Pseudogout Crystals Birefringence

Calcium pyrophosphate crystals show weak positive birefringence; the crystals are blue whenparallel to the slow direction and yellow whenperpendicular. The crystals are spotted and yellow when parallel and blue when vertical to the compensator and may be intracellular or extracellular. Pathologic Diagnosis: Pseudogout (Chondrocalcinosis Articularis) Calcium pyrophosphate dihydrate (CPPD) crystals show the diagnostic positive birefringence (Figure 2, D and H) observed in this lesion. 1 synonym for birefringence: double refraction. Gout and pseudogout can be differentiated by examination of the fluid aspirate contents of a joint viewed under polarised red light: Urate crystals – are negatively birefringent – they will appear a needle shaped crystals (image below). Study Pathoma - Joint Disorders flashcards from Don Draper's class online, or in Brainscape's iPhone or Android app. An oslerphile emergency physician and intensivist suffering from a bad case of knowledge dipsosis. A Congo red stain demonstrated scattered amyloid deposits with polarization optics. Birefringence of CPP crystals is weaker or absent compared with MSU crystals, but we aim to evaluate whether the grade of birefringence varies regarding the shape of the CPP crystal. Findings of calcium pyrophosphate crystals and normal serum uric acid levels on joint fluid analysis can differentiate pseudogout from gout. The differentiation between articular gout and pseudogout was based on histologic appearance, histochemical staining for calcium, and birefringence under polarized light. Pseudogout most often involves the knee and less commonly the wrist or ankle with the sudden onset of severe pain, swelling and redness. Under polarized light, the calcified deposits show weekly positive birefringence suggestive of CPPD ((c) low-power view, (d) high-power view). 25% solutions at most pHs stained the crystals well; however, the detachment of the smear remained notice- able. Gout is diagnosed by the finding of the crystals in joint fluid under uncompensated polarized light microscopy, as seen in the images below. Pseudogout is a form of arthritis that causes pain, stiffness, tenderness, redness, warmth, and swelling in some joints. You can see the stones with X-ray and the crystals with a urinalysis; they can be dissolved or surgically removed. 9%) from 76 patients with pseudogout. MSU crystals have needle-like shape and strong negative birefringence, i. Urate crystals appear yellow, and calcium pyrophosphate crystals appear blue when their long axes are aligned parallel to that of a red compensator filter, or a crystal of known birefringence is added to the sample for comparison. Gout as a risk factor pseudogotta myocardial infarction pseudogota stroke in England: Comparative observation of the efficacy on acute pseudogota arthritis between acupuncture combined with infrared irradiation and western medicine. All synovial fluids should be examined with polarized and compensated light microscopy. [5-7] Pseudogout crystals demonstrate diagnostic weak positive birefringence with polarizing microscopy in sections stained with the Shidham method. Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, also known as pseudogout and pyrophosphate arthropathy is a rheumatologic disease which is thought to be secondary to abnormal accumulation of calcium pyrophosphate dihydrate crystals within joint soft tissues. They tried to throw you off with the picture, but the wording in the stem says its a "photomicrograph" -- not exposed to plane polarized light, where you would see the negative birefringence. In contrast, with gout, you see negatively birefringent crystals under polarized light. Diagnosis is based on involvement of multiple joints (approximately 50%) ( 4 ) and on fine needle aspiration/biopsy. Key areas of interest include: the ED-ICU interface, toxicology, simulation and the free open-access meducation (FOAM) revolution. Pathology - joint inflammation caused by deposits of monosodium urate (gout) or calcium pyrophosphate (pseudogout) crystals. I suppose the best way to differentiate this case from pseudogout is that the crystals are sharp & needle-shaped and not rhomboid-shaped. Under polarized light the HA crystals showed a week positive birefringence with Rot I compensator; the intensity of birefringence of HA was much weaker, than the positive birefringence of CPPD crystals. The synovial joint has a joint capsule which contains specialized secretory cells termed synoviocytes (types A and B). As its name implies, pseudogout has many of the same symptoms as gout, including the sudden onset of severe pain, swelling, warmth, and redness in a joint. Polarized light microscopy demonstrates needle-shaped crystals with negative birefringence. The word "ARTHRITIS" literally means “Inflammation of Joint” i. It is a disorder of purine metabolism characterized by hyperuricaemia and the deposition of monosodium urate crystals in articular or peri-articular tissues and in the renal tract (1,2). Polarized light microscopy demonstrates needle-shaped crystals with negative birefringence. Aspiration = needle shaped negative birefringence crystals. Notable things that polarize. Both oral NSAID (with gastroprotective therapy if indicated) and low dose oral colchicine (eg 0. A case of acute low back pain caused by pseudogout attack of the lumbar facet joint is reported. Diagnosis of gout may be confirmed by the presence of crystals in the joint fluid or in a deposit outsi. These crystals typically present positive birefringence. Tophaceous pseudogout. These crystals found in Pseudogout. In pseudogout, CPP crystals appear shorter and. Often you can see them with regular light microscopy within monocytic/histiocytic cells. Calcium pyrophosphate deposition (CPPD) disease is a crystal deposition disease in the joints and soft tissue, resulting in inflammation and tissue damage. A 63-year-old gentleman presents with a hot, swollen and acutely painful right knee. they exhibit negative birefringence). I suppose the best way to differentiate this case from pseudogout is that the crystals are sharp & needle-shaped and not rhomboid-shaped. EULAR Recommendations for CPPD Management 3. Rheumatology 2008;47:608. Calcium pyrophosphate crystals are seen in pseudogout (also known as calcium pyrophosphate deposition disease or, CPPD). Definite diagnosis of CPPD deposition is based on the demonstration of CPPD crystals in SF, and rarely in tissue sections. CPPD crystals are weakly birefringent and rhomboid or rod shaped. The main difference is the type of crystals involved in the inflammation and damage. A large needle like crystal is a monosodium urate crystal which cause inflmmation. Ordinary e-mails are welcome. Water sensitive MR sequences are most sensitive to the detection of chondrocalcinosis. However, the crystal that incites the inflammation of gout is monosodium urate. Identification of Gout Crystals One of the most common medical applications for polarized light microscopy is the identification of gout crystals monosodium urate with a first order retardation plate. The crystals are chemotactic and activate complement. [5-7] Pseudogout crystals demonstrate diagnostic weak positive birefringence with polarizing microscopy in sections stained with the Shidham method. A kidney stone is a solid piece of material that forms in a kidney. Comorbidities included obesity, alcoholic liver disease, chronic renal. Pseudogout is an acute attack of inflammatory arthritis due to shedding of pyrophosphate crystals from articular cartilage. The sign of birefringence can be employed to differentiate between gout. The alcohol-fixed specimen, as expected,. Read "Tophaceous pseudogout (tumoral calcium pyrophosphate dihydrate crystal deposition disease), Human Pathology" on DeepDyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Tools and Resources for The Practicing PA As physician assistants, we have the best career in the world. It is used diagnostically when evaluating the types of crystals in joint fluid. One way to differentiate is by aspirating the region of pain. , gouty arthritis) accounts for millions of outpatient visits annually, and the prevalence is increasing. Crystalline deposit in kidney and joints; Caused by calcium pyrophosphate stone, positively birefringence, rhomboid crystals. Crystals must be distinguished from birefringent cartilaginous or other debris. CPP crystals can be polymorphic (rhomboidal, parallelepiped: R/P), but some look like needles and could be taken as MSU under the bright field microscope. CPPD may also coexist with gout. Calcium pyrophosphate crystals, in contrast, show weak positive birefringence. Pyrophosphate arthropathy is a pathological condition characterized by the deposition of calcium pyrophosphate crystals in the cartilaginous tissue of the joints and the synovium and refers to microcrystalline arthritis. Carpal tunnel syndrome (CTS) caused by pseudogout is an uncommon disease. Pseudogout Pseudogout is characterized by acute monoarthritis due to deposition of calcium pyrophosphate dihydrate (CPPD) crystals. A1 With optically biaxial crystals, the cross resolves into two dark hyperbola branches (the so-called isogyres) depending on stage rotation, which are surrounded by colored interference patterns depending on the amount of birefringence and specimen. Surgical decompression was performed. The sign of birefringence can be employed to differentiate between gout. Hence, their appearance is the opposite of MSU crystals. • Difference between circular and linear birefringence • Linear birefringence requires sample to be geometric anisotropic while circular birefringence does not. (Clumps of crystals may be seen by light microscopy with Wright’s stain. Polarized light. MSUM and CPPD crystals. With pseudogout, synovial fluid examination reveals positively birefringent crystals that are shaped like rhomboids. Both oral NSAID (with gastroprotective therapy if indicated) and low dose oral colchicine (eg 0. (On a side note, for board review, an easy way I remembered negative versus positive birefringence in gout or pseudogout was that: Positive starts with a "P," and pseudogout starts with a "P. 12 The simultaneous occurrence of a combined ar-thropathy (septic arthritis and calcium pyrophos-phate disease) in the same joint has previously been reported. YOUNGSON, OStJ, MB, ChB, DTM&H, DO, FRCOphth, is a medical graduate of Aberdeen University and has postgraduate qualifications from the Royal College of Surge. Pseudogout has a classic radiologic appearance: Because of calcium deposition into the joint, you see chondrocalcinosis. Gout Uric acid (gout) is “Needle-shaped crystals with Negative birefringence) Calcium Pyrophosphate (pseudogout) is Prism-shaped crystals with Positive birefringence. Tophaceous pseudogout is characterized by deposition of calcium pyrophosphate dihydrate (CPPD) crystals within soft tissue. Six months after surgery, the clinical symptoms are very mild, with inter-incisal opening of 40mm. The presence of such crystals intracellularly is pathognomonic for acute pseudogout. Also, gout classically strikes great Toe, and its hallmark is Tophi. The episode of acute pseudogout in these four cases, three of whom had no previous history of symptomatic joint diseases, indicates a possible relation between the changes in calcium metabolism. Positive birefringent crystals are calcium pyrophosphate and they are rhomboid shape. This process, first reported by Erasmus Bartholinus in 1669, is called double refraction. The first line of treatment should be pain relief. Tophaceous pseudogout is one of the rarest forms of crystal deposition disease, typically presenting as a destructive and invasive mass involving the temporomandibular joint or the infratemporal fossa region in the absence of any other articular manifestations. The identification of rod- or rhomboid-shaped CPPD crystals showing no or weakly positive birefringence by compensated light microscopy of joint fluid aspirated from an actively symptomatic joint is diagnostic of pseudogout or chondrocalcinosis. Calcium pyrophosphate crystals, in contrast, show weak positive birefringence. What is the diagnosis? rheumatoid arthritis septic arthritis pseudogout gout aseptic arthritis gout Answer: E Gout Uric acid (gout) is "Needle-shaped crystals with Negative birefringence) Calcium Pyrophosphate (pseudogout) is Prism-shaped crystals with Positive birefringence. It is more commonly known by alternative names that specify certain clinical or radiographic findings, although neither is synonymous with CPPD. (N OTE: From a practical standpoint, most of the useful information that can be obtained from the study of joint fluid is available from a simple Gram stain, cell count, crystal analysis, and culture and sensitivity. Same: Both gout and pseudogout cause sudden, severe pain in one joint with little to no warning. Pseudogout refers to the acute symptoms of joint inflammation or synovitis: red, tender, and swollen joints that may resemble gouty arthritis. , FNAC offers a simple, cost effective tool in elucidating the nature of periarticular nodule. NIST scientists discover an unexpected optical property important to microchip manufactures. Gout and pseudogout are the two most common crystal-induced arthropathies. While the precipitants of a pseudogout attack are less well defined than those of gout, dehydration and joint surgery have both been identified as predisposing factors. In the histologic study, a calcium pyrophosphate dihydrate crystal deposit was confirmed. The crystals look blue when parallel to the compensator beam, and yellow when perpendicular to it. These findings are in contrast to pseudogout, in which crystals are rhomboid shaped and demonstrate positive birefringence on polarized microscopy. 73) A 64-year-old male presents to his primary care physician with a chief complaint of left knee pain. PDF | Hematoxylin-eosin (H&E)-stained sections may not allow proper evaluation of birefringence properties of the crystals in the lesions of pseudogout, gout, and tumoral calcinosis. Synonyms for birefringent in Free Thesaurus. It occurs in 5 percent or less of patients with symptomatic CPPD crystal deposition disease. aseptic arthritis E. Joint fluid aspiration demonstrates monosodium urate crystals that are needle shaped histologically and display negative birefringence on polarized microscopy. Calcium pyrophosphate crystals show weak positive birefringence; the crystals are blue whenparallel to the slow direction and yellow whenperpendicular. Gout Vs Pseudogout Birefringence It could be as damage to these treatments for epilepsy gout accepted by the "sesamoid" bone). In some cases the colour and histomorphology can be specific enough to be diagnostic. amcinoline hexacetonide crystals and range in length from approximately 10/x to 20/*. Birefringence is the optical property of a material having a refractive index that depends on the polarization and propagation direction of light. Research has shown that Hematoxylin and Eosin staining may not allow proper evaluation of birefringence properties of the crystals in a specimen. Ordinarily, a crystal with a cubic structure such as calcium fluoride does not exhibit birefringence in stress-free material because of its high symmetry. A definitive diagnosis of CPPD deposition disease in the left TMJ was made. Morphologically, the pseudogout lesions may resemble gout and other conditions, such as tumoral calcinosis. Results: Figure 1 shows the comparison of MSU crystal images taken by a compensated polarizing microscope (A), a lens-free differential grayscale image (B) and a lens-free color-coded image (C). To view a pseudogout crystal. Section stained with. There have been some reports of lumbar spinal stenosis caused by calcium pyrophosphate dihydrate crystal deposition. Generally more rectangular birefringent pyrophosphate crystals are seen in other arthritides. In rare instances, gout leads to a more chronic type of joint inflammation which mimics rheumatoid arthritis. The knee is the most commonly involved joint, followed by the wrist and ankle. A definitive diagnosis of CPPD deposition disease in the left TMJ was made. The fluoroscopy-guided aspiration yielded bloody synovial fluid, with rhombus-shaped extracellular calcium pyrophosphate crystals (weak positive birefringence under polarized light microscopy), consistent with pseudogout. But MSU crystals are negative birefringent and needle shaped. Pathology – joint inflammation caused by deposits of monosodium urate (gout) or calcium pyrophosphate (pseudogout) crystals. In pseudogout, CPP crystals appear shorter and. Learn how your doctor tells the difference between these rheumatic diseases. Articles Cases Courses Quiz. Learn vocabulary, terms, and more with flashcards, games, and other study tools. We presume that tophaceous pseudogout results from. Microscopic examination of the joint fluid reveals negative, birefringent, needle-shaped crystals. Less often, it can involve the hips, shoulders, elbows, finger joints, toes, or ankles. Calcium pyrophosphate dihydrate deposition disease (CPPD)/Pseudogout of the temporomandibular joint - FNA findings and microanalysis. Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is a disease of the elderly and extremely rare in young individuals. Urate crystals usually remain in the synovium after the acute attack has settled. Pseudogout crystals (CPP) are rod-shaped with blunt ends and are positively birefringent. Joint aspiration and crystal analysis shows thin, tapered, needle shaped intracellular crystals that are strongly negatively birefringent. YOUNGSON, OStJ, MB, ChB, DTM&H, DO, FRCOphth, is a medical graduate of Aberdeen University and has postgraduate qualifications from the Royal College of Surge. 163 GOUT, PSEUDOGOUT, AND RELATED DISEASES Harrison's Manual of Medicine 163 GOUT, PSEUDOGOUT, AND RELATED DISEASES Gout Definition Pathogenesis Clinical Manifestations Evaluation Pseudogout Definition and Pathogenesis Clinical Manifestations Diagnosis Hydroxyapatite Arthropathy Calcium Oxalate Deposition Disease Bibliography GOUT Definition The term gout is applied to a spectrum of. Pseudogout Pseudogout is characterized by acute monoarthritis due to deposition of calcium pyrophosphate dihydrate (CPPD) crystals. To view a pseudogout crystal. Erosions are only intraarticular in location with rheumatoid. They are seen in both intracellular and extracellular locations. Urate crystals appear yellow, and calcium pyrophosphate crystals appear blue when their long axes are aligned parallel to that of a red compensator filter, or a crystal of known birefringence is added to the sample for comparison. Although any joint may be involved, knees and wrists are most common. Calcium pyrophosphate crystals are seen in pseudogout (also known as calcium pyrophosphate deposition disease or, CPPD). This video describes the pathophysiology, causes, symptoms, and treatment of gout. Gout and pseudogout are the 2 most common crystal-induced arthropathies. why do an aspiration for gout? to r/o infections causes. What are synonyms for birefringent?. Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is a disease of the elderly and extremely rare in young individuals. To the Editor: We thank Dr. Calcium pyrophosphate crystals are seen in pseudogout (also known as calcium pyrophosphate deposition disease or, CPPD). Sodium Urate Crystals w/ Negative Birefringence under Polarized Light Microscopy--> Long Needle-Like Crystal. Thermal analysis reveals that ASHS crystal is stable up to 213 °C. Purpose/Policy Statement:. Yet, in CPPD, a different type of crystal, called calcium pyrophosphate, triggers the reaction. OBJECTIVE To determine the proportion of calcium pyrophosphate dihydrate (CPPD) crystals that appear as non-birefringent when observed under the polarised. Morphologically, the pseudogout lesions may resemble gout and other conditions, such as tumoral calcinosis. Pearls: A WBC Count >50,000 is septic arthritis until cultures are negative. The diagnosis of CPDD remains challenging, because the disease may mimic chondrosarcoma or chondroblastoma. Acute Pseudogout (Calcium Pyrophosphate Dihydrate Crystals) Polarized light microscopy showing calcium pyrophosphate dihydrate crystals. Polarization is a useful characteristic as it is only seen in handful of pathologies. Histologically, calcium pyrophosphate dihydrate crystals were found in the fluid, and she was diagnosed as having a pseudogout attack of the yellow ligament. Image credit: Gulwani H. • occurring in 10–15% of persons aged 65–75 years and 30–50% of those >85 years. Chondrocalcinosis, unstained section, viewed under polarized light, (a) without Red I compensator, (b) with Red I compensator (a) The CPPD crystals have a rhomboid shape, they range in size from 5 to 40μm, and show a strong birefringence, x600, (b) The birefringence is positive with Red I compensator, x600. These crystals are rod-shaped or rhomboids varying in length from 2 to 20 µm and with positive birefringence (blue with parallel light, yellow with perpendicular light). Learn as you go with immediate feedback. The definitive diagnosis for pseudogout is made by noting the presence of rhomboid or rod-like crystals in synovial fluid or articular tissue: under polarized light microscopy, the crystals show positive birefringence; There is a poor correlation between X-ray calcifications and symptom severity. Characteristically, rhomboid-shaped, weakly positively, birefringent crystals are seen both intracellularly and extracellularly using compensated polarized microscopy. In gout, crystals of monosodium urate (MSU) appear as needle-shaped intracellular and extracellular crystals. In gout, crystals of MSU appear as needle-shaped intracellular and extracellular crystals. Calcium pyrophosphate dihydrate (CPPD) crystals, which are present in conditions termed "pseudogout," exhibit positive birefringence. The crystals are rhombic or odd-shaped. Sodium Urate Crystals. It is therefore imperative that the aspirate from arthrocentesis undergoes screening with microscopy and birefringence testing routinely, to exclude pseudogout. These crystals appear blue when parallel to the compensator's axis, and yellow when perpendicular to the axis. Tophaceous pseudogout. If young people develop CPPD crystal deposition disease, it may be associated with metabolic diseases such as hemochromatosis, hyperparathyroidism, hypophosphatasia, hypomagnesemia, Wil-. MSU crystals are shaped like long needles or toothpicks with thicker centers and tapered, sharp ends, and range from 5-20 cm in length. Birefringence: A Calcite crystal showing that light splits into two beams. The presence of such crystals intracellularly is pathognomonic for acute pseudogout. The clinical differential diagnoses of acute gout are pseudogout (chondrocalcinosis articularis) and septic arthritis. The added value of synovial fluid centrifugation for monosodium urate and calcium pyrophosphate crystal detection. Half of all gout cases are in the big toe, and other common sites include the heel, fingertips. Uric Acid Levels, ESR. View Videos or join the Pseudogout discussion. Tophaceous pseudogout. Cooper Summary: Calcium pyrophosphate dihydrate deposition (CPDD) disease is a disorder that occasionally affects the. they exhibit negative birefringence). pseudogout: crystal lab findings: - P seduogout crystals are P ositive birefringent P Polygon shaped Gout therefore is the negative needle shaped crystals. 1 They used a compensated polarized. 9%) from 76 patients with pseudogout. Color is the key to negative or positive birefringence. Calcium pyrophosphate dehydrate (CPPD) crystals dissolve after several hours. 13 CPPD crystals can be distinguished by polarized microscope based on their rhomboidal shape, which displays weakly positive birefringence. With Rad I compensator the HA crys-tals showed positive birefringence (Figure 14a-c). Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, also known as chondrocalcinosis, pseudogout and pyrophosphate arthropathy is a rheumatologic disorder with varied symptoms and signs arising from the accumulation of crystals of calcium pyrophosphate dihydrate in the connective tissues. Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, also known as pseudogout and pyrophosphate arthropathy is a rheumatologic disorder with varied symptoms and signs arising from the accumulation of crystals of calcium pyrophosphate dihydrate in the connective tissues. If young people develop CPPD crystal deposition disease, it may be associated with metabolic diseases such as hemochromatosis, hyperparathyroidism, hypophosphatasia, hypomagnesemia, Wil-. (N OTE: From a practical standpoint, most of the useful information that can be obtained from the study of joint fluid is available from a simple Gram stain, cell count, crystal analysis, and culture and sensitivity. These crystals typically present positive birefringence. Surgical decompression was performed. Rationales: A. We report a case of a Calcium pyrophosphate dihydrate deposition disease (CPPD) presenting as a mass in the parotid and temporomandibular joint (TMJ) that simulated a parotid tumor. Calcium pyrophosphate dihydrate crystals with positive birefringence. The crystals had not undergone dissolution in the formalin fixative, as usually occurs with gout tophi. A definitive diagnosis of CPPD deposition disease in the left TMJ was made. Demonstration of CPPD crystals and tissue or synovial fluid by definitive means (for example, characteristic x-ray defraction or chemical analysis) and Identification of monoclinic or triclinic crystals showing no or weakly positive birefringence by compensated polarized light microscopy. The sign of birefringence can be employed to differentiate between gout crystals and those consisting of pyrophosphate. [ 10 , 17 ]. -Calcium Pyrophosphate Dehydrogenase (CPPD) for Pseudogout. The birefringence is positive if the refractive index parallel to the long axis of the crystal is greater than the refractive index perpendicular to the long axis of the crystal. Acute Pseudogout (Calcium Pyrophosphate Dihydrate Crystals) Polarized light microscopy showing calcium pyrophosphate dihydrate crystals. Learn as you go with immediate feedback. An experienced clinician or technician is recommended to assess for the. 12 o Rapid development severe joint pain, stiffness, swelling, and tenderness peaking at 6-24 hours o Most common joints involved are knee, wrist and shoulder. However, the existence of both gout and pseudogout in a single joint in a patient is relatively rare2-4. In the article Crystal lography the nature and behaviour of twinned crystal s receives full treatment; here it is sufficient to say that when the planes and axes of twinning are planes and axes of symmetry, a twin would exhibit higher symmetry (but remain in the same crystal system) than the primary crystal; and, also, if a crystal approximates. Pseudogout, though it presents with similar symptoms, is caused by smaller, block-like crystals of calcium pyrophosphate dihydrate (CPPD). Monosodium urate (MSU) crystals are needle-shaped or long rods, approximately 2-20 micrometer long and exhibit strong birefringence and negative elongation. Specific gravity: Estimate of U Osm. A 63-year-old gentleman presents with a hot, swollen and acutely painful right knee. Characteristically, rhomboid-shaped, weakly positively, birefringent crystals are seen both intracellularly and extracellularly using compensated polarized microscopy. pseudogout gout D. Gout can be distinguished from pseudogout in that gout crystals (sodium urate) are needle shaped and have negative birefringent, while pseudogout crystals (calcium pyrophosphate) are rhomboid shaped and have weak positive birefringent. He describes acute-onset knee pain last evening that was accompanied by redness of the skin around the joint. For showing birefringence we need a lambda plate compensator. Start studying gout vs pseudogout. crystals under polarised light. Tools and Resources for The Practicing PA As physician assistants, we have the best career in the world. Gentry, and Karen A. • occurring in 10-15% of persons aged 65-75 …. Using this method, we present the measurements of the polarization-dependent light scattering of a liquid crystal droplet and individual silver nanowires over scattering angles of 50°. A 35 year-old man presented with pain in the left ear area. MSU crystals have needle-like shape and strong negative birefringence, i. It can affect one or several joints at once. Metrics Links Files Go to Pseudogout of the Knee after Intraarticular Injection of Hyaluronic Acid. Calcium pyrophosphate crystals are seen in pseudogout (also known as calcium pyrophosphate deposition disease or, CPPD). Massive Calcium Pyrophosphate Dihydrate Crystal Deposition Disease: A Cause of Pain of the Temporomandibular Joint Kathlyn Marsot-Dupuch, Wendy R. In this Article. • Circular birefringence - Optical properties are the same from any direction • Circular dichroism an absorbance of left- and right- circularly polarized light. Polarized light. Gout can be distinguished from pseudogout in that gout crystals (sodium urate) are needle shaped and have negative birefringence, while pseudogout crystals (calcium pyrophosphate) are rod or rhomboid shaped and have no or weak positive birefringence. Polarization microscope showed calcium pyrophosphate dihydrate crystals. Many crystals are anisotropic to light ("optical anisotropy"), and exhibit properties such as birefringence. CPPD is a type of arthritis that, as the old name of pseudogout suggests, can cause symptoms similar to gout. CPPD crystals have rhomboid or parallelelipedic morphology, and although frequently described as being weakly birefringent, it has been noted that some CPPD crystals lack birefringence when analysed under polarized LM. uk Gout and pseudogout can be differentiated by examination of the fluid aspirate contents of a joint viewed under polarised red light: Urate crystals – are negatively birefringent – they will appear a needle shaped crystals (image below). The 24 multiple choice questions about Synovial Fluid. Histologic Findings The presence of crystal deposits in soft tissue results in adjacent chondroid metaplasia. Pseudogout is a common presentation. Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, also known as pseudogout and pyrophosphate arthropathy is a rheumatologic disorder with varied symptoms and signs arising from the accumulation of crystals of calcium pyrophosphate dihydrate in the connective tissues. Calcium Pyrophosphate (pseudogout) is Prism-shaped crystals with Positive birefringence - To remember this think "P"seudogout has "P"rism shaped crystals and "P"ositive birefringence. Figure 6 - Interference Colors in Gout and Pseudo-Gout Crystals. Comorbidities included obesity, alcoholic liver disease, chronic renal. Both monosodium urate (gout) and calcium pyrophosphate dihydrate (pseudogout) crystals generally cause an acutely painful arthritis with an inflammatory fluid that has a leukocyte count >2000 per mm 3; these types of crystals can be visualized using polarized light microscopy. An "axis of anisotropy" is defined as the axis along which isotropy is broken (or an axis of symmetry, such as normal to crystalline layers). Uric acid (gout) is "Needle-shaped crystals with Negative birefringence). Pathology - joint inflammation caused by deposits of monosodium urate (gout) or calcium pyrophosphate (pseudogout) crystals. Gout can be distinguished from pseudogout in that gout crystals (sodium urate) are needle shaped and have negative birefringence, while pseudogout crystals (calcium pyrophosphate) are rod or rhomboid shaped and have no or weak positive birefringence. Specific gravity: Estimate of U Osm. The crystals are rhomboid, long or short rods, or small squares ranging in length from 2 to 20 µm. In cases of pseudogout and pseudo-rheumatoid arthritis, the synovial fluid has a low viscosity, cloudy, contains polymorphic-nuclear leukocytes from 5000 to 25 000. Cystine stones tend to reoccur and are typically larger than other kidney stones. Aspiration = needle shaped negative birefringence crystals. , gouty arthritis) accounts for millions of outpatient visits annually, and the prevalence is increasing. I suppose the best way to differentiate this case from pseudogout is that the crystals are sharp & needle-shaped and not rhomboid-shaped. gout, pseudogout, lipoid proteinosis, colloid milium, mucopolysaccharidoses, cutaneous deposition disease, urate crystals, birefringence, tophi Introduction The cutaneous deposition disorders are a heterogeneous group of conditions characterized by the presence of primarily endogenous substances within the dermis or the subcutis. However tophaceous pseudogout is common in the temporomandibular joint. Ding T, Roddy E, Pande I. The two rays of light are each plane polarized by the calcite such that the planes of polarization are mutually perpendicular. However, the crystal. The authors report a 65-year-old female who complained of sudden pain and neurological symptoms on her left hand. It is caused by the deposition of calcium pyrophosphate crystals. Gout is diagnosed by the finding of the crystals in joint fluid under uncompensated polarized light microscopy, as seen in the images below. Hyperparathyroidism : hypercalcaemia and subperiosteal erosion's. They were detected in 7. He describes acute-onset knee pain last evening that was accompanied by redness of the skin around the joint. Ethylene glycol poisoning. It is seen primarily in the elderly and the commonest joint affected is the knee joint. Morphologically, the pseudogout lesions may resemble gout and other conditions, such as tumoral calcinosis. The time interval separating the first attack from subsequent episodes of acute synovitis may be widely variable, ranging from a few days to several years. Calcium pyrophosphate crystals are seen in pseudogout (also known as calcium pyrophosphate deposition disease or, CPPD). com No texting or chat messages, please. Erosions are only intraarticular in location with rheumatoid. Joint Fluid Crystal Analysis Analysis of joint fluid aspirate for crystals may establish the diagnosis of gout or pseudogout, depending on their shape and birefringence. The strong association of AS with HLA-B27 is direct evidence of the importance of genetic predisposition. Ethylene glycol poisoning. These produce the components of the synovial fluid and contribute to the local production of cytokines, small-molecule mediators of inflammation, and proteolytic enzymes. The crystals will exhibit a yellow interference color when the crystals long axis is orientated parallel to the slow axis of the full wave retarder 45° degrees to the crossed polarizers). Urate crystals = needle shaped, strong negative birefringence. Histological examination showed that the crystals were weakly birefringent under polarized light microscopy. crystals exhibiting yellow birefringence under polarizing microscopy were seen. Ankylosing spondylitis (AS) is a chronic, multisystem inflammatory disorder primarily involving the sacroiliac (SI) joints and the axial skeleton. No crystals were found in circulating leucocytes. Get Pseudogout essential facts below. The definitive diagnosis for pseudogout is made by noting the presence of rhomboid or rod-like crystals in synovial fluid or articular tissue: under polarized light microscopy, the crystals show positive birefringence; There is a poor correlation between X-ray calcifications and symptom severity. [5-7] Pseudogout crystals demonstrate diagnostic weak positive birefringence with polarizing microscopy in sections stained with the Shidham method. Notable things that polarize. These crystals are strongly negative birefringent crystals under compensated polarized light microscopy; 400×. Hyperparathyroidism : hypercalcaemia and subperiosteal erosion's. Gout and pseudogout are the two most common crystal-induced arthropathies. , the fast axis is along the axial direction of the crystal, which, when observed under a CPLM, appear yellow (or blue) when the MSU crystal is aligned parallel (or perpendicular) with the slow axis of the full-wave retardation plate, upon a red/magenta background color. These crystals typically present positive birefringence. We report a case of a Calcium pyrophosphate dihydrate deposition disease (CPPD) presenting as a mass in the parotid and temporomandibular joint (TMJ) that simulated a parotid tumor. ) Direct and Compensated Polarized Microscopy The ability of these synovial fluid crystals to be viewed under polarized light increases the sensitivity of their detection. Compensated polarized light microscopy reveals rhomboidal or rod-like intracellular crystals with weakly positive birefringence. Definite diagnosis of CPPD deposition is based on the demonstration of CPPD crystals in SF, and rarely in tissue sections. Buildup of crystal in the joint fluid results in swollen joints and acute pain. The first line of treatment should be pain relief. These urate crystals can incite inflammation in the bursae leading to pain and swelling around the joints, a condition called bursitis. One way to differentiate is by aspirating the region of pain. The buildup of crystals in gout is triggered by elevated levels of uric acid, while pseudogout is caused by a buildup of calcium pyrophosphate dihydrate. crystals, different staining and nonstaining tech-niques have been developed. crystals with absent or weak positive birefringence) in synovial fl uid, or occasionally biopsied tissue. Advanced electron microscopy techniques can be used to finalize the diagnosis. Crystal associated arthropathies 1. Joint fluid aspiration demonstrates monosodium urate crystals that are needle shaped histologically and display negative birefringence on polarized microscopy.