Age was the only significant influencing factor on CPPD crystal formation in patients with RA. In conclusion, demographic, clinical and serological characteristics of patients with RA were not associated with the occurrence of CPPD crystals. An age-independent association of long-time treatment with diuretics and CPPD crystal formation was not found. Patients positively tested for CPPD crystals had a significantly higher age than CPPD-negative patients (p < 0.0001). CPPD-positive and CPPD-negative subjects did not differ significantly in sex, duration of disease, Steinbrocker radiologic stage, disease activity score 28, as well as serum rheumatoid factor and anti-CCP positivity. CPPD crystals were observed in 20 of the 113 cases, representing 17.7%. The most common types of crystals found in synovial fluid are uric acid crystals and calcium pyrophosphate dihydrate (CPPD) crystals. In the case of MSUM and CPPD crystals it is clear that the identification of these crystals in a synovial fluid that also has a high polymorphonuclear cell count is the only certain way to diagnose an attack of gout or pseudogout respectively. Demographic, clinical and serological data, acquired from the medical records, were compared between crystal-positive and crystal-negative subjects. Leader Identification of crystals in synovial fluid. After cytocentrifugation, the sediments were examined by polarized microscopy for the occurrence of CPPD crystals. When released into the synovial fluid, it causes unbearable pain to the patient. We examined 113 consecutive SF samples of patients with RA, obtained from therapeutic arthrocentesis of knee joints. CPPD chrystals appear as shattered glass under the microscope. In chronic pyrophosphate arthropathy, synovial fluid findings are more variable, and range from inflammatory to non-inflammatory. Synovial fluid cell count is usually greatly elevated with >90 neutrophils. With most bacterial organisms, particularly Staphylococcus aureus, the synovial fluid WBC count is typically >50,000 cells/microL (and often >100,000 cells/microL). Aspirated fluid in acute CPP crystal arthritis is often turbid with diminished viscosity. The objectives of this study were to determine the prevalence of CPPD crystals in the synovial fluid (SF) of patients with RA and to investigate whether the detection of CPPD crystals is correlated with demographic, clinical and serological features. WBC: white blood cell RBC: red blood cell CPPD: calcium pyrophosphate dihydrate deposition. In particular, data determined by the cytospin technique, which is an effective tool to enhance the crystal detection rate, are lacking. All the specimens were also analyzed by SEM and x-ray diffractometry, as gold stan- dards. There are only a few studies dealing with the detection and clinical impact of calcium pyrophosphate (CPPD) crystals in patients with rheumatoid arthritis (RA) published to date.
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