pyrophosphate and Pain

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: Anti-Inflammatory Agents, Non-Steroidal; Apatites; Calcium Pyrophosphate; Crystallization; Diphosphates; Humans; Osteoarthritis; Pain; Pain Management; Synovial Fluid; Synovial Membrane

Topics: Calcium; Diphosphates; Diphosphonates; Humans; Kidney Calculi; Muscular Diseases; Pain; Phosphates

Topics: Adipose Tissue; Autophagy; Bone and Bones; Diphosphates; Humans; Multiple Myeloma; Musculoskeletal Diseases; Osteoarthritis; Osteoporosis, Postmenopausal; Pain

We have studied the occurrence of skeletal muscle uptake of 99mtechnetium pyrophosphate (Tc-PYP), creatine kinase (CK) release and muscle pain in normal subjects after exercise. Five subjects stepped on and off a high bench in such a way that one leg stepped up and the other down. Pain only developed in the muscles used for descending: quadriceps, adductors and gluteal muscles of one leg and the calf muscle of the other. A large rise in plasma CK occurred in four subjects but no increased Tc-PYP muscle uptake was seen in the quadriceps. In the four subjects with high CK effluxes, increased isotope uptake was seen in the thigh adductors used when stepping down; in the two subjects with the largest CK effluxes there was extensive uptake into the gluteal muscles. Muscle pain preceded and was not well correlated with either the magnitude of the enzyme release or the amount and distribution of increased muscle isotope uptake. We conclude that delayed onset muscle pain, the cause of which remains unknown, is a poor indicator of muscle damage as indicated by circulating muscle enzymes and muscle isotope uptake. Tc-PYP uptake by skeletal muscle can provide useful information about the localisation and time course of muscle damage.

Topics: Adult; Creatine Kinase; Diphosphates; Humans; Muscle Contraction; Muscles; Pain; Physical Exertion; Technetium; Technetium Tc 99m Pyrophosphate

Total body Tc-99m pyrophosphate scintigraphy was performed on 11 "ultramarathon" runners to assess the ability of nuclear medicine techniques to evaluate skeletal-muscle injury due to exercise. We found increased muscle radionuclide concentration in 90% of the runners. The pattern of muscle uptake correlated with the regions of maximum pain. The detection of exercise-induced rhabdomyolysis appeared to be best when scintigraphy was performed within 48 hr after the race, and to be almost undetectable after about a week. It was possible to differentiate muscle injury from joint and osseous abnormalities such as bone infarct or stress fracture. Although 77% of the runners had elevated serum creatine kinase MB activity, cardiac scintigraphy showed no evidence of myocardial injury.

Topics: Adult; Athletic Injuries; Creatine Kinase; Diphosphates; Heart; Humans; Male; Middle Aged; Muscles; Pain; Physical Exertion; Radionuclide Imaging; Running; Technetium; Technetium Tc 99m Pyrophosphate

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