1
|
Enríquez-Luna A, Soto-Fajardo C, Carranza-Enríquez F, Clavijo-Cornejo D, Lopez-Reyes A, Pineda C. Miliarial-type gout in association with chronic use of glucocorticoids. Rheumatol Int 2024; 44:543-547. [PMID: 37851076 DOI: 10.1007/s00296-023-05486-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023]
Abstract
A 59-year-old male patient with long-standing tophaceous gout (more than 30 years) characterized by polyarticular involvement and recurrent disseminated tophi formation; his past medical history is relevant for poor adherence to urate-lowering medications, as well as persistent use of self-prescribed systemic glucocorticoids. Despite achieving therapeutic goals for serum uric acid levels, new tophi formation with an intradermal location in the form of "miliarial-type gout" was documented. Due to functional limitations, the patient underwent surgical resection of the olecranon bursa. This case illustrates a widespread and recurrent tophi formation associated with long-standing gout and regular and sustained glucocorticoid use, despite an adequate disease control based on serum urate levels and involving an intradermal location of tophi presenting as "miliarial-type" lesions. In addition, the coexistence of urate and cholesterol crystal deposition disease in olecranon gouty bursitis is presented. Finally, a sonographic extended field of view of lesions distributed along the patient's extremities is presented as a novel characterization of this condition.
Collapse
Affiliation(s)
- A Enríquez-Luna
- Rheumatology Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - C Soto-Fajardo
- Rheumatology Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - F Carranza-Enríquez
- Rheumatology Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - D Clavijo-Cornejo
- Rheumatology Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - A Lopez-Reyes
- Gerosciences Laboratory, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - C Pineda
- Rheumatology Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.
| |
Collapse
|
2
|
Bansal P, Virata AR. Cholesterol and Monosodium Urate Monohydrate Crystals in Synovial fluid From a Patient With Gout. Arthritis Rheumatol 2020; 72:1706. [DOI: 10.1002/art.41391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
3
|
Xie B, Halter T, Borah BM, Nancollas GH. Aggregation of Calcium Phosphate and Oxalate Phases in the Formation of Renal Stones. CRYSTAL GROWTH & DESIGN 2015; 15:204-211. [PMID: 25598742 PMCID: PMC4291782 DOI: 10.1021/cg501209h] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 11/11/2014] [Indexed: 05/04/2023]
Abstract
The majority of human kidney stones are comprised of multiple calcium oxalate monohydrate (COM) crystals encasing a calcium phosphate nucleus. The physiochemical mechanism of nephrolithiasis has not been well determined on the molecular level; this is crucial to the control and prevention of renal stone formation. This work investigates the role of phosphate ions on the formation of calcium oxalate stones; recent work has identified amorphous calcium phosphate (ACP) as a rapidly forming initial precursor to the formation of calcium phosphate minerals in vivo. The effect of phosphate on the nucleation of COM has been investigated using the constant composition (CC) method in combination with scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Our findings indicate COM nucleation is strongly promoted by the presence of phosphate; this occurs at relatively low phosphate concentrations, undersaturated with respect to brushite (dicalcium phosphate dehydrate, DCPD) formation. The results show that ACP plays a crucial role in the nucleation of calcium oxalate stones by promoting the aggregation of amorphous calcium oxalate (ACO) precursors at early induction times. The coaggregations of ACP and ACO precursors induce the multiple-point nucleation of COM. These novel findings expand our knowledge of urinary stone development, providing potential targets for treating the condition at the molecular level.
Collapse
Affiliation(s)
| | | | - Ballav M. Borah
- Department of Chemistry, University at
Buffalo, The State University of New
York, Buffalo, New York 14260, United
States
| | - George H. Nancollas
- Department of Chemistry, University at
Buffalo, The State University of New
York, Buffalo, New York 14260, United
States
| |
Collapse
|
4
|
Horta-Baas G, Vargas-Gutiérrez C, Barile-Fabris L. Large joint destructive arthropathy and tumoral calcinosis associated to primary oxalosis: case report and literature review. REUMATOLOGIA CLINICA 2013; 9:181-185. [PMID: 23570963 DOI: 10.1016/j.reuma.2012.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 09/13/2012] [Accepted: 09/19/2012] [Indexed: 06/02/2023]
Abstract
A case of destructive arthropathy of hips and shoulders with tumoral calcinosis associated with calcium oxalate deposits in a patient with primary oxalosis and end stage renal disease on hemodialysis.
Collapse
Affiliation(s)
- Gabriel Horta-Baas
- Departamento de Reumatología, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, IMSS, México DF, México.
| | | | | |
Collapse
|
5
|
Schumacher HR, Chen LX. Other crystal-related arthropathies. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00188-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
6
|
Martínez-Castillo A, Núñez C, Cabiedes J. [Synovial fluid analysis]. ACTA ACUST UNITED AC 2010; 6:316-21. [PMID: 21794741 DOI: 10.1016/j.reuma.2009.12.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 12/23/2009] [Indexed: 11/24/2022]
Abstract
At present, the study of the synovial fluid (SF) is a tool that is used frequently in specialized laboratories because it allows the establishment of diagnosis of crystal associated arthropathies, supports the diagnosis of septic arthritis and helps establish other rheumatologic diagnoses such as monoarthritis or joint effusion. The complete study of the SF includes the following analyses: 1. Macroscopic; 2. Microscopic; and 3. Specific stains. Each one provides information of the joint's state and helps in the establishment of diagnosis and treatment. The characteristics that must be described in the macroscopic analysis are: color, volume and viscosity. Microscopic analysis of the SF confirms the presence of an inflammatory or infectious processes and allows for the detection and identification of crystals. Polarized light microscope is a fundamental tool for the analysis of SF and for the identification of the crystals present in the samples, which not only depend on the form, but also of their birefringence. It is important to mention that in the microscopic analysis, artifacts can confuse the inexperienced observer. A suitable interpretation of the analysis of SF requires the observation by at least two experienced observers. The information that the analysis of SF provides to the clinicians gives them the necessary elements to establish the diagnosis and to decide on treatment. Specific stains in the analysis of SF help in the identification of non-birefringent crystals as those of calcium hydroxypatite. In SF analysis, new fields are being explored that include quantification of cytokines, chemokines, immunoglobulins and the characterization of cell lineages.
Collapse
Affiliation(s)
- Araceli Martínez-Castillo
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Laboratorio de Inmunología, Departamento de Inmunología y Reumatología, Tlalpan, México D.F., México
| | | | | |
Collapse
|
7
|
Abstract
Uric acid crystals [monosodium urate (MSU)] have emerged as an important factor for both gouty arthritis and immune regulation. This simple crystalline structure appears to activate innate host defense mechanisms in multiple ways and triggers robust inflammation and immune activation. The recognition mechanisms of MSU following its phase change from soluble uric acid are diverse, involving both protein receptors and non-specific plasma membrane attachment. Upon contact with host cells, MSU induces a set of membrane events that trigger Syk and PI3K activation, phagocytosis, and cytokine production. Having entered the cell, MSU further triggers NALP3 inflammasome activation and induces the production of IL-1 beta, likely inducing a full spectrum of inflammation. This review describes the recognition mechanisms and activation pathways involved in MSU-mediated inflammation and adjuvanticity and hypothesizes that direct membrane binding by solid surfaces, such as MSU, may function as a generic mechanism in tissue responses to particulate and crystalline structures.
Collapse
Affiliation(s)
- Yan Shi
- Department of Microbiology and Infectious Diseases, and Immunology Research Group, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.
| | | | | |
Collapse
|
8
|
Suganthi RV, Girija EK, Narayana Kalkura S, Varma HK, Rajaram A. Self-assembled right handed helical ribbons of the bone mineral hydroxyapatite. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2009; 20 Suppl 1:S131-S136. [PMID: 18568388 DOI: 10.1007/s10856-008-3495-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Accepted: 06/04/2008] [Indexed: 05/26/2023]
Abstract
A self-assembled right handed helical ribbon of bone mineral, hydroxyapatite (HAp) was crystallized in sodium meta silicate gel matrix at 27 degrees C and the physiological pH (7.4). At temperatures 37 and 47 degrees C, helical structures were followed by many Liesegang rings. The samples were characterized by FT-IR, XRD, SEM, ICP-OES and TG-DTA techniques. The helical ribbon consisted of platy Ca-deficient apatite crystals of size 2.8 microm. Liesegang ring had a continuous network of fibers with interconnected pores. The samples exhibited bioactivity when soaked in SBF.
Collapse
Affiliation(s)
- R V Suganthi
- Crystal Growth Centre, Anna University, Chennai 600 025, India
| | | | | | | | | |
Collapse
|
9
|
Sarraf P, Kay J, Reginato AM. Non-crystalline and crystalline rheumatic disorders in chronic kidney disease. Curr Rheumatol Rep 2008; 10:235-48. [PMID: 18638433 DOI: 10.1007/s11926-008-0038-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Rheumatic syndromes are cause for morbidity in patients with end-stage renal disease. Recent advances in understanding the role of tissue remodeling have provided insight into the pathogenic mechanisms responsible for some of these manifestations. Here, we survey recent and clinically relevant advances in translational research that impact our understanding of rheumatic syndromes seen in patients with significant renal disease. The management of acute and chronic crystalline arthropathies in chronic kidney disease and hemodialysis patients is discussed.
Collapse
Affiliation(s)
- Pasha Sarraf
- US National Instituteof Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, USA
| | | | | |
Collapse
|
10
|
Van Linthoudt D, Joris F, Christen B, Pazera A, Nobel M, Magnanelli L, Malterre L. Suspected Gouty Tophus in a Woman's Breast. J Clin Rheumatol 2005; 11:277-9. [PMID: 16357777 DOI: 10.1097/01.rhu.0000182195.26541.d7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A postmenopausal woman treated with diuretics for hypertension and who underwent surgery for a previous fibroadenoma of the left breast presented, in December 2003, with a sudden bloody discharge of the left nipple with local swelling, redness, and pain. Radiologic investigations revealed a well-delimited tumor under the areola. Needle aspiration disclosed many histiocytes but no bacteria. Despite improvement with antibiotics, the tumor was removed. Pathological examination shows features suggesting the tumor was a gouty tophus. Birefringent crystals were retrospectively found on the smears of the aspirated material. To our knowledge, only 3 similar cases have been reported in the literature.
Collapse
Affiliation(s)
- Daniel Van Linthoudt
- Département de Rhumatologie, Hôpital, La Chaux-de-Fonds, La Chaux-de-Fonds, Switzerland.
| | | | | | | | | | | | | |
Collapse
|
11
|
de Water R, Noordermeer C, Houtsmuller AB, Nigg AL, Stijnen T, Schröder FH, Kok DJ. Role of macrophages in nephrolithiasis in rats: an analysis of the renal interstitium. Am J Kidney Dis 2000; 36:615-25. [PMID: 10977795 DOI: 10.1053/ajkd.2000.16203] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Interstitial calcium oxalate (CaOx) crystals can be found in primary oxalosis and in secondary hyperoxaluria. In a rat model for nephrolithiasis, we investigated whether such crystals can be removed by the surrounding interstitial cells. CaOx crystals were induced by a crystal-inducing diet based on ethylene glycol (EG) and ammonium chloride (CID). Both lithogenic compounds were added to the drinking water. After 9 days, the animals received normal drinking water for 2 days. Using this CID, only the interstitial crystals are retained. Subsequently, half of the population remained on normal drinking water (normo-oxaluria), whereas the other half received a low dose of EG alone (chronic hyperoxaluria). The rats were killed at regular times thereafter. The results showed that the kidney-associated oxalate significantly declined during normo-oxaluria, but remained high during chronic hyperoxaluria. Interstitial cells positive for the leukocyte common antigen (CD45; which identifies all types of leukocytes), the ED1 antigen (which is specific for monocytes and macrophages), and the major histocompatibility class II antigen (MCHII), respectively, had increased in number, with minor differences between both rat populations. The cells around the interstitial crystals were mostly positive for ED1. Multinucleate giant cells were regularly observed. These cells were positive for CD45 and ED1 and sometimes also for MCHII. The crystals in these cells were moderately positive for acid phosphatase and carbonic anhydrase II. It is concluded that interstitial CaOx crystals can be removed under normo-oxaluric conditions and that, in all likelihood, macrophages and multinucleate giant cells are involved in that process.
Collapse
Affiliation(s)
- R de Water
- Departments of Experimental Urology, Pathology, and Epidemiology & Biostatistics, Faculty of Medicine, Erasmus University, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
12
|
Kay J, Bardin T. Osteoarticular disorders of renal origin: disease-related and iatrogenic. Best Pract Res Clin Rheumatol 2000; 14:285-305. [PMID: 10925746 DOI: 10.1053/berh.2000.0066] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Osteoarticular disorders significantly limit the quality of long-term survival with chronic renal failure. beta 2M amyloidosis is a complication of chronic renal failure that has been recognized mostly in patients receiving long-term haemodialysis. Patients with beta 2M amyloidosis typically present with the triad of shoulder periarthritis, carpal tunnel syndrome, and flexor tenosynovitis of the hands. Other musculoskeletal manifestations of beta 2M amyloidosis include destructive spondyloarthropathy, cervico-occipital pseudotumours, bone cysts, and pathological fractures. At present, only renal transplantation may slow or halt the progession of beta 2M amyloidosis. Crystal-induced arthropathy, most commonly caused by basic calcium phosphate crystals, is an important cause of acute joint inflammation in the patient with renal failure. The incidence of bone and joint infection is increased in patients undergoing dialysis. Haemodialysis and peritoneal dialysis are also associated with an erosive or destructive arthropathy of finger joints, which is not explained by local amyloid deposition.
Collapse
Affiliation(s)
- J Kay
- Department of Internal Medicine, Lahey Clinic Medical Center, Burlington, Massachusetts, USA
| | | |
Collapse
|
13
|
Kesarwani M, Azam M, Natarajan K, Mehta A, Datta A. Oxalate decarboxylase from Collybia velutipes. Molecular cloning and its overexpression to confer resistance to fungal infection in transgenic tobacco and tomato. J Biol Chem 2000; 275:7230-8. [PMID: 10702293 DOI: 10.1074/jbc.275.10.7230] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Oxalic acid is present as nutritional stress in many crop plants like Amaranth and Lathyrus. Oxalic acid has also been found to be involved in the attacking mechanism of several phytopathogenic fungi. A full-length cDNA for oxalate decarboxylase, an oxalate-catabolizing enzyme, was isolated by using 5'-rapid amplification of cDNA ends-polymerase chain reaction of a partial cDNA as cloned earlier from our laboratory (Mehta, A., and Datta, A. (1991) J. Biol. Chem. 266, 23548-23553). By screening a genomic library from Collybia velutipes with this cDNA as a probe, a genomic clone has been isolated. Sequence analyses and comparison of the genomic sequence with the cDNA sequence revealed that the cDNA is interrupted with 17 small introns. The cDNA has been successfully expressed in cytosol and vacuole of transgenic tobacco and tomato plants. The transgenic plants show normal phenotype, and the transferred trait is stably inherited to the next generation. The recombinant enzyme is partially glycosylated and shows oxalate decarboxylase activity in vitro as well as in vivo. Transgenic tobacco and tomato plants expressing oxalate decarboxylase show remarkable resistance to phytopathogenic fungus Sclerotinia sclerotiorum that utilizes oxalic acid during infestation. The result presented in the paper represents a novel approach to develop transgenic plants resistant to fungal infection.
Collapse
Affiliation(s)
- M Kesarwani
- National Center for Plant Genome Research, Jawaharlal Nehru University Campus and Molecular Biology Laboratory, School of Life Sciences, Jawaharlal Nehru University, New Delhi 110 067, India
| | | | | | | | | |
Collapse
|
14
|
Abstract
Trauma is the commonest cause of acute monoarticular joint pain and swelling in patients attending an accident and emergency (A&E) department. However, in a significant minority of patients there will be no history of trauma and consequently a different approach to assessment and investigation is required. Our aim is to offer an outline of how to assess, investigate, and manage a patient with monoarthritis. Despite advances in antibiotic treatment diagnostic delay partly explains why septic arthritis is still associated with considerable morbidity and mortality. It is therefore imperative that joint infection is considered above all other diagnoses. Arthrocentesis is a relatively safe procedure and doctors in A&E medicine are encouraged to develop the skills required to aspirate large joints. In the same way that the A&E department is often portrayed as the shop window of a hospital, the joint can reflect a wide variety of internal diseases. Connective tissue disease, inflammatory bowel disease, sarcoidosis, and vasculitis can all present with a monoarthritis. A non-specific reactive monoarthritis may be a feature of a wide variety of common and uncommon infections including, brucellosis, Lyme disease, and leptospirosis. Drugs are also associated with acute arthritis either through their metabolic consequences or as idiosyncratic drug reactions. The ability for the joint to reflect multisystem disease necessitates close liaison with specialists from other fields. A multidisciplinary approach to the management of these patients is strongly encouraged as some will have unusual diseases that require specialist advice. It is not difficult to appreciate how the patient with monoarthritis can present the clinician with a fascinating diagnostic and therapeutic challenge, which we hope this article will help to unravel.
Collapse
Affiliation(s)
- S H Till
- Leicester Royal Infirmary and Nottingham City Hospital
| | | |
Collapse
|
15
|
Falasca GF, Ramachandrula A, Kelley KA, O'Connor CR, Reginato AJ. Superoxide anion production and phagocytosis of crystals by cultured endothelial cells. ARTHRITIS AND RHEUMATISM 1993; 36:105-16. [PMID: 8381009 DOI: 10.1002/art.1780360118] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To show that cultured human umbilical vein endothelial cells (HUVEC) are capable of phagocytizing inflammation-causing crystals and of generating superoxide anion (SOA) during phagocytosis. METHODS The superoxide dismutase-inhibitable reduction of nitroblue tetrazolium (NBT) dye was used as a measure of SOA production. Phagocytosis was quantified by light microscopy and confirmed by transmission electron microscopy. Cytochrome C was also studied but was found to undergo spontaneous reduction by monosodium urate (MSU) without cells. RESULTS Crystals of MSU, calcium oxalate, hydroxyapatite, and calcium pyrophosphate dihydrate (CPPD) were phagocytized and, except for the CPPD crystals, induced NBT reduction. Cholesterol and cholesterol monohydrate were neither phagocytized nor did they induce NBT reduction. CONCLUSIONS Endothelial cells may be a significant source of oxygen radicals in crystal-associated and other arthritides.
Collapse
Affiliation(s)
- G F Falasca
- Department of Medicine, Cooper Hospital/University Medical Center, NJ 08103
| | | | | | | | | |
Collapse
|