Carbonated apatite-induced arthropathy: a consideration in cases of polyarthritis.
BACKGROUND
A 79-year-old woman was referred for evaluation of her painful and swollen joints. She had a medical history of congestive heart failure, renal insufficiency and peptic ulcer disease. For the past 3 years she had experienced recurrent bouts of debilitating arthritis, lasting approximately 3-4 weeks at a time. The symptoms were most severe in the hands and knees, where the joints were warm, swollen and tender. During each flare-up, the patient was housebound and required therapeutic dosing of nonsteroidal anti-inflammatory drugs and codeine to control joint pain.


METHODS
Physical examination, fine-detailed radiographs of the hands, standing radiographs of the knees, arthrocentesis including cell count and gram stain, compensated polarized light microscopy, alizarin-red staining, X-ray diffraction, scanning and transmission electron microscopy with energy dispersive spectrometry, electron microprobe analysis with energy dispersive spectrometry, Fourier transform infrared spectroscopy, and atomic force microscopy.


METHODS
Carbonated-substituted apatite arthropathy.


RESULTS
Both knees were aspirated and large volumes of a straw-colored synovial fluid was removed. The knees were injected with corticosteroid, resulting in excellent symptomatic response.
Blair-Levy
Joy M
JM
National Institute of Arthritis and Musculoskeletal and Skin Disease, Intramural Research Program, National Institutes of Health, Bethesda, MD, USA. blairj1@mail.nih.gov
D000368:Aged; D000880:Anthraquinones; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001168:Arthritis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D002130:Calcium Phosphates / Q000032:analysis; D003460:Crystallization; D006801:Humans; D007719:Knee Joint; D008859:Microscopy, Polarization; D013582:Synovial Fluid / Q000737:chemistry; D014222:Triamcinolone Acetonide / Q000031:analogs & derivatives / Q000627:therapeutic use; D014961:X-Ray Diffraction
D000880:Anthraquinones; D000893:Anti-Inflammatory Agents; D002130:Calcium Phosphates; C010078:alizarin; C020243:calcium phosphate; D014222:Triamcinolone Acetonide; C005900:triamcinolone hexacetonide