Synovial Biopsy, Synovium, Synovial Fluid & Arthrocentesis
Hydroxyapatite (Synovium) Photo/Slide Viewer
APATITE (BASIC CALCIUM PHOSPHATE) ASSOCIATED ARTHROPATHIES
These crystals are those identified in calcific tendinitis and periarthritis, tumoral calcinosis, idiopathic calcification of spinal ligaments and disks, diffuse idiopathic skeletal hyperostosis, and Milwaukee shoulder syndrome. In addition, BCP crystals are present in synovial fluids, cartilage and synovium (Fig. 11) in a large subset of patients with osteoarthritis (21). Some apatite can be from bone fragments embedded in synovium in advanced OA. Studies of synovial fluids from osteoarthritic knee joints reveal apatite crystals in approximately 30 to 60% and such fluids more often contain both BCP and CPPD crystals than either species alone (23-26). The presence of BCP correlates with more severe radiographic joint degeneration and at times is associated with neuropathic-like arthropathy on x-ray (27). Synovial apatite deposits are also seen in some renal dialysis patients and in scleroderma or other connective tissue diseases (3,20) embedded in the matrix or in phagocytic vacuoles. Apatite crystals are often present in synovial fluid rice bodies which are presumably most often fragments of synovium in rheumatoid arthritis (30). Materials associated with apatite deposits have received little study. Granular protein-like material is often present and can include immunoglobulins and complement (3,31) (Fig. 12) . Tendons with deposits of apatite often have hypovascular areas that are hematoxyphilic (32). As in synovium there may also be adjacent chondrometaplasia (32).
References Sited in above text
21. Gordon GV, Villanvera T, Schumacher HR, Gohel V. Autopsy study correlating degree of osteoarthritis, synovitis and evidence of articular calcification. J Rheumatol 1984;11:681-686.
22. Doyle DV. Tissue calcification and inflammation in osteoarthritis. J Pathol 1982;136:199-216.
23. Derfus BA, Kurian JB, Butler JJ. The high prevalence of pathologic calcium crystals in preoperative knees. J Rheumatol2002;29:570-574.
24. Gibilisco P A, Schumacher HR, Jr., Hollander JL, Soper KA. Synovial fluid crystals in osteoarthritis. Arthritis Rheum 1985;511-515.
25. Swan A, Chapman B, Heap P, Seward H, Dieppe P. Submicroscopic crystals in osteoarthritic synovial fluids. Ann Rheum Dis 1994;53:467-470.
26. Halverson PB, McCarty DJ. Patterns of radiographic abnormalities associated with basic calcium phosphate and calcium pyrophosphate dihydrate crystal deposition in the knee. Ann Rheum Dis 1986;45:603-605.
27. Resnick D. Calcium hydroxyapatite crystal deposition disease. In: Resnick D, editor. Diagnosis of bone and joint disorders. 4th ed. Philadelphia: WB Saunders; 2002. p. 1619-1657
28. Gatter RA, McCarty DJ. Pathological tissue calcification in man. Arch Pathol 1967;84:346-353.
29. Reginato AJ, Schumacher HR. Synovial calcification in a patient with collagen-vascular disease: Light and electron microscopic studies. J Rheumatol 1877;4:261-271.
30. Li-Yu J, Clayburne GM, Sieck MS, et al. Calcium apatite crystals in synovial fluid rice bodies. Ann Rheum Dis 2002;61:387-390.
31. Schumacher HR, Cherian PV. Transmission electron microscopic studies on articular calcium crystals and associated protein coatings. Scanning Electron Microscopy 1984;11:965-968.
32. Uhthoff Hk, Sarkar K, Maynard JA. Calcifying tendonitis: A new concept on pathogenesis Clin Orthop 1976;118:164-.
References Related to Hydroxyapatite (Synovium)
Molloy EA and McCarthy GM. How crystals damage tissue. Current Rheumatology Reports 6:228-234. 2004.
VanLinthoudt D, Beutler A, Clayburne G, Sieck M, Fernandes L, Schumacher HR: Morphometric studies on synovium in advanced osteoarthritis: Is there an association between apatite-like material and collagen deposits? Clin and Exper Rheumatol 15: 493-497, 1997.
Gerster J-C and Fallet GH: Periarticular hand hydroxyapatite deposition after corticosteroid injections. J Rheumatol 14: 1156-1159, 1987.
Gerster JC and Lagier R: Acute synovitis with intra-articular apatite deposits in an osteoarthritic metacarpophalangeal joint. Annals of the Rheumatic Diseases 44: 207-210, 1985.
Halverson PB, Garancis JC, McCarty DJ: Histopathologic and ultrastructural studies of synovium in Milwaukee shoulder syndrome-a basic calcium phosphate crystal arthropathy. Annals of the Rheumatic Diseases 43: 734-741, 1984.
Gravanis MB, Gaffney ER: Idiopathic calcifying tenosynovitis: histopathologic features and possible pathogenesis. Am J Surg Pathol 7: 357-361, 1983.
Schumacher, HR, Miller JL, Ludivico C, Jessar RA: Erosive arthritis associated with apatite crystal deposition. Arthritis & Rheumatism 24: 31-37, 1981.
Reginato AJ, Schumacher HR: Synovial calcification in a patient with collagen vascular disease. Light and electron microscopic studies. J Rheumatol 4:261-271, 1977.
Reginato AJ, Schumacher HR, Brighton C: Experimental hydroxyapatite synovial and articular cartilage calcification. Light and electron microscopic studies. Arthritis Rheum 25:1239-1249, 1982.
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