통풍성 관절염 환자에서 관절강 내 윤활액의 세포 소견 - 증례보고 2예 -
Cytology of Synovial Fluid in Gouty Arthritis - Two Cases Report -
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Synovial fluid (SF) aspiration cytology is a useful diagnostic tool. For patients with gouty arthritis, the diagnosis is confirmed by the presence of monosodium uric acid (MSU) crystals in the SF, and these crystals are long, pointed ended and needle-shaped and they show strongly negative birefringence. So metimes, it is difficult to diagnosis between gouty arthritis and other type of inflammatory arthritis. We experienced two unusual cases of gouty arthritis that we performed SF analysis for. The first patient was a 35 year old male who presented with relatively typical clinical symptoms with hyperuricemia, but the SF showed acute inflammatory cells without crystals on light microscopy. Only a few suspected crystals of MSU were identified on polarizing microscopy. The second patient was a 45 year old male who presented with atypical symptoms and pain and swelling of the left ankle and knee joint for 3 weeks. The uric acid level in the serum and urine was increased, but not over the normal limit. However, on light and polarizing microscopy, there were numerous MSU crystals in the SF. Conclusively, in some cases of gouty arthritis, the crystals are not identified on light microscopy or the uric acid level is not dramatically increased. So, the polarizing microscopy, the clinical information and the laboratory findings are all included in the work-up when evaluating the SF cytology of arthritis patients.
Abstract
Synovial fluid (SF) aspiration cytology is a useful diagnostic tool. For patients with gouty arthritis, the diagnosis is confirmed by the presence of monosodium uric acid (MSU) crystals in the SF, and these crystals are long, pointed ended and needle-shaped and they show strongly negative birefringence. So metimes, it is difficult to diagnosis between gouty arthritis and other type of inflammatory arthritis. We experienced two unusual cases of gouty arthritis that we performed SF analysis for. The first patient was a 35 year old male who presented with relatively typical clinical symptoms with hyperuricemia, but the SF showed acute inflammatory cells without crystals on light microscopy. Only a few suspected crystals of MSU were identified on polarizing microscopy. The second patient was a 45 year old male who presented with atypical symptoms and pain and swelling of the left ankle and knee joint for 3 weeks. The uric acid level in the serum and urine was increased, but not over the normal limit. However, on light and polarizing microscopy, there were numerous MSU crystals in the SF. Conclusively, in some cases of gouty arthritis, the crystals are not identified on light microscopy or the uric acid level is not dramatically increased. So, the polarizing microscopy, the clinical information and the laboratory findings are all included in the work-up when evaluating the SF cytology of arthritis patients.
참고문헌 (20)
- Zaharopoulos P, "Identification of crystals in joint fluids", Acta Cytol, 24, pp.197~202 (1980)
- Roubenoff R, "Incidence and risk factors for gout in white men", JAMA, 266, pp.3004~3007 (1991)
- Lumbreras B, "Analysis for crystals in synovial fluid: training of the analysts results in high consistency", Ann Rheum Dis, 64, pp.612~615 (2005)
- Getta B, "Atypical presentation of acute gout in an elderly patient", J Am Geriatr Soc, 56, pp.764~765 (2008)
- Alappatt C, "Concomitant polyarticular septic and gouty arthritis", J Rheumatol, 33, pp.1707~1708 (2006)
- Ravi Kumar AS, "Florid polyarticular gout mimicking septic arthritis", Clin Nucl Med, 29, pp.262~263 (2004)
- Wallace SL, "Preliminary criteria for the classification of acute arthritis of primary gout", Arthritis Rheum, 20, pp.895~900 (1977)
- Gerlag DM, "Synovial fluid analyses, synovial biopsy, and synovial pathology. in: Kelley’s Textbook of Rheumatology", pp.675~691 (2005), W.B Saunders
- Selvi E, "Diff Quik staining method for detection and identification of monosodium urate and calcium pyrophosphate crystals in synovial fluids", Ann Rheum Dis, 60, pp.194~198 (2001)
- Schlesinger N, "Diagnosis of gout: clinical, laboratory, and radiologic findings", Am J Manag Care, 11, pp.S443~S450 (2005)
- Shoji K, "Alizarin red S staining of calcium compound crystals in synovial fluid", Nippon Seikeigeka Gakkai Zasshi, 67, pp.201~210 (1993)
- Nero P, "Synovial fluid crystal identification by electron microscopy", Acta Reumatol Port, 31, pp.75~81 (2006)
- Segal JB, "Diagnosis of crystal-induced arthritis by synovial fluid examination for crystals: lessons from an imperfect test", Arthritis Care Res, 12, pp.376~380 (1999)
- Gordon C, "Detection of crystals in synovial fluids by light microscopy: sensitivity and reliability", Ann Rheum Dis, 48, pp.737~742 (1989)
- Chen LX, "Update on identification of pathogenic crystals in joint fluid", Curr Rheumatol Rep, 6, pp.217~220 (2004)
- Wold LE, "Atlas of orthopedic pathology", pp.125~133 (2008), W.B Saunders
- Le Goff B, "Ultrasonography for diagnosing atypical gout. Two case reports", Joint Bone Spine, 75, pp.610~612 (2008)
- Swan A, "The value of synovial fluid assays in the diagnosis of joint disease: a literature survey", Ann Rheum Dis, 61, pp.493~498 (2002)
- Antommattei O, "Prospective study of morphology and phagocytosis of synovial fluid monosodium urate crystals in gouty arthritis", J Rheumatol, 11, pp.741~744 (1984)
- O’Connell PG, "Coexistent gout and septic arthritis: a report of two cases and literature review", Clin Exp Rheumatol, 3, pp.265~267 (1985)