2005 Oct. 7(10):656-60. Clinical Utility of Multi-Energy Spectral Photon-Counting Computed Tomography in Crystal Arthritis. 2014 Jan. 66(1):69-73. The urate transporter 1 (URAT1) gene is involved with the urate-organic anion exchanger. [Medline]. [Full Text]. Arthritis Rheum. It can affect one or several joints at once. In a cross-sectional study in the national Veterans Affairs (VA) population that included 25,157 patients with CPDD, the strongest positive associations with CPDD were as follows Diseases & Conditions, 2010 378 (13):1200-1210. Gout as a risk factor for myocardial infarction and stroke in England: evidence from record linkage studies. [Medline]. [Medline]. 2011 Mar 3. [emedicine.medscape.com] Soft Tissue Mass. Treatment-failure gout: a moving target. Slideshow, encoded search term (Calcium Pyrophosphate Deposition Disease) and Calcium Pyrophosphate Deposition Disease, Trending Clinical Topics for October 2018. 2006 Apr. Krystexxa (pegloticase). Ultrasound characteristics of gouty tophi in the olecranon bursa and evaluation of their reproducibility. Ann Rheum Dis. Chohan S, Becker MA, MacDonald PA, Chefo S, Jackson RL. Arthritis Rheum. 21(2):89-93. Arthritis Care Res (Hoboken). Meta-analysis of 28,141 individuals identifies common variants within five new loci that influence uric acid concentrations. [Medline]. Dalbeth N, Reid S, Stamp LK, Arroll B. FitzGerald JD, Mikuls TR, Neogi T, Singh JA, Robbins M, Khanna PP, et al. Taniguchi Y, Yoshida M, Tamaki T. Posterior interosseous nerve syndrome due to pseudogout. Ann Rheum Dis. 2014 Jan. 53(1):95-103. 2005 Nov. 54(11):1435-41. 2011 May. Perez-Ruiz F, Sundy JS, Miner JN, Cravets M, Storgard C, RDEA594-203 Study Group. 1953 May 2. [2] : Patients with CPDD can experience significant morbidity due to the pain of an acute attack of pseudogout or to symptoms of chronic arthropathy. (See Presentation.). Jacques T, Michelin P, Badr S, Nasuto M, Lefebvre G, Larkman N, et al. These patients should be properly evaluated and counseled. [Medline]. Yokose C, McCormick N, Chen C, Neogi T, Chaisson C, Terkeltaub R, et al. JAMA. [Medline]. 17(3):341-5. [Medline]. Arthritis Rheum. [23] : Overproduction of uric acid may also occur in disorders that cause high cell turnover with release of purines that are present in high concentration in cell nuclei. [Medline]. Urate crystals can form in people who have high levels of uric acid in the blood. [Guideline] Qaseem A, Harris RP, Forciea MA, Clinical Guidelines Committee of the American College of Physicians. BCP crystal deposits in periarticular soft tissue can be asymptomatic or elicit acute calcific periarthritis, tendonitis, bursitis, enthesitis and, less often, arthritis. Calcium pyrophosphate deposition disease. J Rheumatol . ... Hunt B, Streit J, et al. [11] Nearly 50% of people older than 85 years have radiologic evidence of chondrocalcinosis. 10(3):218-27. [Medline]. Radiograph of the wrist and hand showing chondrocalcinosis of the articular disc of the wrist and atypical osteoarthritis involving the metacarpophalangeal joints in a patient with underlying hemochromatosis. 46 (7):748-750. The direction of the compensator was not changed and is indicated by the black arrow. 2013 Sep 17. A literature review of the epidemiology and treatment of acute gout. Available at https://wayback.archive-it.org/7993/20170113075756/http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm116853.htm. Semin Arthritis Rheum. 2010 Nov 24. Charcot arthropathy results in progressive destruction of bone and soft tissues at weightbearing joints; in its most severe form, it may cause significant disruption of the bony architecture. [Medline]. Kobylecki CJ, Afzal S, Nordestgaard BG. 54(3):1025. J Rheumatol. Share cases and questions with Physicians on Medscape consult. [34, 35] A study of 514 male twin pairs did show a strong concordance in hyperuricemia among monozygotic (MZ) twins (53%) as compared with dizygotic (DZ) twins (24%), but it did not show a significant difference between MZ and DZ twins with regard to the lifetime prevalence of gout. Zaka R, Williams CJ. [Full Text]. 2004 Aug. 31(8):1575-81. Febuxostat. 13(3):634-6. 2002 Ryan LM, Wortmann RL, Karas B. Pyrophosphohydrolase activity and inorganic pyrophosphate content of cultured human skin fibroblasts. [40, 41]. [Medline]. Clin Exp Rheumatol. 152(1):37-8. 108(7):352; author reply 352-3. May 9, 2017; Accessed: May 15, 2017. Choi HK, Curhan G. Gout: epidemiology and lifestyle choices. 2008 Feb 9. Ultrasound detection of cartilage calcification at knee level in calcium pyrophosphate deposition disease. 2012 Oct. 64(10):1447-61. Curr Rheumatol Rep. 2004 Jun. Gout. [30, 31, 32, 33], In particular, 3 genes are noted to have a strong association with hyperuricemia. Rheumatology (Oxford). [Medline]. [Medline]. Bruce M Rothschild, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Rheumatology, International Skeletal Society, New York Academy of Sciences, Sigma Xi, The Scientific Research Honor Society, Society of Skeletal RadiologyDisclosure: Nothing to disclose. Arch Intern Med. The gout patient in general practice. BMJ. 2008;3(1):1-9.: Garg R, Sayles HR, Yu F, Michaud K, Singh J, Saag KG, et al. 2015 Nov. 35 (11):1799-807. 68(13):1865-74. 42(3):513-20. Calcium pyrophosphate deposition disease (CPDD) is a metabolic arthropathy caused by the deposition of calcium pyrophosphate dihydrate in and around joints, especially in articular cartilage and fibrocartilage. This video describes the pathophysiology, causes, symptoms, and treatment of gout. Gout is caused by monosodium urate monohydrate crystals; pseudogout is caused by calcium pyrophosphate (CPP) crystals and is more accurately termed calcium pyrophosphate disease (CPPD). The crystals parallel to the compensator were blue, while those perpendicular to the compensator were yellow. [Medline]. February 21, 2019; Accessed: February 24, 2019. Polymorphisms in the ABCG2 gene, which is located on chromosome 4 and codes for an intestinal urate transporter, are strongly associated with high serum uric acid concentrations and gout. [69] Among middle-aged men, hyperuricemia is a significant independent risk factor for death from cardiovascular disease. 372(9654):1953-61. 2018 May. [Medline]. The role of uric acid in pediatric hypertension. [Medline]. 14(4):R193. [Medline]. Kelly JC. [28, 55] The estimated prevalence of gout is 5.9% in men and 2% in women. [Medline]. Outcome evaluations in gout. Pritzker KP, Cheng PT, Renlund RC. Cyclosporine A can cause an accelerated form of gout, even in premenopausal women, that can present after only a few years of hyperuricemia, particularly if the patient is also receiving diuretics. [Medline]. KOSKOFF YD, MORRIS LE, LUBIC LG. Moltó A, Ea HK, Richette P, Bardin T, Lioté F. Efficacy of anakinra for refractory acute calcium pyrophosphate crystal arthritis. Stocker SL, Graham GG, McLachlan AJ, Williams KM, Day RO. McQueen FM, Doyle A, Reeves Q, Gao A, Tsai A, Gamble GD. ... Gout Although roentgen alterations may accompany the initial bouts of gouty arthritis, the roentgenographic evaluation of most patients with clinical evidence of gout spanning many years will show no important changes. Cases of simultaneous crystal arthropathy and septic arthritis can also occur however, further complicating the clinical evaluation[6]. 113(3):462-5. Hall AP, Barry PE, Dawber TR, McNamara PM. Individual gout flares are often triggered by acute increases or decreases in urate levels that may lead to the production, exposure, or shedding of crystals. Puig JG, Michan AD, Jimenez ML, et al. Dietary and lifestyle changes associated with high prevalence of hyperuricemia and gout in the Shandong coastal cities of Eastern China. SLC2A9 is a newly identified urate transporter influencing serum urate concentration, urate excretion and gout. Chen JH, Lan JL, Cheng CF, Liang WM, Lin HY, Tsay GJ, et al. [Medline]. Ann Rheum Dis. Accessed: September 8, 2014. [5]. [Medline]. 2012 Jun 7. Biologics in the treatment of calcium pyrophosphate deposition disease: a systematic literature review. [Medline]. Arch Ophthalmol. Spinal Cord. Acute podagra due to gout in elderly man. [Medline]. Janssens HJ, Fransen J, van de Lisdonk EH, van Riel PL, van Weel C, Janssen M. A diagnostic rule for acute gouty arthritis in primary care without joint fluid analysis. [Full Text]. Lottmann K, Chen X, Schädlich PK. CMAJ. Forien M, Combier A, Gardette A, Palazzo E, Dieudé P, Ottaviani S. Comparison of ultrasonography and radiography of the wrist for diagnosis of calcium pyrophosphate deposition. Examination of joi… Prevalence and Natural Course of Transverse Ligament of the Atlas Calcification in Asymptomatic Healthy Individuals. Currently, East La Paz Family Medical Clinic specializes in General Practice with 1 physician. Oostveen JC, van de Laar MA. [45] Some disorders that can lead to secondary pseudogout, such as hemochromatosis, do have a clear genetic cause. Kudoh K, Kudoh T, Tsuru K, Miyamoto Y. Cardiovascular Safety of Febuxostat or Allopurinol in Patients with Gout. Genetic factors associated with gout and hyperuricemia. 2010. [72, 73], Risk for vascular disease is increased in patients with gout, particularly women, according to a retrospective cohort study from the United Kingdom that included 8386 patients with gout and 39,766 matched controls. 1982 Nov. 12(2):256-64. [1, 2] known since the time of the ancient Greeks. Saffar P. Chondrocalcinosis of the wrist. [Medline]. European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Certain comorbid conditions are associated with a higher incidence of gout, including the following Dalbeth N, Choi HK, Terkeltaub R. Review: Gout: A Roadmap to Approaches for Improving Global Outcomes. J Am Coll Radiol. 1966 Mar. Changes in the cartilage matrix may play an important role in promoting CPPD deposition. Rate ratios for stroke were 1.71 for all stroke, 1.68 for ischemic stroke, 1.69 for hemorrhagic stroke, and 2.00 for stroke of unspecified type. The presence of urate crystals in the soft tissues and synovial tissues is a prerequisite for a gouty attack. [8] (See Treatment. Curr Rheumatol Rep. 2008 Jul. High-powered view of calcium pyrophosphate dihydrate crystals with compensated polarized microscopy. [Medline]. Wallace C, Newhouse SJ, Braund P, Zhang F, Tobin M, Falchi M, et al. 321(5):287-92. 2007. [Full Text]. 2008. Clin Rheumatol. 2012 May. When excretion is insufficient to maintain serum urate levels below the saturation level of 6.8 mg/dL, hyperuricemia may develop, and urate can crystallize and deposit in soft tissues. Clinical Utility of Multi-Energy Spectral Photon-Counting Computed Tomography in Crystal Arthritis. 2003 Jun. Rheumatology (Oxford). [Medline]. 353(23):2450-61. Efficacy and tolerability of pegloticase for the treatment of chronic gout in patients refractory to conventional treatment: two randomized controlled trials. BMC Geriatr. Singer JZ, Wallace SL. Ultrasound-detected musculoskeletal urate crystal deposition: which joints and what findings should be assessed for diagnosing gout?. Right images depict anterior cruciate ligament. Rheumatology (Oxford). 2004 Jul. [57] The higher prevalence of gout in elderly persons may also reflect an increased prevalence of metabolic syndrome, high rates of diuretic treatment for hypertension and chronic heart failure, and the use of low-dose aspirin. Gout may be either primary or secondary (see Etiology). 2015 Sep. 21 (6):314-7. [Medline]. Treatment of the acute phase of pseudogout follows the same approaches as are used in gout, and colchicine is effective for prophylaxis. Loffler C, Sattler H, Peters L, Loffler U, Uppenkamp M, Bergner R. Distinguishing gouty arthritis from calcium pyrophosphate disease and other arthritides. Crystal Fancher is a practicing General Surgery doctor in Macon, GA. Dr. Fancher graduated from the Medical University of South Carolina College of Medicine in 2014. 13(2):124-30. Lin HY, Rocher LL, McQuillan MA, Schmaltz S, Palella TD, Fox IH. Rheumatol Int. 357:j1794. Arthritis Rheum. [Medline]. 38(5):904-10. 151(4):726-32. The radiographic hallmark of CPPD is the presence of chondrocalcinosis and secondary osteoarthritic changes. [Medline]. 2019 Jul. 2017 May. Gout. Advances in early diagnosis and the availability of definitive treatment have significantly improved the prognosis of gout, as evidenced by the declining incidence of disabling chronic tophaceous gout. Br J Rheumatol. 35(3):771-3. [Medline]. Radiograph of the knee showing chondrocalcinosis involving the meniscal cartilage, as well as evidence of osteoarthritis. 2006 Oct. 65(10):1312-24. J Rheumatol. [Medline]. [Medline]. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Gutierrez M, Di Geso L, Salaffi F, Carotti M, Girolimetti R, De Angelis R, et al. [Medline]. [Medline]. Calcium pyrophosphate deposition disease. Podagra (initial joint manifestation in 50% of gout cases and eventually involved in 90%; also observed in patients with pseudogout and other conditions) 2. Al-Arfaj AM, Nicolaou S, Eftekhari A, Munk P, Shojani K, Reid G, et al. 46(7):1116-21. [Medline]. [Medline]. [Medline]. Agents used include the following: Because these agents change serum and tissue uric acid levels, they may precipitate acute attacks of gout. Nat Rev Rheumatol. 2008 Jul 15. Gout-related health care utilization in US emergency departments, 2006 through 2008. Poh YJ, Dalbeth N, Doyle A, McQueen FM. Medscape Medical News. 10(3):112. 168(10):1104-10. Association between gout and all-cause as well as cardiovascular mortality: a systematic review. Unnecessary morbidity and mortality. 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