Abstract
Objectives: To define clinical differences in the acute phase response and serum acute phase reactants between gout, pseudogout and crystal-induced arthritis in the presence of non-articular infections (CAI). Patients and Methods: Eleven patients with definite gout, 12 patients with pseudogout and 5 patients with CIA were included in the study. Results: The erythrocyte sedimentation rate (ESR) was significantly different between gout (68.2 ± 49.9 mm/Hr) and CIA (113.8 ± 37.2 mm/Hr) but not between gout and pseudogout (83.9 ± 45.6 mm/Hr) or between pseudogout and CIA. The C-reactive protein (CRP) was significantly increased between gout (10.1 ± 7.9 mg/dL) and pseudogout (18.9 ± 9.8 mg/dL), gout and CIA (36.5 ± 12.4 mg/dL) as well as between pseudogout and CIA. The peripheral white cell count was significantly different between gout (9.27 ± 3.7 k/μL) and CIA (16.5 ± 6.8 k/μL), and between pseudogout (8.9 ± 3.2 k/μL) and CIA. Conclusions: Measurement of ESR and CRP are helpful in crystal-induced arthritis. The CRP has more discriminating utility than the ESR in distinguishing between gout, pseudogout and CIA. Peripheral wbc is most useful for differentiating crystal-induced arthritis from CIA.
Highlights
The crystal-induced arthropathies are a group of diseases with a broad range of clinical manifestations from asymptomatic to severely inflammatory
We have examined the relationship between the acute phase response and the acute phase reactants, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in acute gout and pseudogout
We have compared those responses in patients with acute gouty arthritis or pseudogout in the presence or absence of non-intra-articular infections
Summary
The crystal-induced arthropathies are a group of diseases with a broad range of clinical manifestations from asymptomatic to severely inflammatory. The most common presentations at the inflammatory end of the disease spectrum are gout and pseudogout, precipitated by intraarticular monosodium urate monohydrate (MSUM) and calcium pyrophosphate dihydrate (CPPD) crystals respectively [1]. Both conditions have very high prevalence [2,3,4,5]. Gout and pseudogout are highly inflammatory forms of arthritis associated with the release of proinflammatory cytokines through a variety of pathways including the activation of inflammasomes in neutrophils, macrophages and other cell types [7].
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