The Significance of Calcium Phosphate Crystals in the Synovial Fluid of Arthritic Patients: The "Pseudogout Syndrome"
Authors: NORMAN N. KOHN
Journal: Annals of Internal Medicine (1962)

Article1 May 1962The Significance of Calcium Phosphate Crystals in the Synovial Fluid of Arthritic Patients: The "Pseudogout Syndrome"II. Identification of CrystalsNORMAN N. KOHN, M.D., ROBERT E. HUGHES, PH.D., DANIEL J. MCCARTY JR., M.D., JAMES S. FAIRES, M.D.NORMAN N. KOHN, M.D.Search for more papers by this author, ROBERT E. HUGHES, PH.D.Search for more papers by this author, DANIEL J. MCCARTY JR., M.D.Search for more papers by this author, JAMES S. FAIRES, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-56-5-738 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIn the course of examining over 200 consecutive specimens of synovial fluid with phase contrast and polarized light microscopy, a collection of fluids from seven patients was obtained containing significant amounts of an unknown crystalline material. Since crystalline urates had previously been identified from the joint fluids of patients with acute and chronic gout it was initially thought that some of these patients had this disorder. With increased experience with this group, however, it became evident that such was not the case: There were significant differences clinically between the gouty patients and the group under discussion; the serum urate levels...References1. MCCARTYKOHNFAIRES DJNNJS: The significance of calcium phosphate crystals in the synovial fluid of arthritic patients; the "pseudogout" syndrome. I. Clinical aspects. Ann. Intern. Med. 56: 711, 1962. LinkGoogle Scholar2. MCCARTYHOLLANDER DJJL: Identification of urate crystals in gouty synovial fluid. Ann. Intern. Med. 54: 452, 1961. LinkGoogle Scholar3. CORBRIDGELOWE DEEJ: The infrared spectra of some inorganic phosphorus compounds. J. Chem. Soc.: 493, 1954. CrossrefGoogle Scholar4. PARSONSEURS JF: X-ray diffraction analysis of crystals in pathology. Amer. J. Clin. Path. 32: 405, 1959. CrossrefMedlineGoogle Scholar5. CARLSTROM D: X-ray crystallographic studies on apatites and calcified structures. Acta Radiol. (Stockh.) supp. 121, 1955. Google Scholar6. PRIENFRONDEL ELC: Studies in urolithiasis: 1. The composition of urinary calculi. J. Urol. 57: 949, 1947. CrossrefMedlineGoogle Scholar7. PEPINSKI R: X-ray diffraction analysis of calcium salts in gallstones. (Abstract) Phys. Rev. 60: 168, 1941. Google Scholar8. BLATTDENNINGZUMBERGEMAXWELL IMRMJHJH: Studies in sialolithiasis. I. The structure of mineralogical composition of salivary gland calculi. Ann. Otol. 67: 595, 1958. Google Scholar9. BLATTMIKKELSENDENNING IMWHRM: Studies in sialolithiasis. II. Uric acid calculus of the parotid gland. Ann. Otol. 67: 1022, 1958. Google Scholar10. FRONDELPRIEN CEL: Deposition of calcium phosphates accompanying senile degeneration and disease. Science 103: 326, 1946. CrossrefGoogle Scholar11. MARSHALLHORWITH VFM: Oxalosis. J. Urol. 82: 278, 1959. CrossrefMedlineGoogle Scholar12. PARSONSBEHERBAKER JWTGD: X-ray diffraction powder data and index for the steroids. Henry Ford Hosp. Med. Bull. 6: 365, 1958. MedlineGoogle Scholar13. BARNESSHEPPARD WHHM: Physical methods for the identification of narcotics. II B. X-ray diffraction data for 83 narcotics. Bull. Narcotics UN Dept. Social Affairs 6: 27, 1954. Google Scholar14. KLUGALEXANDER HPLE: X-ray Diffraction Procedures for Polycrystalline and Amorphorus Materials, John Wiley and Sons, Inc., New York, 1954. Google Scholar15. AZAROFBUERGER LVMJ: The Powder Method in X-ray Crystallography, McGraw-Hill Book Co., Inc., New York, 1958. Google Scholar16. PEISERROOKSBYWILSON HSHPAJ: X-ray Diffraction by Polycrystalline Materials, Institute of Physics, London, 1955. Google Scholar17. Index of X-ray Diffraction Patterns (with card files). American Society for Testing Materials, Philadelphia, 1961. Google Scholar18. Standard X-ray diffraction patterns. National Bureau of Standards Circular 539, vol. 1-9, United States Department of Commerce, National Bureau of Standards. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Philadelphia, PennsylvaniaFrom the Arthritis Section, Department of Medicine, Hahnemann Medical College and Hospital, Philadelphia, Pennsylvania, and the Harrison Department of Chemistry, University of Pennsylvania, Philadelphia, Pennsylvania.Supported in part by research grant A-4626 and training grant 2A-5201, National Institute of Arthritis and Metabolic Disease, United States Public Health Service, Bethesda, Maryland.Requests for reprints should be addressed to Norman N. Kohn, M.D., Department of Medicine, Hahnemann Medical College and Hospital, 230 North Broad Street, Philadelphia 2, Pennsylvania. 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SMYTH, M.D., F.A.C.P., ROGER L. BLACK, M.D., CHARLES CHRISTIAN, M.D., MACK L. CLAYTON, M.D., F.A.C.S., DONALD F. HILL, M.D., F.A.C.P., JOSEPH LEE HOLLANDER, M.D., F.A.C.P., WILLIAM M. MIKKELSEN, M.D., F.A.C.P., MAX M. MONTGOMERY, M.D., F.A.C.P., CARL M. PEARSON, M.D., F.A.C.P., HUGH A. SMYTHE, M.D., F.R.C.P. (C), L. EMMERSON WARD, M.D., F.A.C.P., HOWARD J. WEINBERGER, M.D., F.A.C.P.Identification of Calcium Hydrogen Phosphate Dihydrate Crystals in Human FibrocartilageThe Significance of Calcium Phosphate Crystals in the Synovial Fluid of Arthritic Patients: The "Pseudogout Syndrome" I. Clinical AspectsDANIEL J. MCCARTY JR., M.D., NORMAN N. KOHN, M.D., JAMES S. FAIRES, M.D. 1 May 1962Volume 56, Issue 5_Part_1Page: 738-745KeywordsArthritisCalciumHospital medicineMedical servicesMetabolic disordersPhosphatesResearch grantsSynovial fluidSystems biologyUric acid Issue Published: 1 May 1962 PDF DownloadLoading ...