Objective. To determine the inflammatory potential of basic calcium phosphate (BCP) crystals, which have been identified in human joints.Methods. Hydroxyapatite, carbonate apatite, whitlockite, and octacalcium phosphate crystals were injected in rat air pouches. Volume and cellularity of the exudate were measured. Physicochemical properties of the injected BCP crystals were determined, and correlations with the magnitude of induced inflammatory responses were sought.Results. Significant differences were observed among the volumes and white blood cell (WBC) counts of the pouch exudates, based on the various crystal types used to induce inflammation. A strong correlation was demonstrated between the specific surface (SS) area of the injected crystals and the area under the curve for induced WBC count versus time (R2 = 0.88, P = 0.05). Conclusion. The inflammatory potential of BCP crystals appeared to vary according to crystal features. SS area and the Ca:P ratio (which correlates with crystal solubility) influenced inflammatory properties. These results could explain the variable clinical consequences of BCP deposits, and must be taken into account in the choice of apatite ceramics for use as biomaterials. This correlation was observed forVarious basic calcium phosphatc (BCP) crystals (i.c., synthcsizcd under basic pH, as opposed to acidic CP crystals such as brushite) can be identified in human joints, where tolerance of them appears highly variable. Crystal dcposits are usually asymptomatic, but have been considered responsible for acute periarticular (1-3) or articular (43) inflammation, subchondral ( 6 ) or diaphyseal (7) bone erosions, and destructive arthropathies (8).

This report describes the case of a woman who was admitted to the hospital for highly destructive axial and peripheral arthropathy in association with acute malignant hypertension and skin purpura. Type I IgGK serum cryoglobulinemia was identified and was classified as a monoclonal gammopathy of unknown significance. Cryoglobulin was shown to crystallize in the serum and synovium fluid and was responsible for both granulomatous microcrystalline synovial inflammation and occlusive vasculopathy in the kidneys and skin. Cryocrystalglobulinemia pathogenicity and therapeutic implications are discussed.Monoclonal immunoglobulins may crystallize within or adjacent to plasma cells, mostly in multiple myeloma (1). Localized crystal deposits independent of plasma cells have been seen in various tissues with differing degrees of organ failure, including skin, cornea, synovium, testes, thyroid, adrenal glands, spleen, liver, lungs, coronary and renal arteries, renal glomeruli, and tubules. We report a case of cryocrystalglobulinemia responsible for skin and renal vasculopathy and associated with highly erosive arthropathy involving both peripheral and axial joints. CASE REPORTClinical course and laboratory findings. The patient, a 45-year-old woman, presented with severe polyarthropathy and gave a history of pain dating back to 1991. She had pain in multiple joints including the distal and proximal interphalangeal joints, metacarpophalangeal joints, wrists, elbows, shoulders, cervical spine, sacroiliac joints, heels, ankles, and metatarsophalangeal joints, which caused progressive disability. At different times on subsequent examinations there was gross and sometimes pseudotumoral swelling of the tendon sheaths of the fingers, dorsum of the hands, and elbows, and considerable restriction of movement of all involved joints. There was no rash on the palms or soles, acne, psoriasis, subcutaneous nodules, tophi, lymphadenopathy, or enlargement of the spleen or liver. Hemography results were normal.The erythrocyte sedimentation rate was 120 mmhour. The C-reactive protein level ranged from 2 mg/dl to 4 mg/dl. Liver test results and lactate dehydrogenase and muscle enzyme levels were within normal ranges. The uric acid level was 200 pMAiter. The serum calcium level was 2.5 M A i t e r , and the phosphate level was 1.5 M l l i t e r . Findings of serologic studies for infectious agents, including Lyme borreliosis, human immunodeficiency virus, parvovirus B19, and hepatitis B and C were negative. The results of tests for autoantibodies, including rheumatoid factor, antinuclear antibodies, anti-DNA, antiextractable nuclear antigen, antiphospholipid antibodies, antineutrophil cytoplasmic antibodies, and direct Coombs' test were negative. Serum C3 and C4 complement components and CH50 values were within normal ranges. HLA class I typing was negative for B27. A monoclonal cryoprecipitable 1gGK gammopa-

For patients, the social and emotional repercussions of stroke include shame, personality changes, and upheavals experienced by the couple (i.e. patient and main family caregiver). These impacts on the couple ‘patient/family caregiver’ are scarcely documented. Focusing on the perceptions of the patients and the family caregivers living at home, two years after a stroke occurrence, the aims of the study were to analyse the concordance of attitudes towards the emotional and social repercussions of stroke and to determine the profiles of the differing dyads. Two researchers conducted separate face-to-face structured interviews with stroke survivors and their family caregivers. Eleven items, identified through a content analysis of interviews and after a qualitative process of generating questionnaire items, assessed the commonly experienced impact of stroke on the family, the social repercussions of stroke, and its emotional effects on the stroke survivors. The kappa concordance coefficient was used to determine the response convergence between patients and family caregivers. Four items, selected by a panel of experts, were included in logistic regressions (i.e., demographic characteristics and patients’ impaired functions) to identify the differing dyadic profiles. Family caregivers’ and patients’ attitudes towards the social repercussions of stroke were similar. Patients with motor deficiencies tended to underestimate the upheaval brought to their couple by stroke, whereas caregivers of language-impaired patients tended to underestimate their feelings of shame and demeaning. Communication disturbances, but also residual physical disabilities in stroke survivors, may affect the understanding of each other’s attitudes within dyads. In order to avoid dysfunctional relationships between family caregivers and patients, healthcare professionals need to pay special attention to this issue, especially in cases of aphasia and motor deficiencies.