Crystal-induced arthritis: An overview

  • H. Ralph Schumacher Jr.
    Requests for reprints should be addressed to H. Ralph Schumacher, Jr., MD, Division of Medicine, University of Pennsylvania School of Medicine, Division of Rheumatology, Hospital of the University of Pennsylvania, 3400 Spruce Street, 3rd floor, Suite G, Philadelphia, Pennsylvania 19104.
    From the Department of Medicine, Division of Rheumatology, University of Pennsylvania School of Medicine, and the Veterans Administration Medical Center, Philadelphia, Pennsylvania, USA
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.
      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Reginato A
        • Paul H
        • Schumacher HR
        Crystal-induced arthritis.
        Arch Phys Med Rehabil. 1982; 63: 401-408
        • Schumacher Jr, HR
        • Reginato AJ
        Calcium pyrophosphate dihydrate crystals.
        in: Schumacher Jr, HR Reginato AJ Atlas of Synovial Fluid and Crystal Identification. Lea & Febiger, Philadelphia1991: 121-132
        • Eisenberg JM
        • Schumacher HR
        • Davidson PK
        • Kaufmann L
        Usefulness of synovial fluid analysis in the evaluation of joint effusions. Use of threshold analysis and likelihood ratios to assess a diagnostic test.
        Arch Intern Med. 1984; 144: 715-719
        • Baker DG
        • Schumacher Jr, HR
        Acute monoarthritis.
        N Engl J Med. 1993; 329: 1013-1020
        • Schumacher Jr, HR
        • Moreno Alvarez JM
        Clues to common crystal-induced arthropathies.
        IM. 1993; 14: 35-47
        • McCarty DJ
        A historical note: Leeuwenhoek's description of crystals from a gouty tophus.
        Arthritis Rheum. 1970; 13: 414-418
        • Levinson DJ
        • Becker MA
        Clinical gout and the pathogenesis of hyperuricemia.
        in: McCarty DJ Koopman WJ Arthritis and Allied Conditions. 12th ed. Lea & Febiger, Philadelphia1993: 1773-1805
        • Yü TF
        • Gutman AB
        Principles of current management of primary gout.
        Am J Med Sci. 1967; 254: 893-907
        • McCarty DJ
        • Hollander JL
        Identification of urate crystals in gouty synovial fluid.
        Ann Intern Med. 1961; 54: 452-460
        • Dorwart BB
        • Hansell JR
        • Schumacher Jr, HR
        Effects of cold and heat on urate crystal-induced synovitis in dog.
        Arthritis Rheum. 1974; 17: 563-571
        • Wallace SL
        • Singer JZ
        Therapy in gout.
        Rheum Dis Clin North Am. 1988; 14: 441
        • Reginato AJ
        • Schumacher Jr, HR
        Crystal-associated arthropathies.
        Clin Geriatr Med. 1988; 4: 295-322
        • Halz-Leblanc BAE
        • Reynolds WJ
        • MacFadden DK
        Allopurinol hypersensitivity in a patient with chronic tophaceous gout: success of intravenous densensitization after failure of oral densensitization.
        Arth Rheum. 1991; 34: 1329-1331
        • Zitnan D
        • Sitaj S
        Chondrocalcinosis articularis section. I. Clinical and radiological study.
        Ann Rheum Dis. 1963; 22: 142-152
        • McCarty Jr, DJ
        • Kohn N
        • Faires JS
        The significance of calcium phosphate crystals in the synovial fluid of arthritic patients: the “pseudogout syndrome.” I. Clinical aspects.
        Ann Intern Med. 1962; 56: 711-737
        • McCarty DJ
        Calcium pyrophosphate dihydrate crystal deposition disease—1975.
        Arthritis Rheum. 1976; 19: 275-285
        • Ferrari AJL
        • Van Linthoudt D
        • Schumacher HR
        Evaluation of synovial fluids for crystals.
        Rheum Rev. 1992; 1: 193-203
        • Alvarellos A
        • Spilberg I
        Colchicine prophylaxis in pseudogout.
        J Rheumatol. 1986; 13: 804-805
        • Dieppe P
        • Crocker P
        • Huskisson EC
        • Willoughby DA
        Apatite deposition disease: new arthropathy.
        Lancet. 1976; i: 266-269
        • Schumacher HR
        • Somlyo AP
        • Tse RL
        • Maurer K
        Arthritis associated with apatite crystal.
        Ann Intern Med. 1977; 87: 411-416
        • Codman EA
        The Shoulder.
        Thomas Todd, Boston1932
        • Murphy BB
        • Schumacher HR
        How does patient education affect gout?.
        Clin Rheumatol Prac. 1984; March/April: 77-80