Association between crystals and cartilage degeneration in the ankle - PubMed (original) (raw)

. 2008 Jun;35(6):1108-17.

Epub 2008 Apr 15.

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Association between crystals and cartilage degeneration in the ankle

Carol Muehleman et al. J Rheumatol. 2008 Jun.

Abstract

Objective: Monosodium urate (MSU) and calcium pyrophosphate dihydrate (CPPD) crystals have been observed in synovial joints both before and after the onset of osteoarthritis (OA). The relationship between crystals and OA, however, remains controversial. We compared histologic and immunohistochemical patterns in articular cartilage of ankle joints with and without crystals.

Methods: A sample of 7,855 human cadaveric tali was examined for the presence of surface and beneath-the-surface crystals. A random subsample of tali with and without crystals underwent crystal analysis by Fourier transform infrared spectroscopy (FTIR), histologic examination, and immunohistochemistry for S100 protein, superficial zone protein, collagen X, cSRC.

Results: The prevalence of grossly visible crystals in the pool of donors over 18 years of age was 4.7% and correlated with advanced age, male sex, and obesity. Crystals were strongly associated with cartilage lesions and these lesions appeared to be biomechanically induced, being located where opposing articular surfaces might not be in congruence with each other. Thirty-four percent of the random subsamples of crystals upon which FTIR was performed contained CPPD, and the remainder were MSU crystals. Both crystal types were associated with higher levels of superficial zone protein and collagen X.

Conclusion: We show that the presence of surface crystals of either MSU or CPPD is strongly correlated with cartilage lesions in the talus. The histologic similarities in cartilage from joints with CPPD crystals compared to those with MSU crystals, together with what is known about the dramatically different etiologic factors producing these crystals, strongly suggest that these lesions are biomechanically induced.

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Figures

Figure 1.

Figure 1.

The process of selecting tali used for histology and immunohistochemistry.

Figure 2.

Figure 2.

Crystals (white arrows) associated with cartilage lesions (black arrows). The crystals surround the lesion in more severe cases. Lesions are located in regions that could be subject to biomechanically-induced damage from the opposing articular surface, particularly in joint instability. Note that in regions with a smooth normal appearance, without lesions, no crystals are present.

Figure 3.

Figure 3.

FTIR curves for the tested material (MSU, top; CPPD, bottom) on histological sections of tali compared to the sodium urate standard.

Figure 4.

Figure 4.

Representative macroscopic (top row) and microscopic views of normal, MSU crystal, and CPPD crystal tali (left, middle, and right columns, respectively). Note the middle zone CPPD crystal cysts that are often in continuity with the articular surface.

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