One of the more difficult diseases to diagnose and treat properly is crystal induced arthritis.

Of the many types of arthritis that can affect multiple joints, crystal-induced, or as it is sometime referred to, crystal associated arthritis, is probably one of the most common. It may cause arthritis in a single joint, two or three joints, or many joints.

When arthritis affects a single joint, it is termed "monoarticular." When it affects two or three joints is called "oligoarticular." When the arthritis affects more than three joints, it is called "polyarticular."

Crystal induced arthritis generally starts as an oligoarticular arthritis but often rapidly becomes polyarticular.

It may be accompanied by other symptoms such as fever and perhaps even chills. Usually, the joint pain from crystal arthritis comes on relatively suddenly and becomes intense after a few hours.

The joints involved swell, become red, become warm, and are exquisitely sensitive and painful. Often times swelling of the joint extends into the soft tissues beyond the joint.

There are three major types of crystal induced arthritis. The most common is gout. Gouty arthritis is due to deposits of monosodium urate (uric acid) crystals. The underlying abnormality is a metabolic defect that leads to over production of uric acid or inability to excrete (get rid of) uric acid.

Gouty arthritis often affects the feet during the first attack. In particular, the great toe joint is classically affected.

Over the course of months and years, attacks become more frequent and more intense. Deposits of uric acid may accumulate near joints and in soft tissues. These are called tophi.

Gout is generally more common in men than women. However, after menopause, women begin to develop gout more frequently. In particular, women who are on diuretic therapy may be susceptible to developing gout.

The danger is that untreated gout can lead to kidney failure.

The second most common type of crystal induced arthritis is calcium pyrophosphate arthritis. This is caused by deposits of calcium pyrophosphate crystals inside the joint. Joints most commonly affected include the shoulders, hips, knees, and wrists.

Calcium pyrophosphate arthritis, because of its symmetry, may be confused for other types of arthritis, particularly rheumatoid arthritis.

What is more confusing is that often times both calcium pyrophosphate arthritis and rheumatoid arthritis co-exist.

Calcium pyrophosphate arthritis is often called pseudogout. Pseudogout attacks most often occur in the knees and wrists. Pseudogout is much more common in people past the age of 60.

The third type of crystal induced arthritis is hydroxyapatite disease. This is a close cousin to calcium pyrophosphate disease.

Identification of the type of crystal induced arthritis is made by examining joint fluid under a polarizing microscope.

The establishment of a correct diagnosis is imperative.

Appropriate treatment may be administered only after a definite diagnosis has been made.

Crystal induced arthritis may be difficult to manage.

In addition to non-steroidal anti-inflammatory drugs, intra-articular steroid injection, physical therapy, and occupational therapy may be helpful. Unfortunately, treatments are generally unsatisfactory.

Some practitioners have used drugs such as hydroxychloroquine and methotrexate with some degree of success.

In addition, debridement of the affected joint using arthroscopy may be helpful.

It is my opinion that many people who have osteoarthritis often have crystal induced arthritis as well. This makes management much more difficult.