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J R Soc Med. 1984 September; 77(9): 747–750.
PMCID: PMC1440018

Crystal deposition in the knee and great toe joints of asymptomatic gout patients.


Crystal deposition in asymptomatic knee and first metatarsophalangeal (MTP) joints has been studied in 31 patients with previously proven gout. All had had clinical gout in their MTP joints but their knee joints had never been the site of acute gout. Knee arthroscopy was performed permitting synovial membrane inspection, photography and biopsy. Crystalline material was seen in 9 knees (28%) and confirmed histologically as monosodium urate (MSU) in 4 (12.5%). Synovial fluid analysis on 26 samples using a polarizing light microscope demonstrated MSU crystals in 4 (12.5%) and calcium pyrophosphate dihydrate (CPPD) in 2 (6%). Fluid aspirated from 27 of the metatarsophalangeal joints revealed MSU crystals in 14 (52%) and no CPPD crystals.

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Selected References

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  • Doherty M, Whicher JT, Dieppe PA. Activation of the alternative pathway of complement by monosodium urate monohydrate crystals and other inflammatory particles. Ann Rheum Dis. 1983 Jun;42(3):285–291. [PMC free article] [PubMed]
  • Fields TR, Abramson SB, Weissmann G, Kaplan AP, Ghebrehiwet B. Activation of the alternative pathway of complement by monosodium urate crystals. Clin Immunol Immunopathol. 1983 Feb;26(2):249–257. [PubMed]
  • Ginsberg MH, Jaques B, Cochrane CG, Griffin JH. Urate crystal--dependent cleavage of Hageman factor in human plasma and synovial fluid. J Lab Clin Med. 1980 Apr;95(4):497–506. [PubMed]
  • Gordon TP, Bertouch JV, Walsh BR, Brooks PM. Monosodium urate crystals in asymptomatic knee joints. J Rheumatol. 1982 Nov-Dec;9(6):967–969. [PubMed]
  • Grahame R, Scott JT. Clinical survey of 354 patients with gout. Ann Rheum Dis. 1970 Sep;29(5):461–468. [PMC free article] [PubMed]
  • Hasselbacher P. C3 activation by monosodium urate monohydrate and other crystalline material. Arthritis Rheum. 1979 Jun;22(6):571–578. [PubMed]
  • McCarthy DJ. The gouty toe - a multifactorial condition. Ann Intern Med. 1977 Feb;86(2):234–236. [PubMed]
  • MCCARTY DJ, HOLLANDER JL. Identification of urate crystals in gouty synovial fluid. Ann Intern Med. 1961 Mar;54:452–460. [PubMed]
  • Paul H, Reginato AJ, Schumacher HR. Morphological characteristics of monosodium urate: a transmission electron microscopic study of intact natural and synthetic crystals. Ann Rheum Dis. 1983 Feb;42(1):75–81. [PMC free article] [PubMed]
  • Rae SA, Davidson EM, Smith MJ. Leukotriene B4, an inflammatory mediator in gout. Lancet. 1982 Nov 20;2(8308):1122–1124. [PubMed]
  • Rouault T, Caldwell DS, Holmes EW. Aspiration of the asymptomatic metatarsophalangeal joint in gout patients and hyperuricemic controls. Arthritis Rheum. 1982 Feb;25(2):209–212. [PubMed]
  • Scott JT. New knowledge of the pathogenesis of gout. J Clin Pathol Suppl (R Coll Pathol) 1978;12:205–213. [PMC free article] [PubMed]
  • Weinberger A, Schumacher HR, Agudelo CA. Urate crystals in asymptomatic metatarsophalangeal joints. Ann Intern Med. 1979 Jul;91(1):56–57. [PubMed]
  • ZEVELY HA, FRENCH AJ, MIKKELSEN WM, DUFF IF. Synovial specimens obtained by knee joint punch biopsy; histologic study in joint diseases. Am J Med. 1956 Apr;20(4):510–519. [PubMed]
  • ZVAIFLER NJ, PEKIN TJ. Significance of urate crystals in synovial fluids. Arch Intern Med. 1963 Jan;111:99–102. [PubMed]

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