Mixed Crystal Disease: A Tale of 2 Crystals

Pascual, Eliseo; Sivera, Francisca; Andrés, Mariano

doi:10.3899/jrheum.191316

Cited by 3 publications

(2 citation statements)

References 21 publications

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“…Looking at these results, we can diagnose 13 instances of gout and 7 instances of CPPD. A combination of multiple crystals, referred to as mixed crystal disease, [ 34 ] was found in 13 patients. Mixed crystal disease is known as a very rare condition, and these results demonstrate that this might not be the case.…”

Section: Resultsmentioning

confidence: 99%

Raman hyperspectral imaging detects novel and combinations of crystals in synovial fluids of patients with a swollen joint

Niessink

Kuipers

Jong

et al. 2022

J Raman Spectroscopy

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The identification of synovial crystals is important for diagnosing rheumatic diseases. Currently, rheumatologists worldwide use compensated polarized light microscopy (CPLM) for crystal identification, but this technique is flawed. Raman spectroscopy might offer an objective, accurate alternative. We have tested Raman hyperspectral imaging on synovial fluid samples of 28 patients with swollen joints, measuring 5–10 crystals in each of these. Reference spectra for identification were measured using patient material, synthetic compounds, and oxalate kidney stones. Additionally, RRUFF and PANGAEA Raman databases were used to identify spectra. We identified the classical pathological crystals monosodium urate for gout and calcium pyrophosphate for calcium pyrophosphate deposition disease (CPPD). Hydroxyapatite, lipid spherules, and calcium oxalate monohydrate have also been observed and had been previously identified in synovial fluids. Other crystals, which were not previously observed in synovial fluid using CPLM, have been identified as well: calcite, aragonite, anatase, rutile, thenardite, dolomite, and a carotenoid. In addition, we found combinations of crystals in 13 out of 28 patients. We propose that the observed large variation of detectable crystals from a small population of patients and a small number of crystals per patient has significant ramifications for the use of compensated polarized light microscopy for the diagnosis of gout and CPPD. Further studies are required to learn the clinical significance of these crystals in human arthritis.

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Section: Resultsmentioning

confidence: 99%

Raman hyperspectral imaging detects novel and combinations of crystals in synovial fluids of patients with a swollen joint

Niessink

Kuipers

Jong

et al. 2022

J Raman Spectroscopy

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show abstract

“…The question rises whether a synergistic effect can be attributed to CPP and TiO 2 , as both particles can induce arousal of the NLRP3 inflammasome [15,18]. The combination of two pro-inflammatory particles in the same inflamed joint is known as mixed crystal disease [19], a condition mostly attributed to the simultaneous presence of MSU and CPP crystals. As this is a rare phenomenon, there is little known about the severity of the disease and optimal disease management.…”

Section: Discussionmentioning

confidence: 99%

The Prevalence of Titanium Dioxide Particles in Synovial Fluid Samples Drops after European Union Ban

Niessink,

Janssen,

Jansen

et al. 2024

GUCDD

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Due to health concerns, the European Union has banned the use of titanium dioxide nanoparticles in consumables in February 2022, with a 6-month transitional period ending in August 2022. We studied the prevalence of titanium dioxide nanoparticles in synovial fluid samples during and after the transitional period. A total of 302 samples were collected as a consecutive series between 1 April 2022 and 15 June 2023 from patients visiting the department of rheumatology at VieCuri Medical Centre in Venlo, The Netherlands. The samples were primarily collected for diagnostic purposes and only clinical waste material was used for this study. From each sample, up to 40 μl of fluid was analysed with Raman spectroscopy for the presence of titanium dioxide particles. The trend in prevalence was calculated with a 3-month wide moving average. A total of 13 out of 302 samples (4.3%) contained titanium dioxide (TiO2). The prevalence of TiO2 decreased between the transitional period and the period after the ban (p = 0.0154, with a relative risk ratio of 4.9 (95% CI 1.35–17.74). There was no significant difference in patient characteristics between the TiO2 positive and the TiO2 negative group. These results are hinting towards a possible relationship between the EU-ban and the identified decrease in prevalence.

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Crystal-Associated Arthritis: Calcium Pyrophosphate Arthritis

Pascual

Andrés

2022

Synovial Fluid Analysis and the Evaluation of Patients With Arthritis

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Mixed Crystal Disease: A Tale of 2 Crystals

Cited by 3 publications

References 21 publications

Raman hyperspectral imaging detects novel and combinations of crystals in synovial fluids of patients with a swollen joint

Raman hyperspectral imaging detects novel and combinations of crystals in synovial fluids of patients with a swollen joint

The Prevalence of Titanium Dioxide Particles in Synovial Fluid Samples Drops after European Union Ban

Crystal-Associated Arthritis: Calcium Pyrophosphate Arthritis

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