Le disque des arthrites microcristallines

Abstract

All three types of microcrystals involved in human diseases are able to make crystal deposits within the intervertebral disk structures, from the cervical spine to the coccyx. This includes monosodium urate tophi in well-known and severe tophaceous gout, calcium pyrophosphate crystal deposits in CPPD disease, and finally basic calcium phosphate in various conditions. Intervertebral disk crystal deposits are able to trigger acute inflammation, with typical pattern including acute onset and fever, with destructive radiographic lesions. In these atypical locations, diagnosis might be puzzled, and it is mandatory when infection or tumor is considered, to perform biopsy samples. MRI features can be unusual with hypointense signals in T1 and T2 images, hypointense T1 and hyperintense T2 signals in some cases, with partial enhanced Gd-T1 images. Treatment of acute attack is similar to peripheral crystal-induced arthritis, and it is mandatory to start urate lowering therapy where appropriate in gouty patient. Spinal fusion might be needed after medullary cord decompression in some gouty patients.