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Crystal Arthropathies

para>Colchicines and NSAIDs contraindicated in pregnancy

Ongoing Care

Follow-up Recommendations

  • Gout: as indicated to control hyperuricemiaMonitor uric acid level within 6 weeks of diagnosis.
  • CPPD: Unlike MU crystals, CPPD crystals deposition is irreversible, so reoccurrence is likely if underlying disorder is not treated or inflammatory pathways are not inhibited.
  • Calcium oxalate: referral indicated

Patient Monitoring

  • NSAID therapy: Monitor for renal and GI side effects.
  • Colchicine: Monitor liver and kidney function if on extended course.
  • Calcium oxalate disease warrants nephrology consult to monitor kidney function.

Diet

  • Gout: Decrease red meat and seafood.
  • Calcium oxalate: Decrease ascorbic acid/oxalates.

Prognosis

  • Gout: excellent with appropriate medication to control inflammation and uric acid levels
  • CPPD: Fair, due to chronic nature of crystals, but if reversible underlying disease is controlled, then chance of recurrence decreases.
  • Calcium oxalate: fair to good if underlying hyperoxalemia is controlled

References

1.Singh JA. Racial and gender disparities among patients with gout. Curr Rheumatol Rep. 2013;15(2):307.

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2.Macmullan P, McCarthy G. Treatment and management of pseudogout: insights for the clinician. Ther Adv Musculoskelet Dis. 2012;4(2):121-131.

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3.Courtney P, Doherty M. Joint aspiration and injection and synovial fluid analysis. Best Pract Res Clin Rheumatol. 2013;27(2):137-169.

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4.Lorenz EC, Michet CJ, Milliner DS, et al. Update on oxalate crystal disease. Curr Rheumatol Rep. 2013;15(7):340.

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5.Announ N, Guerne PA. Treating difficult crystal pyrophosphate dehydrate deposition disease. Curr Rheumatol Rep. 2008;10(3):228-234.

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6.Schlesinger N, Schumacher R, Catton M, et al. Colchicine for acute gout. Cochrane Database Syst Rev. 2006;(4):CD006190.

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Additional Reading

  • Eggebeen AT. Gout: an update. Am Fam Physician. 2007;76(6):801-808. []
  • Mies Richie A, Francis ML. Diagnostic approach to polyarticular joint pain. Am Fam Physician. 2003;68(6):1151-1160. []
  • Siva C, Velazquez C, Mody A, et al. Diagnosing acute monoarthritis in adults: a practical approach for the family physician. Am Fam Physician. 2003;68(1):83-90.

See Also

Codes

ICD09

  • 712.90 Unspecified crystal arthropathy, site unspecified
  • 712.30 Chondrocalcinosis, unspecified, site unspecified
  • 712.97 Unspecified crystal arthropathy, ankle and foot
  • 712.37 Chondrocalcinosis, unspecified, ankle and foot
  • 274.9 Gout, unspecified
  • 275.49 Other disorders of calcium metabolism

ICD10

  • M11.9 Crystal arthropathy, unspecified
  • M11.20 Other chondrocalcinosis, unspecified site
  • M11.879 Other specified crystal arthropathies, unspecified ankle and foot
  • M1A.9XX0 Chronic gout, unspecified, without tophus (tophi)

SNOMED

  • 18834007 Crystal arthropathy (disorder)
  • 239834007 Pyrophosphate arthritis (disorder)
  • 75468006 Crystal arthropathy of ankle AND/OR foot (disorder)
  • 35885006 Hyperuricemia (disorder)
  • 90560007 Gout (disorder)

Clinical Pearls

  • Gout more likely monoarticular, MTP joint
  • CPPD monoarticular or polyarticular, knee common
  • Apatite and calcium oxalate not common, usually associated with underlying conditions
  • CPPD, apatite, oxalate crystal arthropathy correlates with advanced age more than gout.
  • Joint aspiration is key to all crystal arthropathy diagnoses.