Musculoskeletal

Crystal Arthropathy

An acute hot-joint syndrome caused by crystal-triggered inflammation; aspirate when uncertain to distinguish monosodium urate, calcium pyrophosphate and septic arthritis, then tailor acute and long-term care to the result.

Definition

Crystal arthropathy is inflammatory arthritis caused by deposition of crystals within or around a joint, principally monosodium urate in gout and calcium pyrophosphate in CPPD.

First principles

A hot joint is a safety problem before it is a label

Gout and acute calcium pyrophosphate crystal arthritis can both present with a rapidly painful, red and swollen joint. Septic arthritis can look identical and can coexist with crystals, so the initial assessment must actively consider infection rather than treating the appearance as diagnostic.

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