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Crystal-Induced Arthritis

Simon H.K. Huang, MD, FRCPC, Clinical Associate Professor, Division of Rheumatology, Faculty of Medicine, University of British Columbia, Vancouver, BC.
Ian K. Tsang, MB, FRCPC, Clinical Professor Emeritus, Division of Rheumatology, Faculty of Medicine, University of British Columbia, Vancouver, BC.

The two most common forms of crystal-induced arthritis among older adults are gout and calcium pyrophosphate dihydrate (CPPD) deposition disease. Gout in older adults has unique clinical features. The new case incidence is the same in males and females over age 60. Upper limb and polyarticular involvement are not unusual. CPPD deposition disease may present as asymptomatic chondrocalcinosis on radiographs and symptomatically as pseudogout, pseudo–rheumatoid arthritis, or pseudo-osteoarthritis. Other crystals may cause periarthritis or arthritis. Management of crystal-induced arthritis among older adults requires special considerations due to comorbid conditions and concomitant medications. Nonsteroidal anti-inflammatory drugs may be contraindicated. Steroids taken either orally or intra-articularly are often an alternative.
Key words: gout, chondrocalcinosis, pseudogout, pseudo–rheumatoid arthritis, pseudo-osteoarthritis.