Gout And Crystal Arthritis Introduction Gout is
an inflammatory joint disease where disease where meat is broken down into purines
and uric acid, which is deposited as crystal deposits in and around joints. When
meat and alcohol are consumed together, it makes gout worse. In the middle ages
gout was a disease of the affluent and royalty was afflicted by gout. Gout is actually only one of the manifestations of
a faulty uric acid metabolism. Kidney stones are another manifestation. Apart
from uric acid crystal disease there are other crystal-induced diseases such as
pseudogout, which is produced by precipitation of another crystalized salt, calcium
pyrophosphate dihydrate (CPPD). The other name for pseudogout therefore is CPPD
crystal deposit disease. These crystal deposits cause an inflammatory arthritis
that leads to scarring and a lack of range of motion, if it is not detected early
and treated.
GoutIntroduction: Not
everybody can handle uric acid in their system as well as the person next door.
Uric acid is one of the breakdown products of meat. We are all born with slightly
different enzyme patterns. However, the person that cannot break down purines
as well will end up with too much uric acid in the system until it reaches a critical
point of solubility where it preciptates as uric acid crystals. When uric
acid levels exceed 7.0 mg/dL (or 0.41 mmol/L) in plasma, a critical point is reached
where monosodium urate crystals, which under the microscope look like micro-needles,
will be spontaneously deposited in tissue with a lack of blood supply such as
tendons, joints, ligaments or cooler tissues such as ear lobes. This point can
also be reached in patients who have leukemia, lymphomas, hemolytic anemias or
other cancers where purines are overproduced because of rapid cell division. Some
children are born with an enzyme defect, which leads to uric acid kidney stones,
severe gout and kidney damage at a young age. Most cases of gout though are in
adults and are often associated with an overindulgence of meals containing large
helpings of meat in combination with consumption of alcohol. This might be part
of the explanation why males are much more commonly affected by gout then females
(ratio of 20:1).
Pseudogout
(calcium pyrophosphate dihydrate crystal deposit disease or CPPD crystal disease)Introduction The
clinical course is very similar to gout, except that the symptoms are not as acute
as with gout. It appears that CPPD crystals are a byproduct of degenerative or
metabolic tissue changes. This explains why pseudogout is often associated
with other rheumatological diseases such as calcific rotator cuff tendinitis,
calcific bursitis, degenerative arthritis and gout. There are also associations
with metabolic diseases such as hypothyroidism, hemochromatosis, hyperparathyroidism
and amyloidosis (Ref. 2). CCPD crystal disease is a disease of persons older than
60 years of age. Signs and symptoms: Pseudogout
presents as an acute attack similar to gout, affecting mainly the knee, wrist
or shoulder. The diagnosis is often more difficult than that of gout as the CPPD
crystals are not as concentrated in the synovial fluid. However, with centrifugation
and a lab that specializes in its detection the diagnosis is now easier to make.
Treatment of pseudogout: The
acute joint pain responds very well to colchicine therapy. Antiinflammatories
such as NSAIDs or Cox-2 inhibitors will help very well for arthritis of joints
and for calcific tendinitis or bursitis cases affected by pseudogout. Maintenance
therapy on low dose colchicine can be used longterm, but must be balanced by the
physician and patient against the toxic side-effects on the bone marrow and kidneys.
Occasionally there is a patient where all therapies fail and severe joint destruction
results. | 
