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The most common crystal-related arthropa-Thies—gout, calcium pyrophosphate dihydrate
disease or “pseudogout,” and calcific periarthritis/tendinitis—may be appropriately
diagnosed and managed by the primary care physician. Definitive diagnosis via synovial
tap is recommended, as the clinical picture may not identify some cases. The acute
pain and swelling of attacks, regardless of etiology, generally respond to treatment
with nonsteroidal anti-inflammatory drugs and local or occasionally systemic corticosteroids.
Once a causative crystal has been identified and a diagnosis established, a plan for
long-term management and prevention of recurrences may be devised. Thus, uric-acid-lowering
therapy may be indicated in a patient who has experienced recurrent attacks of gout,
whereas control of serum phosphate levels might be effective in some individuals with
hyperphosphatemia and hydroxyapatite-associated periarthritis or arthritis. Crystal
deposits in joints can be destructive as well as painful. Treatment, therefore, has
two objectives: To relieve the pain of the acute attack, thus restoring normal function,
and to prevent the accumulation of crystals that can lead to degenerative disease.
Identification and subsequent treatment of preventable or correctable underlying disorders
may be one of the most gratifying aspects of managing crystal-induced arthropathies.
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© 1996 Published by Elsevier Inc.
