Identificarea cristalelor din lichidul articular

- microscopie -

In MSU, it is negative (and bright), while in

CPPD, it is positive (and weak) birefringence.
Cholesterol crystals are sometimes noted in chronic
inflammatory synovial fluids.

- notched polygonal plates.

- in contrast to cholesterol, some neutral fat (lipid) droplets

have a "Maltese cross" appearance when viewed with
polarizing microscopy that is identical to that of lipid
droplets seen in the urine sediment of patients with
nephrotic syndrome.

- when lipid droplets are present in synovial fluid, articular

fracture should be suspected.

Lipid doplets

Apatite (hydroxyapatite) crystals

- too small to detect on light microscopy, unless they are

aggregated.

- only light microscopy with alizarin red or von Kossa stains,

which have an affinity for calcium-containing crystals, are
considered to be practical for clinical use (sensitivity and
specificity of microscopy using one or the other of these
calcium stains is uncertain)

In contrast to MSU and CPPD, BCP crystals usually appear as

an amorphous substance, which is not birefringent and
cannot be seen under polarised light microscopy and they
can easily be mistaken for artefacts or debris.
Oxalate arthropathy is a rare cause of arthritis characterized by deposition of calcium
oxalate crystals within synovial fluid. This condition typically occurs in patients with
underlying primary or secondary hyperoxaluria. Primary hyperoxaluria constitutes a
group of genetic disorders resulting in endogenous overproduction of oxalate,
whereas secondary hyperoxaluria results from gastrointestinal disorders associated
with fat malabsorption and increased absorption of dietary oxalate. In both conditions
oxalate crystals can deposit in the kidney leading to renal failure. Since oxalate is
primarily renally eliminated, it accumulates throughout the body in renal failure, a
state termed oxalosis. Affected organs can include bones, joints, heart, eyes and skin.
Since patients can present with renal failure and oxalosis before the underlying
diagnosis of hyperoxaluria has been made, it is important to consider hyperoxaluria in
patients who present with unexplained soft tissue crystal deposition.

Negatively birefringent lipid crystals can Talc from gloves Charcot-Leyden crystals in eosinophilic
form in neutral lipid droplets in specimens laden synovial fluid.
left over night.

Cortisone
crystals
WBC: white blood cell; MSU: monosodium urate; CPPD: calcium
pyrophosphate crystal deposition.

* Septic arthritis is typically associated with synovial fluid white

blood cell counts >20,000 cells/microL, but lower counts may be
observed, especially for arthritis due to disseminated
gonococcal infection. With most bacterial organisms, particularly
Staphylococcus aureus, the synovial fluid white blood cell count
is typically >50,000 cells/microL (and often >100,000
cells/microL).

¶ Crystal-induced arthritis may still be considered despite the

absence of identified crystals; false-negative results occur,
especially with CPPD.

Δ If treatment of crystal-induced arthritis does not result in

clinical improvement, consider other inflammatory or infectious
arthridites.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2625400/

https://www.uptodate.com/contents/synovial-fluid-analysis?search=cppd
%20crystals&source=search_result&selectedTitle=4~150&usage_type=default&display_rank=4#H3760308528

https://musculoskeletalkey.com/synovial-fluid-crystal-analysis/

https://www.med.upenn.edu/synovium/Documents/smllsynovial_fluid_ACR_for2008workshop.pdf

https://www.rheumatology.org/Portals/0/Files/ViP-Adult-Arthrocentesis-ORourke.pdf