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PubMed2001

Cholesterol crystallization in model biles: effects of bile salt and phospholipid species composition.

Cholesterol in human bile is solubilized in micelles by (relatively hydrophobic) bile salts and phosphatidylcholine (unsaturated acyl chains at sn-2 position). Hydrophilic tauroursodeoxycholate, dipalmitoyl phosphatidylcholine, and sphingomyelin all decrease cholesterol crystal-containing zones in the equilibrium ternary phase diagram (van Erpecum, K. J., and M. C. Carey. 1997. Biochim. Biophys. Acta. 1345: 269-282) and thus could be valuable in gallstone prevention. We have now compared crystallization in cholesterol-supersaturated model systems (3.6 g/dl, 37 degrees C) composed of various bile salts as well as egg yolk phosphatidylcholine (unsaturated acyl chains at sn-2 position), dipalmitoyl phosphatidylcholine, or sphingomyelin throughout the phase diagram. At low phospholipid contents [left two-phase (micelle plus crystal-containing) zone], tauroursodeoxycholate, dipalmitoyl phosphatidylcholine, and sphingomyelin all enhanced crystallization. At pathophysiologically relevant intermediate phospholipid contents [central three-phase (micelle plus vesicle plus crystal-containing) zone], tauroursodeoxycholate inhibited, but dipalmitoyl phosphatidylcholine and sphingomyelin enhanced, crystallization. Also, during 10 days of incubation, there was a strong decrease in vesicular cholesterol contents and vesicular cholesterol-to-phospholipid ratios (approximately 1 on day 10), coinciding with a strong increase in crystal mass. At high phospholipid contents [right two-phase (micelle plus vesicle-containing) zone], vesicles were always unsaturated and crystallization did not occur. Strategies aiming to increase amounts of hydrophilic bile salts may be preferable to increasing saturated phospholipids in bile, because the latter may enhance crystallization.

1,2-Dipalmitoylphosphatidylcholine↗
PubMed2002

The high prevalence of pathologic calcium crystals in pre-operative knees.

OBJECTIVE: Calcium pyrophosphate dihydrate (CPPD) and basic calcium phosphate (BCP) crystals are important in the pathogenesis of osteoarthritis (OA) but are under recognized even in end stage disease. We determined the prevalence of these calcium crystals in synovial fluid (SF) of persons undergoing total knee arthroplasty for degenerative arthritis. METHODS: SF samples were obtained from 53 knee joints undergoing total arthroplasty for a pre-operative diagnosis of OA. SF were analyzed via compensated light microscopy for CPPD crystals and a semiquantitative radiometric assay for BCP crystals. Fifty pre-operative radiographs were analyzed and graded according to the scale of Kellgren and Lawrence. RESULTS: Patients had an average age of 70 years at the time of surgery. CPPD and/or BCP crystals were identified in 60% of SF. Overall radiographic scores correlated with mean concentrations of BCP crystals. Higher mean radiographic scores correlated with the presence of calcium-containing crystals of either type in SF Radiographic chondrocalcinosis was identified in only 31% of those with SF CPPD. CONCLUSIONS: Pathologic calcium crystals were present in a majority of SF at the time of total knee arthroplasty. Intraoperative SF analysis could conveniently identify pathologic calcium crystals providing information that may be relevant to the future care of the patient's replaced joint and that of other joints. This information could also potentially aid in predicting the likelihood of the need for contralateral total knee arthroplasty.

Aged↗
PubMed2002

The effect of preincubation of seed crystals of uric acid and monosodium urate with undiluted human urine to induce precipitation of calcium oxalate in vitro : implications for urinary stone formation.

BACKGROUND: Previous studies demonstrated that crystals of uric acid (UA) and sodium urate (NaU) can induce the precipitation of calcium oxalate (CaOx) from its inorganic metastable solutions, but similar effects have not been unequivocally shown to occur in urine. The aim of this investigation was to determine whether preincubation of these seeds with urine alter their ability to induce deposition of CaOx from solution and thus provide a possible explanation for discrepancy of results obtained from aqueous inorganic solutions and undiluted urine. MATERIALS AND METHODS: The effects of commercial seed crystals of UA, NaU and CaOx (6 mg/100 ml) on CaOx crystallization were compared in a solution with the same crystals that had been preincubated for 3 hours with healthy male urine. A Coulter Counter was used to follow the crystallization and decrease in soluble (14) C-oxalate was measured to determine the deposition of CaOx. The precipitated particles were examined by scanning electron microscopy (SEM). The preincubated seeds were demineralized and proteins released were analyzed by sodium dodecylsulphate polyacrylamide gel electrophoresis (SDS-PAGE). RESULTS: Analysis of (14) C-oxalate data revealed that while treated UA seeds did not affect CaOx deposition, those of NaU and CaOx inhibited the process by 51.9 (p<0.05) and 8.5% (p<0.05) relative to their respective untreated counterparts. Particle size analysis showed that the average modal sizes of particles precipitated in the presence of treated seed crystals of UA, NaU, and CaOx were very similar to those deposited in the presence of their respective untreated controls. These findings were confirmed by SEM which also showed that seed crystals of UA and NaU, untreated and treated, were attached like barnacles upon the surfaces of CaOx crystals which themselves were bigger than those precipitated in the presence of CaOx seeds. SDS-PAGE analysis of the demineralized treated seeds showed that they all selectively adsorbed urinary proteins, and perhaps other urinary macromolecules and low molecular weight components, on their surface. CONCLUSIONS: It was concluded that preincubation with urine, such as occurs in vivo, only slightly reduces the ability of seed crystals of CaOx, but not of UA, to cause deposition of CaOx. The most striking effect was on NaU seeds where the preincubation quite dramatically attenuated their promotory effect on the mineral deposition. This may explain the discrepancy between findings of studies carried out in inorganic solutions and undiluted human urine. This stresses the invalidity of directly extrapolating results obtained in inorganic solutions to likely effects in urine and more importantly, on stone formation.

Calcium Oxalate↗
PubMed1992

Arthropathies associated with basic calcium phosphate crystals.

Basic calcium phosphate (BCP) crystals refer to a family of crystals including partially carbonate substituted hydroxyapatite, octacalcium phosphate, and tricalcium phosphate. These crystals have been found in and around joints and have been associated with several forms of arthritis and periarthritis. Identification of BCP crystals remains problematic because of the lack of a simple, reliable analytic procedure. Methods currently in use include alizarin red S staining, labelled diphosphonate binding, scanning and transmission electron microscopy with energy dispersive X-ray microanalysis, X-ray diffraction, and atomic force microscopy. Periarthropathies associated with BCP crystals include calcific tendinitis and bursitis. Intra-articular BCP crystal deposition is common in osteoarthritis, often found together with calcium pyrophosphate dihydrate crystals. Uncommon conditions in which BCP crystals are found include destructive shoulder arthropathies, acute inflammatory attacks of arthritis, and erosive arthritis. Secondary deposition of BCP crystals has been observed in chronic renal failure, in patients with "collagen vascular" diseases, following neurologic injury and after local corticosteroid injection.

Arthritis↗
PubMed1988

Calcium pyrophosphate crystal deposition: the effect of soluble iron in a kinetic study using a gelatin matrix model.

The kinetics of calcium pyrophosphate dihydrate (CPPD) crystal growth was studied by allowing calcium and pyrophosphate (PPi-4) ions to diffuse through a denatured collagen matrix (biological grade gelatin) in the presence of either ferric or ferrous ions. Ferric and, to some extent, ferrous ions blocked the migration of the PPi-4 diffusion gradient. This retardation in the [PPi-4] gradient led to numerous changes in the patterns of CPPD crystal formation. At the initial stages of crystal growth, the iron ions induced more crystal growth compared to control. At later incubation times, ferrous and ferric ions enhanced crystal growth at the expense of crystal nucleation. The presence of both ferrous and ferric ions resulted in the more rapid formation of the two crystals observed in vivo, triclinic CPPD and monoclinic CPPD. Further, both ferrous and ferric ions also reduced the solubility of the crystalline material in the broad diffuse band which formed when the Ca+2 and PPi-4 gradients first met. In this system, the presence of either ferrous or ferric ions increased the amount of hydroxyproline included in the crystalline precipitates. Iron was also incorporated into the crystals, particularly into the triclinic CPPD and monoclinic CPPD crystals.

Calcinosis↗
PubMed1985

Relationships between ice crystal size, water content and proton NMR relaxation times in cells.

Biological specimens were frozen under controlled conditions. We questioned how the size of ice crystals, as measured in cryosectioned and cryoadsorbed sections of these biological specimens, relates to the water content and to the proton NMR relaxation times (T1 and T2) of the unfrozen specimens. The results permit the following conclusions: After rapid freezing in liquid propane cooled in a liquid nitrogen bath, the average size of ice crystals at distances of 150 microns or more from the surface of a particular tissue was always the same. Thus, the average size of the ice crystals was found to be characteristic of the type of biological tissue studied. Linear regression analysis showed average ice crystal size to have a significant correlation coefficient to T1 relaxation time and to water content. Specifically ice crystal size increased with T1 relaxation time and with water content. Multiple regression and path analysis demonstrated a positive correlation between the T1 relaxation time and the ice crystal size variation. Path analysis showed that both water content and T2 relaxation time were less directly correlated with ice crystal size. The findings from the path analysis and other observations show that the average size of ice crystals in subcellular compartments is best predicted by the proton T1 relaxation time. A working model is put forth to explain differences in ice crystal size observed between specimens enriched in globular or in parallel filamentous proteins.

Animals↗
PubMed1984

Supersaturated bile from obese patients without gallstones supports cholesterol crystal growth but not nucleation.

Cholesterol crystal formation was studied in gallbladder bile samples collected from 18 patients with cholesterol gallstones, 6 patients with black pigment stones, and 14 obese patients without gallstones. In the absence of seed crystals, bile from patients with cholesterol stones showed a much greater tendency to form cholesterol crystals in vitro than bile of similar cholesterol saturation from patients without cholesterol stones. The ability to form crystals was not related to the biliary hexosamine concentration, an indicator of mucin content. When small seed crystals of cholesterol monohydrate were added to each bile, the seed crystals dissolved in all biles (n = 8) with a cholesterol saturation index less than 0.76. In contrast, 29 of 30 biles with a cholesterol saturation index greater than 0.76 supported crystal growth, even when collected from patients without gallstones. These results indicate that the difference between supersaturated biles in the ability to form cholesterol crystals resides at the nucleation, rather than the growth, stage of crystal formation.

Adult↗
PubMed1984

Enzymatic function in crystals of delta 5-3-ketosteroid isomerase. Catalytic activity and binding of competitive inhibitors.

Crystals of the steroid-metabolizing enzyme, delta 5-3-ketosteroid isomerase (EC 5.3.3.1) from Pseudomonas testosteroni, exhibit many enzymatic properties. Each enzyme subunit in the lattice binds a competitive inhibitor, progesterone, with the same stoichiometry (1:1) and affinity (KD = 6 X 10(-6) M) as the enzyme in solution. Another competitive inhibitor, 19-nortestosterone, competes with progesterone for the same binding sites in the crystal. The enzyme crystals catalyze the conversion of delta 5- to delta 4-ketosteroids, but because the enzyme is so efficient, and substrate diffusion into the crystal is so slow, substrate cannot penetrate deeply into the crystal before being converted to product. A general theoretical formulation is presented to account for the effects of substrate diffusion into enzyme crystals of different shapes and sizes. The dependence of apparent mean enzyme activity in steroid isomerase crystals as a function of crystal size is shown to be consistent with this theoretical formulation. These inhibitor binding and catalytic properties suggest that the enzyme is in an active conformation within these crystals.

Binding Sites↗
PubMed1978

[Factors which influence the size of calcium oxalat crystals during their formation from saturated solutions].

The nucleation and growth of Ca-oxalate crystals from metastable and instable solutions was studied in some detail to find out the dependence of the crystal size on the absolute calcium resp. oxalate concentration, further on their molar ratio, on the presence resp. absence of crystal seeds, on the agitation resp. stagnation of the Ca-oxalate solution, on the duration of crystallization and on the renewing of the Ca-oxalate containing supernatant, thus simulating a prolonged (dietary) oxalate load in vivo. The most important findings are the clear inhibition of crystal growth at higher and very high calcium concentrations (in contrary to the unhindered crystal enlargement at high oxalate concentrations), further the eminent role of the oxalate in the formation of big crystals and crystal aggregates, as well as the substantial crystal enlargement at the persistent oxalate load.

Calcium Oxalate↗
PubMed1978

[Correlations between the metastable solutions of calculus-forming salts and crystals from coexistent insoluble urinary components].

The correlations between the individual stone-forming systems, expecially the induction of heterogeneous crystallization from metastable solutions of one stone-forming system by preformed crystals of the other stone-forming system, were measured semiquantitatively by the Coulter-Counter-Size Distribution Analyzer technique. It has been found out that Ca-oxalate crystals may represent potent triggers and accelerators of the phosphate precipitation from metastable Ca-phosphate solutions. The importance of this phenomenon could be attributed especially to the induction of crystal rich phosphate crystalluria at moderate pH values (6,5--6,8) by the preceding Ca-oxalate crystalluria (,,starter "resp." primer "crystalluria). The favouring, promoting influence of uric acid on the stone formation and growth of Ca-oxalate crystals could be observed with the same experiments under changed conditions. This mechanism could be of some importance in the case when Ca-oxalate precipitates from the urine, saturated by uric acid, at low pH values (5,0--6,0). Uric acid resp. sodium urate crystals showed a moderate by clear favouring effect on the formation of Ca-phosphate crystals from metastable solutions. The influence of Ca-phosphate crystals upon the growth of Ca-oxalate crystals proved to be very limited.

Calcium Oxalate↗
PubMedDate not supplied

Experimental cholesterol crystal arthropathy.

To understand the role of cholesterol crystals in the pathogenesis of synovial effusions, we studied the articular tissue reaction to an intraarticular injection of cholesterol crystals in rabbits' knees. With the right knee as control, the left knees of 14 adult male, white, New Zealand rabbits were injected with 11 mg of cholesterol crystals suspended in 0.5 ml of saline. At 4, 8, 24, 48 h and at 7, 14, 28 and 56 d postinjection, the animals were autopsied and these tissues, including synovial fluid (SF), examined by light and transmission electron microscopy. Crystal injection produced an acute synovitis which peaked at 24 h coincident with phagocytosis of crystals in SF. Cholesterol crystals persisted within the synovium throughout the experiment resulting in cholesterol granulomata, synovial lining cell hyperplasia and synovial fibrosis. Relative to urate and pyrophosphate crystals, cholesterol crystals appear to have weak phlogistic potential. Because of their insolubility and resistance to cellular degradation, crystals persist within the synovium for prolonged periods. This results in a chronic proliferative synovitis and fibrosis.

Animals↗
PubMed1997

Calcium phosphate/calcium oxalate crystal association in urinary stones: implications for heterogeneous nucleation of calcium oxalate.

PURPOSE: Most stones contain more than one type of crystals, and some combinations, such as calcium phosphate/calcium oxalate, are more common than others. Epitaxy between the crystals has been suggested to play a role in growth of such stones. The specific aim of this study is to investigate the involvement of calcium phosphate in crystallization of calcium oxalate. MATERIALS AND METHODS: Twenty calcium oxalate stones or stone fragments were examined using various microscopic techniques, including scanning, transmission and back-scattered electron microscopy. Similarly, calcium oxalate stones induced on a plastic foreign body implanted inside urinary bladders of laboratory rats were also investigated. Examination of the interface between calcium phosphate and calcium oxalate crystals was emphasized. RESULTS: Close association between crystals of calcium phosphate and calcium oxalate were found in both the human and rat stones. All crystals examined were associated with an organic matrix on the surface and contained copious amounts of organic material within the crystalline entities. Interface between the crystals also appeared to be occupied by organic matrix. CONCLUSIONS: Results of this and other studies from our laboratory indicate that epitaxy between various crystals, even though theoretically possible, appears unlikely in vivo. The appearance of specific crystalline combinations in stones is probably a result of the urinary environment being conducive for crystallization of those components. Heterogeneous nucleation of calcium oxalate is most probably induced by biological elements, including membranous cellular degradation products.

Animals↗
PubMed1995

Polyamines enhance calcium pyrophosphate dihydrate crystal dissolution.

OBJECTIVE: Alkaline phosphatase (ALP), an enzyme with pyrophosphatase (PP(i)ase) activity, can dissolve calcium pyrophosphate dihydrate (CPPD) crystals. We investigated the CPPD crystal dissolution activity of polyamines, substrates known to enhance PP(i)ase activity. METHODS: An in vitro model system for crystal enzyme interaction was used to assess CPPD crystal dissolution both biochemically and morphologically. RESULTS: We demonstrated biochemically and morphologically that polyamines such as spermine and spermidine can enhance CPPD crystal dissolution activity of ALP. Polyamines enhanced ALP induced CPPD crystal dissolution and ALP PP(i)ase activity differentially. By scanning electron microscopy, we observed that polyamines enhanced dissolution stereoselectively at the small end faces (optical 010 faces) of CPPD crystals, indicated by the presence of etch pits. CONCLUSION: Polyamines assist ALP to promote the stereoselective dissolution of CPPD crystals. In addition to implications for CPPD crystal dissolution, as ALP is present intracellularly, these studies suggest that polyamines and ALP have synergistic effects when ALP PP(i)ase activity is required for intracellular energy metabolism.

Alkaline Phosphatase↗
PubMed1997

[Morphological studies of hydroxyapatite crystals exposed to disodium pamidronate].

"In vitro" effects of disodium pamidronate on hydroxyapatite crystals morphology, and some "in vivo" data from bone powder of tibia and vertebrae from treated young and mature rabbits are here reported. Hydroxyapatite, synthesized following Rigoli et al method, and bone powder from rabbits were studied with X-ray, infrared and raman emission techniques for crystallographic analysis. Adsorption studies were also performed with a balanced solution of hydroxyapatite exposed to different times, 48, 120 and 168 hours and concentrations 1 x 10(-5) M, 3 x 10(-5) M, 8 x 10(-5) M y 1 x 10(-4) M of pamidronate. Infrared and raman spectrometry were not conclusive due to technical bias, but X-ray difractograms showed pure hydroxyapatite crystals in an hexagonal system. At constant time, pamidronate concentrations were varied, showing after 48 hours of exposition, a slight growth in the 002 plane, an aleatoric behavior in 213 and a marked increase in 004. After 120 hours, 002 plane is steady with a net growth in 004 and 213. After 168 hours, the 3 mentioned planes grow in proportion to pamidronate concentrations, tending to enlarge the crystal shape. Plane 13 markedly grow with pamidronate 8 x 10(-5) M a 1 x 10(-4) M, which are biologically high concentrations. Potentiometric assessments, in the 1 x 10(-5) to 1 x 10(-4) M range of concentrations show that bisphosphonate was completely adsorbed to the crystals. Additional "in vivo" observations showed changes in bone powder crystals isolated from pamidronate treated young animals, involving a growing of planes 002 and 211, in samples from both epiphysis and diaphysis, regarding untreated samples. Changes were more evident at epiphysis. In mature rabbits, it was shown a decrease in basal plane 002 and growing at 210, 211 and 310 with a trend to enlarge the crystal shape in diaphysis and to shorten it in vertebrate spongiosa. The "in vivo" doses are equivalent to those used by Ferretti et al. in intact rats with pamidronate low dose groups, showing an improvement of bone material properties and stiffness. Thus, it may rather be lower than the "in vitro" used concentrations. In concordance with above experimental conditions it can be concluded that bisphosphonates exert morphological changes in hydroxyapatite crystals, in a dose dependent manner, at least when high concentrations are used. In addition, it is postulated that changes observed on "in vivo" samples may be the result with other adaptative factors as for example the local mechanical usage. The latter data were limited, and should be studied with more details if an extrapolation to the bisphosphonate treated osteoporotic women is intended. Finally, it is suggested that any agent that changes BMU activity (all known anti-osteoporotic drugs) may potentially modify the quality of hydroxyapatite crystals, affecting in turn the bone resistance to fracture, independently from the quantity of bone mass gained. Thus, to help predicting the consequences on skeletal fragility, there is a need to know the direct or indirect effect of drugs on bone crystals.

Animals↗
PubMed1998

Calcium oxalate crystal attachment to cultured kidney epithelial cell lines.

PURPOSE: Cultured kidney epithelial cell lines have frequently been used in urolithiasis research, and in particular in studies related to the interactions between stone crystals and cell membranes. There is evidence that when epithelial cell lines are transformed or serially passed to immortalize them, they experience changes in both cell physiology and morphology. Stone research utilizing cell cultures is frequently necessary due to the lack of an animal model for spontaneous stone disease. However, the interpretation of these cell culture research studies might be clouded by any significant differences in cell physiology between primary cells and continuous cell cultures. Therefore, the present study was conducted to compare calcium oxalate monohydrate (COM) crystal attachment to two primary kidney epithelial cell lines and to various continuous cell lines. MATERIALS AND METHODS: The cell lines surveyed were primary mouse proximal tubule cells (pMPT), primary inner medullary collecting duct cells (pIMCD), semi-continuous inner medullary collecting duct cells (cIMCD), BSC-1 cells, COS-1 cells, LLC-PK1 cells, MDCK cells, NRK-52E cells, and OK cells. All cell lines were cultured under identical conditions and the amount of COM attachment was measured using radioactive labeled COM crystals. RESULTS: COM crystal interaction with continuous kidney epithelial cells varied by a factor of two among the different cell lines. In general, cells that grew as regular, confluent cell monolayers, such as pMPT, pIMCD and cIMCD cells, exhibited the lowest levels of crystal attachment. Neither changes in membrane fluidity nor loss of normal epithelial cell membrane asymmetry seemed to correlate well with crystal attachment. After nine days of continuous cell culture, COM attachment to cIMCD cells dropped by 61 percent while crystal attachment to MDCK cells remained unchanged. It is unclear what makes these cell lines more resistant to crystal attachment compared to continuous cell lines. CONCLUSIONS: The significant difference in COM attachment between primary kidney epithelial cells and continuous epithelial cell cultures and the apparent differences in growth morphology between primary and continuous cell cultures must be considered when selecting a cell line for use in kidney stone research. Comparison of cIMCD cells and MDCK cells during extended culture time revealed one possible explanation for the differences in COM attachment: the formation of a mature, end-differentiated, non-dividing cell monolayer could protect the cells from crystal attachment.

Animals↗
PubMed1996

Role of calcium oxalate monohydrate crystal interactions with renal epithelial cells in the pathogenesis of nephrolithiasis: a review.

Renal tubular fluid in the distal nephron is supersaturated with calcium and oxalate ions that nucleate to form crystals of calcium oxalate monohydrate (COM), the most common crystal in renal stones. How these nascent crystals are retained in the nephron to form calculi in certain individuals is not known. Recent studies from this laboratory have demonstrated that COM crystals can bind within seconds to the apical surface of renal epithelial cells, suggesting one mechanism whereby crystals could be retained in the tubule. Adherence of crystals to cells along the nephron may be opposed by specific urinary anions such as glycosaminoglycans, uropontin, nephrocalcin, and citrate. In culture, adherent crystals are quickly internalized by renal cells, and reorganization of the cytoskeleton, alterations in gene expression, and initiation of proliferation can ensue. Each of these cellular events appears to be regulated by extracellular factors. Identification of molecules in tubular fluid and on the cell surface that determine whether a crystal-cell interaction results in retention of the crystal or its passage out of the nephron appears critical for understanding the pathogenesis of nephrolithiasis.

Adhesiveness↗
PubMed1986

Low density lipoprotein inhibits the physical interaction of phlogistic crystals and inflammatory cells.

Low density lipoprotein (LDL) is the major plasma inhibitor of neutrophil oxidative and lytic responses to monosodium urate crystals and may function to modulate acute gouty inflammation. LDL inhibited apparent phagocytosis of urate crystals by human neutrophils, suggesting it may interfere with early events in the crystal-induced stimulation of neutrophils. The effects were not specific for neutrophils, since human platelet secretory and membranolytic responses to urate crystals were also inhibited by purified LDL in doses as low as 10 micrograms/ml. As with neutrophils, the inhibitory activity of LDL was stimulus-specific. Since LDL binds to urate crystals and specifically inhibits a range of cellular responses to them, including phagocytosis, we hypothesized that LDL interferes with the initial crystal-cell interaction. We measured platelet interaction with urate crystals and found that LDL was a potent inhibitor of crystal-induced platelet sedimentation and was 10-100-fold more active than lipoprotein-depleted plasma or purified high density lipoprotein. In summary, LDL inhibits a broad range of responses of a number of inflammatory cell types to certain inflammatory surfaces, and this effect appears to be due to inhibition of physical association of crystals with cell membranes.

Blood Platelets↗
PubMed1991

Persistence of monosodium urate crystals and low-grade inflammation in the synovial fluid of patients with untreated gout.

Synovial fluid (SF) from 74 asymptomatic knees of patients with gout was analyzed. These patients had never been treated with serum uric acid-lowering agents. SF samples were analyzed for the presence of crystals and for cell counts, using undiluted SF directly in a Niebauer cell counting chamber. Thirty-seven of the aspirated knees had previously been inflamed, and monosodium urate (MSU) crystals were seen in SF aspirates from 36 of them (97%). Of the 37 knees that had never been inflamed, only 8 contained MSU crystals (P less than 0.00001). After reaching the joint, MSU crystals will persist in the SF as long as the serum uric acid level has not been lowered by appropriate treatment. In this situation, analysis of SF is an excellent diagnostic test for the intercritical gout. The mean cell count in the 44 SF samples that contained MSU crystals was 449/mm3 (95% confidence interval 310-589); the mean cell count in the 30 SF without MSU crystals was 64/mm3 (95% confidence interval 34-95) (P less than 0.00002). The SF samples that contained MSU crystals also had a higher percentage of polymorphonuclear leukocytes than those without MSU crystals (P less than 0.002). These data suggest that there is a low-grade inflammation present in the knees of patients with MSU crystals, the consequences of which should be investigated.

Adult↗