scholarly journals Monoarticular Crystal Arthropathy of the Knee: Tophaceous Gout

2021 ◽  
pp. 1-5
Author(s):  
Ravikanth Reddy
Keyword(s):  
Knee Joint ◽  
Symptomatic Improvement ◽  
Left Knee ◽  
Joint Fluid ◽  
Monosodium Urate ◽  
Range Of Movement ◽  
Tophaceous Gout ◽  
Crystal Deposition ◽  
Dietary Regimen ◽  
Wide Range

Tophaceous gout is a crystal arthropathy and a disorder of purine metabolism characterized by monosodium urate crystal deposition. A case of tophaceous gout of the knee joint in a 30-year-old female is reported, and the imaging appearances on high-resolution ultrasonography are described. The patient presented with complaints of insidious onset painless swelling of the left knee joint with limitation of range of movement for 1 week. The aspirated joint fluid demonstrated needle-like monosodium urate crystals showing strong negative birefringence consistent with a diagnosis of tophaceous gout. Targeted urate-lowering treatment included oral nonsteroidal anti-inflammatory drugs and oral colchicine. Prophylactic treatment for gout flare-ups included initiation of allopurinol at 300 mg/day along with modification of the dietary regimen including limited consumption of red meat and increased consumption of low-fat dairy products. Symptomatic improvement with reduced pain and swelling of the knee joint was noted at 10 days after treatment. Subsequently, at 3-month follow-up, the patient was disease free with no signs of recurrence and serum uric acid levels at 3.7 mg/dL. In spite of a wide range of therapeutic options available for the management of tophaceous gout, suboptimal management of gout is prevalent till date in both developing and developed nations across the world.

scholarly journals Degenerative joint disease induced by repeated intra-articular injections of monosodium urate crystals in rats as investigated by translational imaging

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Nathalie Accart ◽  
Janet Dawson ◽  
Michael Obrecht ◽  
Christian Lambert ◽  
Manuela Flueckiger ◽  
...  
Keyword(s):  
Knee Joint ◽  
Inflammatory Cells ◽  
Cyst Formation ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Infrapatellar Fat Pad ◽  
Monosodium Urate ◽  
Fat Pad ◽  
Crystal Deposition ◽  
Translational Imaging

AbstractThe objective of this work was to assess the consequences of repeated intra-articular injection of monosodium urate (MSU) crystals with inflammasome priming by lipopolysaccharide (LPS) in order to simulate recurrent bouts of gout in rats. Translational imaging was applied to simultaneously detect and quantify injury in different areas of the knee joint. MSU/LPS induced joint swelling, synovial membrane thickening, fibrosis of the infrapatellar fat pad, tidemark breaching, and cartilage invasion by inflammatory cells. A higher sensitivity to mechanical stimulus was detected in paws of limbs receiving MSU/LPS compared to saline-injected limbs. In MSU/LPS-challenged joints, magnetic resonance imaging (MRI) revealed increased synovial fluid volume in the posterior region of the joint, alterations in the infrapatellar fat pad reflecting a progressive decrease of fat volume and fibrosis formation, and a significant increase in the relaxation time T2 in femoral cartilage, consistent with a reduction of proteoglycan content. MRI also showed cyst formation in the tibia, femur remodeling, and T2 reductions in extensor muscles consistent with fibrosis development. Repeated intra-articular MSU/LPS injections in the rat knee joint induced pathology in multiple tissues and may be a useful means to investigate the relationship between urate crystal deposition and the development of degenerative joint disease.

The effect of uricase on monosodium urate (MSU) crystallization, IL-1β and TNFα in monosodium urate-induced arthritis

2020 ◽  
Author(s):  
Yongmian Chen ◽  
Chengjie Liang ◽  
Rui Wang ◽  
Yiquan He ◽  
Mingya Xiao ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Knee Joint ◽  
Light Microscope ◽  
Gouty Arthritis ◽  
Polarized Light ◽  
Joint Fluid ◽  
Monosodium Urate ◽  
Local Skin ◽  
Acute Gouty Arthritis ◽  
Significant Difference

Abstract Background : Although the symptoms of gouty arthritis could be controlled by clinical methods, it is often impossible to remove tophi from joints that cause acute gouty arthritis. Methods : In study, we injected a suspension of MSU into the knee joint of chicken, and then injected uricase solution into the joint after 4, 8 and 12 hours. Since the beginning of the experiment, we monitored the circumference of the diseased joint and local temperature change. Computer tomography(CT) examination was performed to examine the MSU in the knee joints and then measured the levels of TNFα and IL-1β in synovial fluid. Chicken knee joint fluid was collected under polarized light microscope to observe the condition of the crystals and measured the weight of MSU residued in synovial fluid. Finally, the chicken knee joint was dissected and the joint synovium was sliced. Results : The results showed that injection of MSU suspension into chicken knee joint, significantly increased IL-1β, TNFα levels (p<0.01), circumference of the joint (p<0.05) and the local skin temperature (p<0.05). Moreover, analysis of the joint fluid and synovial slice under the polarized light microscope revealed that crystals significantly reduced. Compared with groupⅡ(control group), the residual weight of MSU in the joint fluid of group Ⅲ and group Ⅳ is very small(p<0.05), but there is no significant difference between group Ⅲ and group Ⅳ(p＞0.05). Conclusions : The comprehensive analysis shows that the reaction process between uricase and MSU is similar to that uric acid. Therefore, it provides a new way for clinical treatment of acute gouty arthritis with fewer side effects and significant reduction in the frequency of attacks.

scholarly journals POS0132 IS THE INTERCRITICAL GOUT REALLY ASYMPTOMATIC? THE INFLAMMATORY ROLE OF THE SILENT URATE CRYSTAL DEPOSITION

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 277.1-278
Author(s):  
C. Diaz-Torne ◽  
M. A. Ortiz ◽  
S. Jeria Navarro ◽  
A. Garcia-Gullien ◽  
L. Sainz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Whole Body ◽  
Subclinical Inflammation ◽  
Monosodium Urate ◽  
Crystal Deposition ◽  
Secretome Analysis ◽  
Healthy Donors ◽  
Cytokine Levels ◽  
Urate Crystal ◽  
Crystal Deposit

Background:Gout is the most prevalent inflammatory arthritis. Gout is chronic inflammatory deposition disease related to an increase of cardiovascular (CV) events and mortality. Subclinical chronic inflammation has been demonstrated in this patients but not its relation with the monosodium urate (MSU) crystal deposit size and the number of CV risk factors.Objectives:To study the subclinical inflammation in intercritical gout patients and its possible relation to the estimated size of the crystal deposition and the number of CV risk factors.Methods:To analyze subclinical inflammation we performed a secretome analysis and a cytokine and adiponektine plasma levels quantification (IL-1β, IL-18, IL-6, sIL-6R, TNFα, CXCL-5, RANTES, leptin, resistin and adiponectin) in a cohort of gout patients. As nowadays it is not feasible to determinate the whole body deposit of MSU crystals we created three different MSU crystal deposit size patient groups using an indirect clinical and analytical classification to estimate it. Then we compared cytokine levels between healthy donors and gout patients. We also compared cytokine levels between the different crystal size deposition groups and studied its association to the number of CV risk factors.Results:Ninety consecutive patients attending a Crystal Arthritis Unit were studied. Mean age was 68.27 (28-101) years. 81.1% were male. Clinical gout evolution was of 10.1±9.8 years. 77.5% were on urate lowering treatment. 24% had tophaceous gout. Mean uric acid was 6.3±2.1 mg/dl with 47.1% of them being on target. Hypertension was present in 68.9%, diabetes mellitus in 18.9%, dislipemia in 48.9%, BMI>30 in 32.9%, abdominal obesity in 50% and 16.1% suffered from ischemic heart disease. From the 102 molecules studied in the secretome analysis in 56 there was at least a 20% difference between donors group and any of the deposition groups. In 74% of them gout patients secreted lower levels. IL-18, sIL-6R, RANTES, leptin and adiponectin were higher in patients than in healthy donors. IL-18, sIL6-R, RANTES and CXCL5 levels were associated to the size of the crystal deposits. IL-18, sIL-6R, RANTES and leptin were higher in gout groups with CV risk factors. IL-18, sIL6-R, RANTES and leptin were higher in gout patients with no risk factors when compared to healthy donors with no risk factors. We found no differences when comparing urate lowering treated and non-treated patients.Conclusion:Our results demonstrate that some proinflammatory cytokines and metabolic proteins are raised in intercritical gout patients. Some of them are different from the flare/inflammasome expected ones. In some cytokines this elevation is related to the size of the monosodium urate crystal deposit and/or to the number of cardiovascular risk factors. This cytokine changes could help to explain the increase of the cardiovascular events in gout patients.Disclosure of Interests:Cesar Diaz-Torne Grant/research support from: Received a grant from Grünenthal, Maria Angels Ortiz: None declared, Sicylle Jeria Navarro: None declared, Andrea Garcia-Gullien: None declared, Lluis Sainz: None declared, Hector Corominas: None declared, Silvia Vidal: None declared

scholarly journals Actinomyces meyeriPopliteal Cyst Infection and Review of the Literature

2017 ◽  
Vol 2017 ◽  
pp. 1-5
Author(s):  
Bharath Raj Palraj ◽  
Ala S. Dababneh
Keyword(s):  
Fluid Collection ◽  
Left Knee ◽  
Joint Fluid ◽  
Popliteal Cyst ◽  
Degenerative Arthritis ◽  
Posterior Aspect ◽  
Medial Meniscectomy ◽  
Complex Fluid ◽  
Magnetic Resonance Imaging Mri ◽  
Mri Study

A 66-year-old, Caucasian male presented with pain and swelling involving the left knee of one-week duration. Arthrocentesis was negative for evidence of septic arthritis. Magnetic resonance imaging (MRI) study of the left knee showed degenerative arthritis, partial tear of medial meniscus, and a complex fluid collection along the posteromedial aspect of the left knee suggestive of popliteal cyst. He underwent arthroscopy with partial medial meniscectomy. Intraoperative joint fluid was noted to be cloudy but cultures were negative. Arthroscopic procedure provided him with temporary relief but the pain and swelling in the posterior aspect of the left knee recurred in 6 weeks. Repeat MRI showed complex fluid collection in the posterolateral aspect of left knee. Ultrasound guided aspiration of the fluid collection revealed purulent material and cultures grewActinomyces meyeri. He was treated with 6 weeks of intravenous penicillin regimen followed by 18 months of oral penicillin.

scholarly journals SAT0561 METATARSOPHALANGEAL JOINT MEDIAL COLLATERAL LIGAMENT MEASUREMENT, A NOVEL ULTRASOUND FEATURE OF MONOSODIUM URATE DEPOSITION IN THE JOINT.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1238.1-1239
Author(s):  
R. Flood ◽  
D. Kane ◽  
R. Mullan
Keyword(s):  
Medial Collateral Ligament ◽  
Metatarsophalangeal Joint ◽  
Musculoskeletal Ultrasound ◽  
Surrounding Tissue ◽  
Foot Pain ◽  
Monosodium Urate ◽  
Collateral Ligament ◽  
Crystal Deposition ◽  
First Metatarsophalangeal Joint ◽  
Double Contour

Background:Acute gouty arthritis most commonly initially affects the first metatarsophalangeal joint (MT1). (1) Musculoskeletal ultrasound (US) is a reliable tool for detecting monosodium urate crystal (MSU) deposition in gout and hyperuricemia with validated, ultrasound features of double contour (DC) sign, tophus, and erosions. (2, 3) The collateral ligaments of MT1, which originate on the medial and lateral epicondyles of the metatarsals and extend to the proximal phalanx, function to stabilize the joint. (4) While tophus deposition typically occurs between the medial collateral ligament (MCL) and head of MT1, small MSU aggregates may be indistinguishable from surrounding tissue. In this study using US, we propose that an increased vertical depth between the superficial surface of the MCL to cortical surface of MT1 (dMC-MT) is indicative of MSU deposition (see figure 1). The aim was to evaluate associations of dMC-MT with serum uric-acid level (sUA) in a cohort of individuals with hyperuricaemia and non-episodic foot pain. We propose a novel sonographic feature of MSU crystal deposition in the MT joint.Objectives:1.)To evaluate the association between sUA and dMC-MT2.)To record the presence/absence of classical features of MSU deposition including; double contour sign, erosions and tophi in a cohort of patients with hyperuricaemia and foot pain.3.)To evaluate the associations between sUA and dMC-MT in those with\without classical features of MSU deposition (DC, erosion, tophi).Methods:Following informed consent, hyperuricaemic patients (n = 52) underwent bilateral US of the 1MT using LogiqE9 at 15 MHz. Features of MSU deposition including DC sign, tophus and juxta-articular erosion were recorded. The dMC-MT was measured as the mean of the perpendicular distance between the superficial surface of the midpoint of the MCL to the MT1 head. Statistical analysis was performed using SPSS V.25 software. Data presented as MEAN ± S.E unless otherwise indicated.Results:DC sign, tophus and erosion occurred in 31%, 20.7% and 19% of cases, respectively. Mean sUA was higher in tophus positive (540 ± 36) versus non tophus (470 ± 16) (p<0.01) and erosion positive (522 ± 32) versus non erosion (477± 17) patients. dMC-MT was significantly greater in tophus positive patients (0.34cm ± 0.17cm) versus non tophus (0.27cm ± 0.01cm) (p < 0.01). dMC-MT was significantly greater in erosion positive patients (0.31cm ± 0.18cm) versus non erosion (0.28cm +0.01cm) (p < 0.05). In DC negative patients dMC-MT was significantly correlated with increasing sUA (r = 0.34 p = <0.05). No correction between dMC-MT and sUA was seen in DC positive patients.Conclusion:dMC-MT is significantly greater both in patients with tophus and erosions indicating its role as an additional marker of MSU crystal deposition. Furthermore a significant association between dMC-MT and sUA in DC negative patients suggests that dMC-MT may be a more sensitive indicator of early urate deposition in a subset of patients where the earliest site of urate deposition has not occurred directly on to articular hyaline cartilage. dMC-MT may therefore be a sensitive tool for very early urate deposition. Further studies clarifying a role for dMC-MT are now required.References:[1]Wallace SL, Robinson H, Masi AT, Decker JL, Mccarty DJ, Yü T -f. Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum. 1977;20(3):895–900.[2]Howard RG, Pillinger MH, Gyftopoulos S, Thiele RG, Swearingen CJ, Samuels J. Reproducibility of musculoskeletal ultrasound for determining monosodium urate deposition: Concordance between readers. Arthritis Care Res. 2011;63(10):1456–62.[3]Stewart S, Dalbeth N, Vandal AC, Rome K. Characteristics of the first metatarsophalangeal joint in gout and asymptomatic hyperuricaemia: A cross-sectional observational study. J Foot Ankle Res. 2015;8(1):1–8.[4]Finney FT, Cata E, Holmes JR, Talusan PG. Anatomy and Physiology of the Lesser Metatarsophalangeal Joints. Foot Ankle Clin. 2018;23(1):1–7.Disclosure of Interests:None declared

COMPARATIVE KINEMATIC ANALYSIS OF THE RANGE OF MOVEMENT OF A NORMAL HUMAN KNEE JOINT, STANDARD ARTIFICIAL KNEE AND NOVEL ARTIFICIAL HIGH FLEXION KNEE

2010 ◽  
Vol 22 (01) ◽  
pp. 41-45
Author(s):  
Sam Prasanna Rajkumar ◽  
Sudesh Sivarasu ◽  
Lazar Mathew
Keyword(s):  
Knee Joint ◽  
Range Of Motion ◽  
Degrees Of Freedom ◽  
Range Of Movement ◽  
High Flexion ◽  
Additional Degree ◽  
Normal Knee ◽  
Standard Version ◽  
Knee Movement ◽  
Human Knee Joint

Total Knee Arthroplasty (TKA) using standard artificial knee implant has a limitation in restriction in the range of motion and freedom of movements'. This study was worked out to compare the kinematics of a reconstructed 3D knee with standard and high flexion artificial knee designs. A CT bone model reconstructed with MIMICS for a 3D normal knee joint and the simulation was done for normal knee, standard version of artificial knee as well as the high flexion knee designs. The results of the analyses, provides us an insight that high flexion designs were most suited and gives increased range of motion and also provides an additional degree of freedom so that it almost mimics the normal knee movement. The high flexion design when tested under simulated environment provided a better functionality and increased movements. It was concluded that the normal knee has 6 degrees of freedom (DOF); the standard version has 1 rotation and 1 translation. The high flexion design provides 2 rotations and 1 translation.

scholarly journals Hyperuricemia and Gout – Ins and Out

2020 ◽  
Vol 15 (2) ◽  
pp. 227-234
Author(s):  
Md Abdur Razzak ◽  
Quazi Audry Arafat Rahman ◽  
Fahtiha Nasreen
Keyword(s):  
Gouty Arthritis ◽  
Polarized Light ◽  
Acute Gout ◽  
Women Patients ◽  
Monosodium Urate ◽  
Tophaceous Gout ◽  
First Metatarsal ◽  
Birefringent Crystals ◽  
Inflammatory Drugs ◽  
Urate Crystals

Gout is a condition characterized by the deposition of monosodium urate crystals in the joints or soft tissue. The four phases of gout include asymptomatic hyperuricemia, acute gouty arthritis, intercritical gout and chronic tophaceous gout. The peak incidence occurs in patients 30 to 50 years old, and the condition is much more common in men than in women. Patients with asymptomatic hyperuricemia do not require treatment, but efforts should be made to lower their urate levels by encouraging them to make changes in diet or lifestyle. Acute gout most commonly affects the first metatarsal joint of the foot, but other joints are also commonly involved. Definitive diagnosis requires joint aspiration with demonstration of birefringent crystals in the synovial fluid under a polarized light microscope. Treatment includes nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, corticosteroids and analgesics. In patients without complications, NSAID therapy is preferred. JAFMC Bangladesh. Vol 15, No 2 (December) 2019: 227-234

scholarly journals Arthroscopic Management of Synovial Chondromatosis of the Knee Joint

2021 ◽  
pp. 651-656
Author(s):  
V. S. Gowtham ◽  
. Mervinrosario ◽  
Vaishak Bhat
Keyword(s):  
Case Report ◽  
Knee Joint ◽  
Viscous Fluid ◽  
Efficient Method ◽  
Histopathological Examination ◽  
Synovial Chondromatosis ◽  
Left Knee ◽  
Loose Bodies ◽  
Benign Condition ◽  
Arthroscopic Management

Synovial Chondromatosis is a rare and it is a benign condition characterized by multiple cartilaginous nodules in synovial facet spaces. Synovial Chondromatosis affects most commonly the knee joint. This is a case report of a 30-year-old male patient presented with pain and swelling over the left knee joint. On evaluation MRI shows loose bodies, for which he underwent, arthroscopic exploration. Viscous fluid and loose bodies were identified and showed synovial hyperemia. Synovial debridement was done and loose bodies were removed and sent to histopathological examination. The result signify that arthroscopy is efficient method both in diagnostic as well as therapeutic management of synovial chondromatosis.

Sign in / Sign up

Export Citation Format

Share Document