Calcium Pyrophosphate Dihydrate Crystal Deposition in Gouty Tophi.
Journal
Arthritis & rheumatology (Hoboken, N.J.)
ISSN: 2326-5205
Titre abrégé: Arthritis Rheumatol
Pays: United States
ID NLM: 101623795
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
29
04
2020
accepted:
25
08
2020
pubmed:
11
9
2020
medline:
2
3
2021
entrez:
10
9
2020
Statut:
ppublish
Résumé
The coexistence of calcium pyrophosphate dihydrate (CPPD) and monosodium urate monohydrate crystals in gouty tophi has rarely been reported. We undertook this study to investigate CPPD crystal deposits in a series of surgically removed gouty tophi and to identify factors associated with these deposits. Twenty-five tophi from 22 gout patients were analyzed using polarized light microscopy, field emission scanning electron microscopy (FESEM), and μ Fourier transform infrared (μFTIR) spectroscopy. Tophi consisted of multiple lobules separated by fibrous septa and surrounded by a foreign-body giant cell reaction. CPPD crystal aggregates were identified in 9 of 25 tophi from 6 patients. CPPD crystals were dispersed or highly compacted, localized at the edge or inside the tophus lobules, with some lobules completely filled with crystals. Both monoclinic and triclinic CPPD crystal phases were identified using FESEM and μFTIR. Compared to patients without CPPD, those with CPPD-containing tophi were older (mean 60.5 years versus 47.2 years; P = 0.009), and had longer-term gout duration (mean 17.0 years versus mean 9.0 years; P < 0.05) and tophi duration (mean 10.0 years versus mean 4.6 years; P < 0.01). None of the patients had radiographic chondrocalcinosis of the knee or wrist. CPPD crystal formation seems to be a late and frequent event of tophus maturation, occurring more frequently with aging, and could contribute to the speed of tophus dissolution and the apparent persistence of tophus sometimes observed even after effective, long-lasting urate-lowering therapy.
Substances chimiques
Uric Acid
268B43MJ25
Calcium Pyrophosphate
X69NU20D19
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
324-329Informations de copyright
© 2020, American College of Rheumatology.
Références
Ankli B, Kyburz D, Hirschmann A, Hügle T, Manigold T, Berger CT, et al. Calcium pyrophosphate deposition disease: a frequent finding in patients with long-standing erosive gout. Scand J Rheumatol 2018;47:127-30.
Robier C, Neubauer M, Quehenberger F, Rainer F. Coincidence of calcium pyrophosphate and monosodium urate crystals in the synovial fluid of patients with gout determined by the cytocentrifugation technique [letter]. Ann Rheum Dis 2011;70:1163-4.
Heselden EL, Freemont AJ. Synovial fluid findings and demographic analysis of patients with coexistent intra-articular monosodium urate and calcium pyrophosphate crystals. J Clin Rheumatol 2016;22:68-70.
Dalbeth N, Pool B, Gamble GD, Smith T, Callon KE, McQueen FM, et al. Cellular characterization of the gouty tophus: a quantitative analysis. Arthritis Rheum 2010;62:1549-56.
Lichtenstein L, Scott HW, Levin MH. Pathologic changes in gout. Am J Pathol 1956;32:871-95.
Bousson V, Bardin T, Zeitoun D, Sverzut JM, Ea HK. Monosodium urate deposition in the articular cartilage and meniscus can mimic chondrocalcinosis [letter]. Joint Bone Spine 2020;87:95-6.
Ottaviani S, Forien M, Dieudé P. A radiographic double contour sign mimicking pseudogout. J Clin Rheumatol 2018;24:92.
Gerster JC, Landry M, Dufresne L, Meuwly JY. Imaging of tophaceous gout: computed tomography provides specific images compared with magnetic resonance imaging and ultrasonography. Ann Rheum Dis 2002;61:52-4.
Grahame R, Sutor DJ, Mitchener MB. Crystal deposition in hyperparathyroidism. Ann Rheum Dis 1971;30:597-604.
Hajri R, Hajdu SD, Hügle T, Zufferey P, Guiral L, Becce F. Dual-energy computed tomography for the noninvasive diagnosis of coexisting gout and calcium pyrophosphate deposition disease. Arthritis Rheumatol 2019;71:1392.
Mohr W, Görz E. Mixed tophi: calcium pyrophosphate dihydrate crystals in gout tophi. Z Rheumatol 2000;59:240-4. In German.
Gras P, Ratel-Ramond N, Teychéné S, Rey C, Elkaim E, Biscans B, et al. Structure of the calcium pyrophosphate monohydrate phase (Ca2P2O7·H2O): towards understanding the dehydration process in calcium pyrophosphate hydrates. Acta Crystallogr C Struct Chem 2014;70:862-6.
Mandel GS, Halverson PB, Mandel NS. Calcium pyrophosphate crystal deposition: the effect of monosodium urate and apatite crystals in a kinetic study using a gelatin matrix model. Scanning Microsc 1988;2:1189-98.
Mohr W, Hersener J, Richter R, Buchner F. Fadengranulome mit Kalziumpyrophosphat-Ablagerungen. Z Orthop Ihre Grenzgeb 1990;128:134-8.
Bos I. Tissue reactions around loosened hip joint endoprostheses. A histological study of secondary capsules and interface membranes. Orthopade 2001;30:881-9. In German.