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. 1993 Feb;52(2):97–103. doi: 10.1136/ard.52.2.97

Association of radiographic changes of osteoarthritis, symptoms, and synovial fluid particles in 300 knees.

M Pattrick 1, E Hamilton 1, R Wilson 1, S Austin 1, M Doherty 1
PMCID: PMC1004986  PMID: 8447704

Abstract

Associations between compartmental distribution of radiographic changes of osteoarthritis (OA), individual features of OA (joint space loss, sclerosis, cyst, osteophyte; each scored 0-3), and presence of synovial fluid calcium particles (calcium pyrophosphate dihydrate (CPPD) crystals identified by polarised light microscopy and other calcium particles by alizarin red positivity (ARP) were sought in 300 osteoarthritic knees (178 patients; mean age 72, range 33-96 years). Patients whose knees were symptom free as well as those with symptoms were included. Osteoarthritis of two or three compartments but not unicompartmental OA was associated with the presence of CPPD or ARP. Involvement of any compartment (not just patellofemoral), and higher mean scores for both total and individual osteoarthritis changes (except cysts) was associated with CPPD and ARP; CPPD, but not ARP, was associated with symptoms: knees reported as having symptoms had higher mean total OA scores. Femoral cortical erosion, found more often in women, was associated with higher mean total OA score at the patellofemoral compartment but not with the presence of particles. Attrition, remodelling, and chondrocalcinosis (each scored as present or absent) occurred more often in knees with CPPD. Age did not correlate with any aspect of the OA score. This study confirms the association of calcium particles with the process of OA. Unlike previous studies confined to symptomatic knees, a radiographic pattern specific to CPPD ('pyrophosphate arthropathy') did not emerge.

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Selected References

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  1. Bennett R. M., Lehr J. R., McCarty D. J. Factors affecting the solubility of calcium pyrophosphate dihydrate crystals. J Clin Invest. 1975 Dec;56(6):1571–1579. doi: 10.1172/JCI108239. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Chayen J. Polarised light microscopy: principles and practice for the rheumatologist. Ann Rheum Dis. 1983 Aug;42 (Suppl 1):64–67. doi: 10.1136/ard.42.suppl_1.64. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Dieppe P. A., Crocker P. R., Corke C. F., Doyle D. V., Huskisson E. C., Willoughby D. A. Synovial fluid crystals. Q J Med. 1979 Oct;48(192):533–553. [PubMed] [Google Scholar]
  4. Dieppe P. A., Crocker P., Huskisson E. C., Willoughby D. A. Apatite deposition disease. A new arthropathy. Lancet. 1976 Feb 7;1(7954):266–269. doi: 10.1016/s0140-6736(76)91400-8. [DOI] [PubMed] [Google Scholar]
  5. Dieppe P. A., Doyle D. V., Huskisson E. C., Willoughby D. A., Crocker P. R. Mixed crystal deposition disease and osteoarthritis. Br Med J. 1978 Jan 21;1(6106):150–150. doi: 10.1136/bmj.1.6106.150. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Dieppe P., Campion G., Doherty M. Mixed crystal deposition. Rheum Dis Clin North Am. 1988 Aug;14(2):415–426. [PubMed] [Google Scholar]
  7. Dieppe P., Watt I. Crystal deposition in osteoarthritis: an opportunistic event? Clin Rheum Dis. 1985 Aug;11(2):367–392. [PubMed] [Google Scholar]
  8. Doherty M., Dieppe P. Clinical aspects of calcium pyrophosphate dihydrate crystal deposition. Rheum Dis Clin North Am. 1988 Aug;14(2):395–414. [PubMed] [Google Scholar]
  9. Forman M. D., Malamet R., Kaplan D. A survey of osteoarthritis of the knee in the elderly. J Rheumatol. 1983 Apr;10(2):282–287. [PubMed] [Google Scholar]
  10. Gibilisco P. A., Schumacher H. R., Jr, Hollander J. L., Soper K. A. Synovial fluid crystals in osteoarthritis. Arthritis Rheum. 1985 May;28(5):511–515. doi: 10.1002/art.1780280507. [DOI] [PubMed] [Google Scholar]
  11. Goodfellow J., Hungerford D. S., Zindel M. Patello-femoral joint mechanics and pathology. 1. Functional anatomy of the patello-femoral joint. J Bone Joint Surg Br. 1976 Aug;58(3):287–290. doi: 10.1302/0301-620X.58B3.956243. [DOI] [PubMed] [Google Scholar]
  12. Halverson P. B., McCarty D. J. Identification of hydroxyapatite crystals in synovial fluid. Arthritis Rheum. 1979 Apr;22(4):389–395. doi: 10.1002/art.1780220412. [DOI] [PubMed] [Google Scholar]
  13. Halverson P. B., McCarty D. J. Patterns of radiographic abnormalities associated with basic calcium phosphate and calcium pyrophosphate dihydrate crystal deposition in the knee. Ann Rheum Dis. 1986 Jul;45(7):603–605. doi: 10.1136/ard.45.7.603. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Hamilton E., Pattrick M., Doherty M. Inorganic pyrophosphate, nucleoside triphosphate pyrophosphatase, and cartilage fragments in normal human synovial fluid. Br J Rheumatol. 1991 Aug;30(4):260–264. doi: 10.1093/rheumatology/30.4.260. [DOI] [PubMed] [Google Scholar]
  15. Kantor T. G. Concepts in pain control. Semin Arthritis Rheum. 1989 May;18(4 Suppl 2):94–99. doi: 10.1016/0049-0172(89)90025-5. [DOI] [PubMed] [Google Scholar]
  16. Lawrence J. S., Bremner J. M., Bier F. Osteo-arthrosis. Prevalence in the population and relationship between symptoms and x-ray changes. Ann Rheum Dis. 1966 Jan;25(1):1–24. [PMC free article] [PubMed] [Google Scholar]
  17. McCarty D. J., Jr, Phelps P., Pyenson J. Crystal-induced inflammation in canine joints. I. An experimental model with quantification of the host response. J Exp Med. 1966 Jul 1;124(1):99–114. doi: 10.1084/jem.124.1.99. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Merritt J. L. Soft tissue mechanisms of pain in osteoarthritis. Semin Arthritis Rheum. 1989 May;18(4 Suppl 2):51–56. doi: 10.1016/0049-0172(89)90016-4. [DOI] [PubMed] [Google Scholar]
  19. Paul H., Reginato A. J., Schumacher H. R. Alizarin red S staining as a screening test to detect calcium compounds in synovial fluid. Arthritis Rheum. 1983 Feb;26(2):191–200. doi: 10.1002/art.1780260211. [DOI] [PubMed] [Google Scholar]
  20. Peyron J. G. Epidemiologic and etiologic approach of osteoarthritis. Semin Arthritis Rheum. 1979 May;8(4):288–306. doi: 10.1016/0049-0172(79)90006-4. [DOI] [PubMed] [Google Scholar]
  21. Puchtler H., Meloan S. N., Terry M. S. On the history and mechanism of alizarin and alizarin red S stains for calcium. J Histochem Cytochem. 1969 Feb;17(2):110–124. doi: 10.1177/17.2.110. [DOI] [PubMed] [Google Scholar]
  22. Seedholm B. B., Takeda T., Tsubuku M., Wright V. Mechanical factors and patellofemoral osteoarthrosis. Ann Rheum Dis. 1979 Aug;38(4):307–316. doi: 10.1136/ard.38.4.307. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Thomas R. H., Resnick D., Alazraki N. P., Daniel D., Greenfield R. Compartmental evaluation of osteoarthritis of the knee. A comparative study of available diagnostic modalities. Radiology. 1975 Sep;116(3):585–594. doi: 10.1148/116.3.585. [DOI] [PubMed] [Google Scholar]

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