Crystal-Induced Arthropathies: Gout, Pseudogout and Apatite-Associated Syndromes PDF

Preface

When most people hear the term "crystal-induced arthropathy," they think of gout, the disease that results from the body's response to monosodium urate crystals. Furthermore, they usually envision a patient with acute, intensely inflammatory monoarthritis, the cardinal feature of gout. However, gout is not the most common crystal-induced arthropathy. The arthropathies that result from the body's response to calcium-containing crystals, those of calcium pyrophosphate dihydrate or basic calcium phosphates, occur more frequently. In fact, it is likely that everyone will develop some sort of calcium-containing arthropathy if they live long enough. Furthermore, although each crystal type can induce an acute monoarticular disease, each can also be associated with a variety of other clinical presentations. Thus, the crystal-induced arthropathies are common and complex diseases.

Whereas gout has been recognized for centuries, not until 1960 was it appreciated that monosodium urate crystals were present in the synovial fluid in patients with attacks of gout. It was at that same time that calcium pyrophosphate dihydrate crystals were identified in joint fluids from patients who were previously believed to suffer from gout and the term "pseudogout" was coined. Our present understanding of basic calcium phosphate arthropathies began to unfold in the early 1980s with the description of Milwaukee shoulder syndrome.

Motivation for this work stemmed from the editors' long-standing interest in the crystal-induced arthropathies, each of us having been actively investigating various elements of these diseases for the last 30 to 40 years. It was our desire to produce a concise but comprehensive review of this large field, recognizing that much of the present understanding of these diseases is the result of observations that have occurred during the span of our careers. In addition to reviewing the present state of understanding regarding the clinical presentations of the various diseases, their respective underlying pathogeneses, and current approaches to management, our goals included providing a sound basis for understanding the discoveries that will be made in the future, both in etiology and in therapy. If we have accomplished our goals, this book will be helpful to clinicians, teachers, and scientists.

The authors who have contributed to this text share the editors' interest and enthusiasm for the field. We were particularly pleased that Dan McCarty was willing to share his perspective on the history of the crystal-induced arthropathies. As one of the individuals who identified monosodium urate crystals in gouty synovial fluids, recognized pseudogout, and described Milwaukee shoulder syndrome, he has contributed greatly to our knowledge of the field. In addition, he has provided training and influenced a large number of investigators, many of whom authored chapters for this edition. Although most authors of this text can not match Dr. McCarty's breadth of observations, each of the senior authors has been involved in original research in the area about which they wrote and is widely recognized for their individual expertise. We are also pleased to have involved younger individuals who will become future leaders in this field.