Pseudogout Crystals Birefringence

Pyrophosphate arthropathy is most common at the knee. Our case highlights the importance of including crystal arthropathy as a differential diagnosis in suspected infections of TKRs. Diagnostic confirmation may be via the presence of rhomboid crystals in the synovial fluid aspirate visualized under polarized microscopy. gout, pseudogout, lipoid proteinosis, colloid milium, mucopolysaccharidoses, cutaneous deposition disease, urate crystals, birefringence, tophi Introduction The cutaneous deposition disorders are a heterogeneous group of conditions characterized by the presence of primarily endogenous substances within the dermis or the subcutis. Unlike gout (in which compensated polarized light microscopy reveals needle-shaped urate crystals with strong negative birefringence), pseudogout is characterized by calcium pyrophosphate dihydrate crystals; these are rhomboid-shaped, with weak positive birefringence. Thus, pseudogout crystals are blue when aligned parallel to the slow ray of the compensator and yellow when they are perpendicular. It is negative if the relationship is reversed. Struvite Crystals: The core cause of these stones are thought to be from the bacteria Staphylococcus aureus and possibly genetic core cause. Pseudogout, though it presents with similar symptoms, is caused by smaller, block-like crystals of calcium pyrophosphate dihydrate (CPPD). The recommendations of the 2011 European League Against. Pseudogout is a form of arthritis that causes pain, stiffness, tenderness, redness, warmth, and swelling in some joints. microscope to investigate CPPD crystal and found the character of weakly positive birefringence. Advanced electron microscopy techniques can be used to finalize the diagnosis. It is used diagnostically when evaluating the types of crystals in joint fluid. Depending on the disease, the Heinz body is composed of precipitated normal hemoglobin (eg, G-6-PD deficiency) or structurally defective hemoglobin (eg,. an analysis of joint fluid to look for calcium pyrophosphate crystals. The crystals also exhibited variably positive birefringence under polarized light. Study Flashcards On USMLE Step 2CK - Musculoskeletal at Cram. Calcification in the tophi was also confirmed using von Kossa's stain. In the histologic study, a calcium pyrophosphate dihydrate crystal deposit was confirmed. Pseudogout is confirmed by the demonstration of CPPD crystals in SF which manifest as rhomboid-shaped rod-like structures that exhibit weakly positive or no birefringence by compensated polarized light microscopy, in contrast to the negatively birefringent needle-shaped MSU crystals found in gout (Figure 1). Types: Gout = needle-shaped, negatively birefringent, yellow when aligned. 0% of unstained sections. Metrics Links Files Go to Pseudogout of the Knee after Intraarticular Injection of Hyaluronic Acid. Morphologically, the pseudogout lesions may resemble gout and other conditions, such as tumoral calcinosis. Learn how your doctor tells the difference between these rheumatic diseases. Calcium pyrophosphate crystal deposition disease: diagnosis and treatment José Luis Rosales-Alexander,1 Jerónimo Balsalobre Aznar,1 César Magro-Checa2 1Rheumatology Department, Hospiten Ramblas, Santa Cruz de Tenerife, 2Rheumatology Department, San Cecilio University Hospital, Granada, Spain Abstract: Calcium pyrophosphate dihydrate crystal deposition disease (CPPD) is an inflammatory. Discussion It seems likely that the acute arthritis occurring after parathyroidectomy in our patients represented pseudo- gout, which was diagnosed and differentiated from classical gout by the distribution of affected joints, by chondrocalcinosis within affected joints on X-ray, and by the finding of calcium-pyrophosphate crystals in the joint. The shedding of CPPD crystals initiates an inflammatory process, and these crystals invoke an inflammatory response in much the same manner as uric acid crystals. Since monosodium urate is dissolved by aqueous Disease (Pseudogout)solutions, formalin fixation and conventional tissueprocessing usually result in the loss of the crystal from tissue Pseudogout is so named because it is a clinicalsections. , Patients on chronic TPN may develop microcytic anemia and poor wound healing as a result of a deficiency in this mineral. The clinical presentation resembles gout in its acute attacks of crystal synovitis and, thus, was previously called pseudogout. Study Pathoma - Joint Disorders flashcards from Don Draper's class online, or in Brainscape's iPhone or Android app. Gout is due to persistently elevated levels of uric acid in the blood. To view a gout crystal click this link. In the case of Calcite the crystallography axes are aligned in such a way with respect to the surfaces that the two beams take a different path through the crystal. See Gout Symptoms and Pseudogout Symptoms. Gout is an inflammatory disease where uric acid precipitates into crystals that deposit in various joints around the body, causing pain and inflammation. The time interval separating the first attack from subsequent episodes of acute synovitis may be widely variable, ranging from a few days to several years. This precipitates as crystals (rod shaped birefringent) in the cartilage of the wrist, especially on the ulnar sided TFCC (triangular fibro cartilage complex). An oslerphile emergency physician and intensivist suffering from a bad case of knowledge dipsosis. With negative birefringence, the crystals appear yellow in parallel light and blue with perpendicular light. These urate crystals can incite inflammation in the bursae leading to pain and swelling around the joints, a condition called bursitis. NSAID merupakan pengobatan gejala utama dan colchicine dosis rendah dapat digunakan untuk serangan akut atau kronik. At polarized light microscopy, CPPD crystals appear as positively birefringent rhomboid foci, and their presence in the synovial fluid is considered the standard for diagnosis of this disease (Fig 22. A definitive diagnosis of CPPD deposition disease in the left TMJ was made. 13-15 In addition to shape and birefringence, MSU and CPPD differ in color depending on the axis of orientation with respect to the polarizer. When a patient presents with acute pain located in one joint you should from CHIN 041 at Dartmouth College. Because both types of crystals are birefringent, they refract the polarized light that passes through them. serum urate acid (SUA) levels do not confirm or exclude gout (although this is the most important risk factor for gout), since many people with hyperuricemia do not develop gout, and SUA levels may be normal during acute attacks. Gout occurs more commonly in those who regularly eat meat or seafood, drink beer, or are overweight. Both monosodium urate (gout) and calcium pyrophosphate dihydrate (pseudogout) crystals generally cause an acutely painful arthritis with an inflammatory fluid that has a leukocyte count >2000 per mm 3; these types of crystals can be visualized using polarized light microscopy. It is important to rule out other differential diagnoses including a septic joint or pseudo-gout, which on microscopic examination would reveal calcium pyrophosphate crystals that are rhomboid-shaped with weak positive birefringence on microscopic examination. Learning'[email protected]' • Understand'normal'ranges'for'Chemical' Pathology' • Understand'mostimportantconcepts'in'the'. However, other crystal materials, such as calcium oxalate, synthetic steroids, and ethylenediaminetetraacetic acid (EDTA), can be positive birefringent under polarized light [ 9 ]. Synovial fluid was opaque with low viscosity and friable clot. 96 Calcium Crystal Disease Calcium Pyrophosphate Dihydrate and Basic Calcium Phosphate Robert Terkeltaub Key Points Dysregulated chondrocyte differentiation to hypertrophy and inorganic pyrophosphate (PPi) metabolism are central in pathogenesis of calcium pyrophosphate dihydrate (CPPD) crystal deposition disease. The attacks typically last for 7 to 10 days, but also can be clustered and last for weeks to. 42 Additionally, radiographic imaging will reveal soft tissue swelling and chondrocalcinosis of the joint in pseudo­gout. Once the diagnosis has been confirmed, the drug options are of nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine and oral glucocorticoids, or intra-articular glucocorticoids administered via a joint injection. Gout and pseudogout are the 2 most common crystal-induced arthropathies. Gout attacks begin abruptly and typically reach maximal intensity within 8-12 hours. Pyrophosphate arthropathy is most common at the knee. Pyrophosphate arthropathy is a pathological condition characterized by the deposition of calcium pyrophosphate crystals in the cartilaginous tissue of the joints and the synovium and refers to microcrystalline arthritis. Tophaceous pseudogout is characterized by deposition of calcium pyrophosphate dihydrate (CPPD) crystals within soft tissue. Gout can be distinguished from pseudogout in that gout crystals (sodium urate) are needle shaped and have negative birefringence, while pseudogout crystals (calcium pyrophosphate) are rod or rhomboid shaped and have no or weak positive birefringence. Pseudogout is an inflammation of joints caused by the deposition of calcium pyrophosphate (CPP) crystals in articular and periarticular tissues. Polarized light microscopy demonstrates needle-shaped crystals with negative birefringence. If POCRS is able to detect these crystals more consistently than CPLM, it may offer clinicians additional and valuable information to aid in the diagnosis of pseudogouts. Urate crystals usually remain in the synovium after the acute attack has settled. ence of crystals with positive birefringence by polar-ized light microscopy, confirming the diagnosis of pe-riarticular pseudogout. Six months after surgery, the clinical symptoms are very mild, with inter-incisal opening of 40mm. If you are going to help alleviate the more you focus on something that is normal for someone didn't drink. 13, 14The authors described cases in which. Gout and pseudogout are arthritic diseases where crystalline deposits collect in the joints, leading to pain, stiffness, redness, and swelling. 14% of H-E stained and in 100. While the precipitants of a pseudogout attack are less well defined than those of gout, dehydration and joint surgery have both been identified as predisposing factors. at most pHs stained the crystals well, but smears frequently became partially de- tached and after dipping in distilled water, some of the dye lakes from around the crystals were washed away leaving some unstained. Birefringent Crystals in Polarized Light This interactive tutorial explores how birefringent anisotropic crystals interact with polarized light in an optical microscope. To view a pseudogout crystal. However, the crystal. [3] All synovial fluid samples obtained from undiagnosed inflamed joints should be examined for these crystals. Gout as a risk factor pseudogotta myocardial infarction pseudogota stroke in England: Comparative observation of the efficacy on acute pseudogota arthritis between acupuncture combined with infrared irradiation and western medicine. Histologic Findings The presence of crystal deposits in soft tissue results in adjacent chondroid metaplasia. tals with positive birefringence in pseudogout, MSU crystals with negative birefringence in gout, and calcium hydroxyapatite crystals without birefrin-gence in tumoral calcinosis. 9%) from 76 patients with pseudogout. An oslerphile emergency physician and intensivist suffering from a bad case of knowledge dipsosis. Making a Pseudogout Diagnosis Pseudogout hurts like gout, but the pain starts in a different spot. A definitive diagnosis of gout is based upon the identification of monosodium urate (MSU) crystals in synovial fluid or a tophus. 12 o Rapid development severe joint pain, stiffness, swelling, and tenderness peaking at 6-24 hours o Most common joints involved are knee, wrist and shoulder. Gout Vs Pseudogout Birefringence It could be as damage to these treatments for epilepsy gout accepted by the "sesamoid" bone). To the Editor: We thank Dr. This clinical image demonstrates the diagnostic value of the examination of joints as well as tendons by ultrasound. Pseudogout refers to articular disease associated with calcium pyrophosphate dehydrate crystals in synovial fluid or synovium. Pseudogout is a form of arthritis that causes pain, stiffness, tenderness, redness, warmth, and swelling in some joints. (On a side note, for board review, an easy way I remembered negative versus positive birefringence in gout or pseudogout was that: Positive starts with a "P," and pseudogout starts with a "P. Ca pyrophosphate crystals = rod shaped / rhomboid, weak positive. Monosodium urate crystals would confirm a gout diagnosis. The initial attack (flare) of gout is usually monarticular and often involves the 1st metatarsophalangeal joint. Tumoral pseudogout: Periarticular: Temporomandibular joint, perispinal tissues, joints of extremities: Radiopaque soft tissue mass with varying densities of calcification: Amorphous calcium deposits with numerous refractile radiating rhomboid crystals, demonstrates positive birefringence on polarized microscopy: Tophaceous gout: Periarticular. Ca pyrophosphate crystals = rod shaped / rhomboid, weak positive. 13 CPPD crystals can be distinguished by polarized microscope based on their rhomboidal shape, which displays weakly positive birefringence. What are synonyms for birefringent?. Learn vocabulary, terms, and more with flashcards, games, and other study tools. We report a case of acute pseudogout in a patient following angi-ography. Chart and Diagram Slides for PowerPoint - Beautifully designed chart and diagram s for PowerPoint with visually stunning graphics and animation effects. In pseudogout, CPP crystals appear shorter and. Acute CPPD arthritis is now the preferred term for this disease. Gout and pseudogout are arthritic diseases where crystalline deposits collect in the joints, leading to pain, stiffness, redness, and swelling. ,, In case of gouty tophus, it also has an added advantage of excellent preservation of crystals. Show References. The crystals havethe appearance ofpleomorphicgranules. GOUT AND PSEUDOGOUT: The 2 most common crystal-induced arthropathies Gout is caused by monosodium urate monohydrate crystals. The condition, which was first described in 1962, appears radiographically as chondrocalcinosis involving hyaline and fibrocartilage (5). Hematoxylin-eosin (H&E)-stained sections may not allow proper evaluation of birefringence properties of the crystals in the lesions of pseudogout, gout, and tumoral calcinosis. Chondrocalcinosis, unstained section, viewed under polarized light, (a) without Red I compensator, (b) with Red I compensator (a) The CPPD crystals have a rhomboid shape, they range in size from 5 to 40μm, and show a strong birefringence, x600, (b) The birefringence is positive with Red I compensator, x600. Discussion It seems likely that the acute arthritis occurring after parathyroidectomy in our patients represented pseudo- gout, which was diagnosed and differentiated from classical gout by the distribution of affected joints, by chondrocalcinosis within affected joints on X-ray, and by the finding of calcium-pyrophosphate crystals in the joint. Examination of the tissue under polarized light showed positively birefringent, short blunt crystals of calcium pyrophosphate dihydrate. Ethylene glycol poisoning. Specific gravity: Estimate of U Osm. Pathologic Diagnosis: Pseudogout (Chondrocalcinosis Articularis) Calcium pyrophosphate dihydrate (CPPD) crystals show the diagnostic positive birefringence (Figure 2, D and H) observed in this lesion. Because both types of crystals are birefringent, they refract the polarized light that passes through them. Antonyms for birefringent. Calcium pyrophosphate (pseudo-gout) crystals (A) are rhombohedral in appearance and show positive birefringence. The birefringence is often quantified as the maximum difference between refractive indices exhibited by the material. crystals with absent or weak positive birefringence) in synovial fl uid, or occasionally biopsied tissue. 1 They used a compensated polarized. Joint fluid aspiration demonstrates monosodium urate crystals that are needle shaped histologically and display negative birefringence on polarized microscopy. Six months after surgery, the clinical symptoms are very mild, with inter-incisal opening of 40mm. aseptic arthritis E. To view a pseudogout crystal. EULAR Recommendations for CPPD Management 3. Due to the wide range of WBC for septic arthritis have a high index of suspicion and do not discount the diagnosis because the WBC count is only 10,000. Pseudogout is caused by calcium pyrophosphate crystals. Gout (see the image below) is caused by monosodium urate monohydrate crystals; pseudogout is caused by calcium pyrophosphate crystals and is more accurately termed calcium pyrophosphate disease. Monosodium urate crystals would confirm a gout diagnosis. What are the radiologic findings in pseudogout? 5. (Case Report, Case study) by "Case Reports in Orthopedics"; Health, general Joint diseases Care and treatment Case studies Diagnosis Health aspects Wrist joint. Tophaceous pseudogout. Pseudogout Pseudogout is characterized by acute monoarthritis due to deposition of calcium pyrophosphate dihydrate (CPPD) crystals. The crystals had not undergone dissolution in the formalin fixative, as usually occurs with gout tophi. Arthrocentesis of these joints is a useful technique to establish the diagnosis of gout between attacks. Morphologically, the pseudogout lesions may resemble gout and other conditions, such as tumoral calcinosis. Surgical decompression was performed. Light passing through a calcite crystal is split into two rays. The differentiation between articular gout and pseudogout was based on histologic appearance, histochemical staining for calcium, and birefringence under polarized light. Pseudogout Page 2 of 5 1. They are almost never visible in Wright-Giemsa-stained blood films, although bite cells are markers of their presence. The sample should be preferably collected from newly affected joints, as well as from previously affected joints. Birefringence of CPP crystals is weaker or absent compared with MSU crystals, but we aim to evaluate whether the grade of birefringence varies regarding the shape of the CPP crystal. It is more common in elderly women. [3] All synovial fluid samples obtained from undiagnosed inflamed joints should be examined for these crystals. The presence of these features involving the knee, wrist or shoulder in patients with upper age 65 years suggests acute CPP crystal arthritis. Acute CPPD arthritis is now the preferred term for this disease. Hyperparathyroidism : hypercalcaemia and subperiosteal erosion's. 3,6,9,10 Synovial fluid analysis from a peripheral joint aspirate can show CPP crystals, with negative or weakly positive birefringence under polarized light microscopy. Fact Explanation; Joint pain: Pseudogout is an acute inflammatory monoarticular or oligoarticular arthritis. While imaging findings consistent with chondrocalcinosis support the diagnosis of CPPD, its absence does not rule it out. tals with positive birefringence in pseudogout, MSU crystals with negative birefringence in gout, and calcium hydroxyapatite crystals without birefrin-gence in tumoral calcinosis. Over a period of time joint may become severely damaged. The main difference is the type of crystals involved in the inflammation and damage. Pseudogout can sometimes be associated with other illnesses, such as:. The strong association of AS with HLA-B27 is direct evidence of the importance of genetic predisposition. With pseudogout, synovial fluid examination reveals positively birefringent crystals that are shaped like rhomboids. Identification of Gout Crystals One of the most common medical applications for polarized light microscopy is the identification of gout crystals monosodium urate with a first order retardation plate. Pseudogout crystals (CPP) are rod-shaped with blunt ends and are positively birefringent. A definitive diagnosis of gout is based upon the identification of monosodium urate crystals in synovial fluid or a tophus. Gout occurs more commonly in those who regularly eat meat or seafood, drink beer, or are overweight. Making a Pseudogout Diagnosis Pseudogout hurts like gout, but the pain starts in a different spot. Intracellular rhomboidal crystals with weakly positive birefringence were characteristic of fluid obtained from the affected joints in two patients. Start studying gout vs pseudogout. What this means is that when light is moving through a birefringent material, the part of light that is polarized along the "fast" axis will overtake the "slow" axis. " It derives its name from its similarity to gout. The initial attack (flare) of gout is usually monarticular and often involves the 1st metatarsophalangeal joint. ; Due to the wide range of WBC for septic arthritis have a high index of suspicion and do not discount the diagnosis because the WBC count is only 10,000. Purpose/Policy Statement:. Gout (see the image below) is caused by monosodium urate monohydrate crystals; pseudogout is caused by calcium pyrophosphate crystals and is more accurately termed calcium pyrophosphate disease. Histologically, calcium pyrophosphate dihydrate crystals were found in the fluid, and she was diagnosed as having a pseudogout attack of the yellow ligament. NSAID merupakan pengobatan gejala utama dan colchicine dosis rendah dapat digunakan untuk serangan akut atau kronik. Note the positive bifringence (blue) of rhomboid-shaped crystals versus the needle-shaped and negatively birefringent (yellow) crystals of gout. Gout Vs Pseudogout Birefringence It could be as damage to these treatments for epilepsy gout accepted by the “sesamoid” bone). The Author ROBERT M. Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, also known as pseudogout and pyrophosphate arthropathy is a rheumatologic disease which is thought to be secondary to abnormal accumulation of calcium pyrophosphate dihydrate crystals within joint soft tissues. We report a case of acute pseudogout in a patient following angi-ography. Birefringence of CPP crystals is weaker or absent compared with MSU crystals, but we aim to evaluate whether the grade of birefringence varies regarding the shape of the CPP crystal. These were examined 24 h after aspiration to test also the effect of 24 h preservation at +4°C on the crystal count. Crystals must be distinguished from birefringent cartilaginous or other debris. CPPD crystals have rhomboid or parallelelipedic morphology, and although frequently described as being weakly birefringent, it has been noted that some CPPD crystals lack birefringence when analysed under polarized LM. I suppose the best way to differentiate this case from pseudogout is that the crystals are sharp & needle-shaped and not rhomboid-shaped. Inflammatory arthritis-NOS was seen in 22% cases. Study Flashcards On USMLE Step 2CK - Musculoskeletal at Cram. OBJECTIVE To determine the proportion of calcium pyrophosphate dihydrate (CPPD) crystals that appear as non-birefringent when observed under the polarised. Arthritis is an illness that causes pain & swelling in joints. (Case Report, Case study) by "Case Reports in Orthopedics"; Health, general Joint diseases Care and treatment Case studies Diagnosis Health aspects Wrist joint. Joint Fluid Crystal Analysis Analysis of joint fluid aspirate for crystals may establish the diagnosis of gout or pseudogout, depending on their shape and birefringence. Birefringence of CPP crystals is weaker or absent compared with MSU crystals, but we aim to evaluate whether the grade of birefringence varies regarding the shape of the CPP crystal. For showing birefringence we need a lambda plate compensator. In pseudogout, the precipitating culprit is calcium-pyrophosphate. Crystal deposits have been provoking inflammatory reaction of different intensity. The diagnosis for gout is made based on a physical examination by your doctor, x-rays, and lab tests. The preparation of synovial fluid control in an aqueous base has been described above. The Author ROBERT M. Examination of the tissue under polarized light showed positively birefringent, short blunt crystals of calcium pyrophosphate dihydrate. Thus, pseudogout crystals are blue when aligned parallel to the slow ray of the compensator and yellow when they are perpendicular. Synovial fluid was opaque with low viscosity and friable clot. Although the symptoms of gout and pseudogout are similar, the underlying causes are different. A 35 year-old man presented with pain in the left ear area. A Congo red stain demonstrated scattered amyloid deposits with polarization optics. Identification of Gout Crystals One of the most common medical applications for polarized light microscopy is the identification of gout crystals monosodium urate with a first order retardation plate. Research has shown that Hematoxylin and Eosin staining may not allow proper evaluation of birefringence properties of the crystals in a specimen. Pathologic Diagnosis: Pseudogout (Chondrocalcinosis Articularis) Calcium pyrophosphate dihydrate (CPPD) crystals show the diagnostic positive birefringence (Figure 2, D and H) observed in this lesion. The crystals showing negative birefringence. Note the positive bifringence (blue) of rhomboid-shaped crystals versus the needle-shaped and negatively birefringent (yellow) crystals of gout. These particular needles made of monosodium urate will, as a rule, when laid flat with. crystal inflammation though not specific to one crystal. Pseudogout is caused by calcium pyrophosphate crystals. The majority of the CPP crystals identified in the lens-free image can be found in the CPLM image, but due to their low birefringence it is hard to distinguish the crystals from the background. It is more common in elderly women. This is the first reported case of pseudogout in TKR. The 24 multiple choice questions about Synovial Fluid. They rotate the plane of polarized light in a weakly positive direction designated as positive birefringence. The sample should be preferably collected from newly affected joints, as well as from previously affected joints. Our case highlights the importance of including crystal arthropathy as a differential diagnosis in suspected infections of TKRs. Chondrocalcinosis is the deposition of CPPD crystals into fibrous or hyaline cartilage. While just another one of the price of tophi will appeal to participants achieved through a wide number of cartilage layer is complication different joint damage and kidney failure is to reduce the risk of. Calcium pyrophosphate dihydrate (CPPD) crystals, which are present in conditions termed "pseudogout," exhibit positive birefringence. Often you can see them with regular light microscopy within monocytic/histiocytic cells. Methylprednisolone acetate crystal fragments are tiny, pleomorphic, andtend to clump or agglutinate. The presence of these features involving the knee, wrist or shoulder in patients with upper age 65 years suggests acute CPP crystal arthritis. Acute podagra due to gout. You can see the stones with X-ray and the crystals with a urinalysis; they can be dissolved or surgically removed. Pseudogout, or calcium pyrophosphate deposition disease, can mimic gout in clinical appearance and may respond to nonsteroidal anti-inflammatory drugs NSAIDs. Gout is an inflammatory disease where uric acid precipitates into crystals that deposit in various joints around the body, causing pain and inflammation. Two main types of crystal arthropathies: Gout - The most common of all the crystal arthropathies, caused by monosodium urate crystal precipitation, and its prevalence appears to be increasing. The fluoroscopy-guided aspiration yielded bloody synovial fluid, with rhombus-shaped extracellular calcium pyrophosphate crystals (weak positive birefringence under polarized light microscopy), consistent with pseudogout. These crystals are rod-shaped or rhomboids varying in length from 2 to 20 µm and with positive birefringence (blue with parallel light, yellow with perpendicular light). PDF | Hematoxylin-eosin (H&E)-stained sections may not allow proper evaluation of birefringence properties of the crystals in the lesions of pseudogout, gout, and tumoral calcinosis. Under polarized light microscopy, needle-shaped crystals with strong negative birefringence were seen in all these surgical specimens. This precipitates as crystals (rod shaped birefringent) in the cartilage of the wrist, especially on the ulnar sided TFCC (triangular fibro cartilage complex). The specimen included synovium with extensive fibrinoid and some cartilaginous degeneration. If a search for CPPD crystals is conducted under polarised light, the majority of the crystals will be missed. The presence of such crystals intracellularly is pathognomonic for acute pseudogout. Tophaceous pseudogout. Section stained with. Acute podagra due to gout. The phagocyte is a neutrophil. Gout is due to hyperuricemia (present in 10% of population, although only half develop gout) and deposition of monosodium urate crystals in joints and viscera and uric acid kidney stones Need serum urate > 7 mg/dl for deposition (saturation threshold for urate at 98. It can affect one or several joints at once. " So, the crystals in pseudogout cases will have positive birefringence, and in gout, they will have negative birefringence). Pyrophosphate arthropathy is a pathological condition characterized by the deposition of calcium pyrophosphate crystals in the cartilaginous tissue of the joints and the synovium and refers to microcrystalline arthritis. Surgical decompression was performed. Pseudogout is a form of arthritis that causes pain, stiffness, tenderness, redness, warmth, and swelling in some joints. Pseudogout Crystals = (+)birefringence under polarized light I know that the above is correct, so how come gout crystals are 2 different colors under polarized light (yellow & blue), while pseudogout crystals are only 1 color under polarized light (blue). As its name implies, pseudogout has many of the same symptoms as gout, including the sudden onset of severe pain, swelling, warmth, and redness in a joint. Calcium pyrophosphate dehydrate (CPPD) crystals dissolve after several hours. Pseudogout refers to articular disease associated with calcium pyrophosphate dehydrate crystals in synovial fluid or synovium. The coexistence of gout and pseudogout is unusual but has been reported previous- ly. Uric acid (gout) is "Needle-shaped crystals with Negative birefringence). Over a period of time joint may become severely damaged. The aim of our study was to investigate the efficacy of a dual-energy computed tomography (DECT) for detecting CPPD crystals in knee meniscus. The gold standard in the diagnosis of gout is the observation of monosodium urate crystals under compensated polarized light microscopy; for this examination, these crystals exhibit negative birefringence. 96 Calcium Crystal Disease Calcium Pyrophosphate Dihydrate and Basic Calcium Phosphate Robert Terkeltaub Key Points Dysregulated chondrocyte differentiation to hypertrophy and inorganic pyrophosphate (PPi) metabolism are central in pathogenesis of calcium pyrophosphate dihydrate (CPPD) crystal deposition disease. However, we did find many crystals in the synovial fluid that exhibited a Maltese cross-like birefringence. IV 99 (97 to 100). Specific gravity: Estimate of U Osm. The coexistence of gout and pseudogout is unusual but has been reported previous- ly. 1 synonym for birefringence: double refraction. In addition, the spectroscopic extension of the polarization-dependent angle-resolved light scattering is demonstrated using wavelength-scanning illumination. Wherever I look about birefringence of gout or pseudogout all I find is negative or positive birefrigence, respectively. The Kansas City Field Guide to Pathology Ed Friedlander MD [email protected] However, it rarely affects the TMJ. Gout attacks begin abruptly and typically reach maximal intensity within 8-12 hours. Findings of calcium pyrophosphate crystals and normal serum uric acid levels on joint fluid analysis can differentiate pseudogout from gout. Since monosodium urate is dissolved by aqueous Disease (Pseudogout)solutions, formalin fixation and conventional tissueprocessing usually result in the loss of the crystal from tissue Pseudogout is so named because it is a clinicalsections. Our new CrystalGraphics Chart and Diagram Slides for PowerPoint is a collection of over 1000 impressively designed data-driven chart and editable diagram s guaranteed to impress any audience. The main difference is the type of crystals involved in the inflammation and damage. Open Access Rheumatology: Research and Reviews Dovepress open access to scientific and medical research Open Access Full Text Article Review Calcium pyrophosphate crystal deposition disease: diagnosis and treatment José Luis Rosales- Abstract: Calcium pyrophosphate dihydrate crystal deposition disease (CPPD) is an inflammatory Alexander 1 arthritis produced by the deposition of calcium. I suppose the best way to differentiate this case from pseudogout is that the crystals are sharp & needle-shaped and not rhomboid-shaped. Gout can be distinguished from pseudogout in that gout crystals (sodium urate) are needle shaped and have negative birefringent, while pseudogout crystals (calcium pyrophosphate) are rhomboid shaped and have weak positive birefringent. — Positive birefringence (i. A large needle like crystal is a monosodium urate crystal which cause inflmmation. Birefringence is responsible for the phenomenon of double re. Gout/pseudogout are covered as part of the PANCE Musculoskeletal Blueprint. Thus, pseudogout crystals are blue when aligned parallel to the slow ray of the compensator and yellow when they are perpendicular. crystals under polarised light. Pseudogout = rhomboid-shaped, positively birefringent, blue when aligned. Ordinary light allows a better rate of CPPD crystal detection but observation under polarised light of crystals showing birefringence is required for definitive CPPD crystal identification. presence of calcium (Fig. This occurs from a combination of diet, other health problems, and genetic factors. Tophaceous pseudogout is characterized by deposition of calcium pyrophosphate dihydrate (CPPD) crystals within soft tissue. Uric acid (gout) is "Needle-shaped crystals with Negative birefringence). Urate crystals have been. See All About Gout - Symptoms, Diagnosis, Treatment. Case 2 A 67-year-old male was referred to our otology clinic for a left middle ear osteoma associated with progressive conductive hearing loss for a few years. Intracellular rhomboidal crystals with weakly positive birefringence were characteristic of fluid obtained from the affected joints in two patients. Urate crystals usually remain in the synovium after the acute attack has settled. Gout and pseudogout can be differentiated by examination of the fluid aspirate contents of a joint viewed under polarised red light: Urate crystals – are negatively birefringent – they will appear a needle shaped crystals (image below). , Classic triad of biotin deficiency, The study best used to determine the most common cause of vitamin B12 deficiency secondary to pernicious anemia is this. The attacks typically involve a large joint, most often the knee and less often the wrist or ankle, and, unlike gout, rarely the first metatarsophalangeal joint. Results: Figure 1 shows the comparison of MSU crystal images taken by a compensated polarizing microscope (A), a lens-free differential grayscale image (B) and a lens-free color-coded image (C). Birefringence of CPP crystals is weaker or absent compared with MSU crystals, but we aim to evaluate whether the grade of birefringence varies regarding the shape of the CPP crystal. There have been some reports of lumbar spinal stenosis caused by calcium pyrophosphate dihydrate crystal deposition. (figure 3) Total count was 4500 cells/cumm with a predominance of neutrophils. what is the best initial treatment for. The aim of our study was to investigate the efficacy of a dual-energy computed tomography (DECT) for detecting CPPD crystals in knee meniscus. In gout, crystals of MSU appear as needle-shaped intracellular and extracellular crystals. Morphologically, the pseudogout lesions may resemble gout and other conditions, such as tumoral calcinosis. The identification of rod- or rhomboid-shaped CPPD crystals showing no or weakly positive birefringence by compensated light microscopy of joint fluid aspirated from an actively symptomatic joint is diagnostic of pseudogout or chondrocalcinosis. BOSTON — To differentiate definitively between acute gout and pseudogout, look at the crystals. The time interval separating the first attack from subsequent episodes of acute synovitis may be widely variable, ranging from a few days to several years. These crystals are rod-shaped or rhomboids varying in length from 2 to 20 µm and with positive birefringence (blue with parallel light, yellow with perpendicular light). In the article Crystal lography the nature and behaviour of twinned crystal s receives full treatment; here it is sufficient to say that when the planes and axes of twinning are planes and axes of symmetry, a twin would exhibit higher symmetry (but remain in the same crystal system) than the primary crystal; and, also, if a crystal approximates. It can affect one or several joints at once. " It derives its name from its similarity to gout. These crystals typically present positive birefringence. CPPD crystals also polarize light but are positively birefringent (crystals aligned with the compensator filter are blue, whereas those lying perpendicular are yellow. 5 mL of pus-like synovial effusion. This occurs from a combination of diet, other health problems, and genetic factors. These are the most common crystals and stones found in the dog and cat. Gout and pseudogout can be differentiated by examination of the fluid aspirate contents of a joint viewed under polarised red light: Urate crystals - are negatively birefringent - they will appear a needle shaped crystals (image below). microscope to investigate CPPD crystal and found the character of weakly positive birefringence. Gout and pseudogout are the two most common crystal-induced arthropathies. The crystals are chemotactic and activate complement. Preview Flashcards. , CPPD crystals) : Present if the crystal appears blue when parallel to the axis of the compensator and yellow when perpendicular. No crystals were found in circulating leucocytes. Uric acid (gout) is "Needle-shaped crystals with Negative birefringence). These crystals found in Pseudogout. Here is a mnemonic from category Pathology named Gout vs. I suppose the best way to differentiate this case from pseudogout is that the crystals are sharp & needle-shaped and not rhomboid-shaped. ; Due to the wide range of WBC for septic arthritis have a high index of suspicion and do not discount the diagnosis because the WBC count is only 10,000. Microscopic examination of the joint fluid reveals negative, birefringent, needle-shaped crystals. Study Pathoma - Joint Disorders flashcards from Don Draper's class online, or in Brainscape's iPhone or Android app. With Rad I compensator the HA crys-tals showed positive birefringence (Figure 14a-c). Generally more rectangular birefringent pyrophosphate crystals are seen in other arthritides. 73) A 64-year-old male presents to his primary care physician with a chief complaint of left knee pain. ,, In case of gouty tophus, it also has an added advantage of excellent preservation of crystals. They rotate the plane of polarized light in a weakly positive direction designated as positive birefringence. These are the most common crystals and stones found in the dog and cat. The images taken by the novel technique was able to accurately demonstrate the direction and the strength of birefringence and the shape of MSU crystals. strongly suggests gout/pseudogout. ; In pseudogout attacks resembling those of acute gout or a more insidious onset that occurs over several days. Sodium Urate Crystals w/ Negative Birefringence under Polarized Light Microscopy--> Long Needle-Like Crystal. Only rarely are MSU crystals sought in tissue samples; because formalin dissolves the crystals, a biopsy performed to search for MSU crystals should be fixed in alcohol or processed by freezing. Metrics Links Files Go to Pseudogout of the Knee after Intraarticular Injection of Hyaluronic Acid. Diagnosis – identification of crystals (on polarising light microscopy) in fluid or tophi samples taken from the joint. Over a period of time joint may become severely damaged.