calcification, Physiologic; Cartilage; Chondrocalcinosis; Crystallography; Diphosphates; Gout; Humans; Joint Diseases; Phenylbutazone; Synovitis