Diseases associated with calcium pyrophosphate dihydrate crystal deposition. A controlled study

Prostaglandin A1

Cirrhosis

Liver function profile Furosemide

Renal function

Acute polyarticular gout.

Hadler NM, Franck WA, Bress NM, Robinson: 56: 715-719, 1974. Am J Med

The clinical features of gout, manifest as an acute polyarthritis, are described in 102 patients. In 34 of these the diagnosis was based on the finding of monosodium urate crystals in synovial fluid. The mean age of the patients was 60 years, and 90 per cent were male. Acute polyarthritis was the first manifestation of gout in 39 per cent of the patients. Of all joints involved, 63 per cent were in the lower extremity, but in one third of the patients the foot was spared. Fever, leukocytosis and dramatic response to therapy with colchicine or anti-inflammatory drugs were the rule. Gout should be considered in the differential diagnosis of acute polyarthritis regardless of the absence of hyperuricemia or foot involvement.

Hyperuricemia

Uric acid

Polyarthritis Gout Foot involvement

Renal and hepatic function were studied in 20 patients with cirrhosis and ascites, before and during infusion of prostaglandin A1 (PGA,), and in 7 patients during infusion of furosemide, with and without PGA 1. The results show that in cirrhotic patients with ascites, PGA, infusion can significantly increase both glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) in all patients but those with the most severe liver impairment. Furosemide consistently increased urine volume and L&V but did not affect GFR or ERPF. Both GFR and ERPF could be related to the extent of hepatic impairment by means of a liver function profile.

Arieff Al, Chidsey CA: Renal function in cirrhosis and the effects of prostaglandin A,. Am J Med 56: 695-703, 1974.

Ascites

Urate gout

Hyperparathyroidism

Joint involvement

Clostridial abscess Thrombosis

Leukemia

A patient with chronic myelogenous leukemia and massive splenomegaly is described in whom an acute abdominal catastrophe developed shortly after the initiation of chemotherapy. Sudden total infarction of the spleen occurred with occlusion of the splenic artery and vein; later a clostridial abscess formed within the necrotic spleen tissue producing a unique combination of clinical, roentgenographic and isotope scan findings. Possible pathophysiologic mechanisms for this process are discussed together with the clinical diagnostic and bacteriologic features.

Rosenblum AL, Bonner H Jr, Milder MS, Brenner VJ, Weinstein MA, Cook AJ, Carbone PP: Cavitating splenic infarction. Am J Med 56: 720-724, 1974.

Spleen

Infarction

A comparison of the frequency of hypertension, diabetes mellitus, urate gout, hemochromatosis, azotemia and hyperparathyroidism in 26 pseudogout patients and 22 control subjects with osteoarthritis of the large weight-bearing joints failed to provide statistical evidence of intergroup differences. lmmunoreactive parathyroid (PTH) levels were increased in most patients in both groups; serum calcium levels correlated significantly with the PTH values, as did roentgenographic evidence of knee joint degeneration in the women patients. If the associated diseases are causally related to calcium pyrophosphate crystal deposits, these finding suggest that pseudogout, like urate gout, has multiple etiologies. A hypothesis relating the possible effects of sustained low grade hyperparathyroidism to the genesis of the articular lesions is advanced.

McCarty DJ, Silcox DC, Coe F, Jacobelli S, Reiss E, Genant H, Ellman M: Diseases associated with calcium pyrophosphate dihydrate crystal deposition. A controlled study. Am J Med 56: 704-714, 1974.

Osteoarthritis

Calcium pyrophosphate crystals