Ettlinger R E, Hunder G G
Mayo Clin Proc. 1979 Jun;54(6):366-74.
Cholesterol crystals were identified in 16 synovial fluids from 12 patients who were seen over the 14-year period 1964 through 1977. Ten of the 12 patients had rheumatoid arthritis of a median duration of 12 years. One patient had ankylosing spondylitis and another had iliopectineal bursitis without other joint disease. The fluids were usually turbid, white, or yellow in color and of thick consistency. When the synovial fluid concentration of cholesterol was determined, it was higher than the serum level. The swollen joints and bursae did not respond favorably to simple aspiration or corticosteroid injections but did to surgical synovectomy. No relationship was found between synovial fluid accumulation of cholesterol crystal and previous intra-articular corticosteroid therapy, serum lipoprotein abnormalities, intra-articular hemorrhage, or generalized arteriosclerosis. The results suggest that local factors are most important in the development of synovial fluid cholesterol crystals, but the exact mechanisms are unknown. The presence of cholesterol crystals in synovial fluid should suggest a severe persistent synovitis, knowledge of which may be helpful in diagnosis and planning therapy.
在1964年至1977年这14年期间诊治的12例患者的16份滑液中发现了胆固醇结晶。12例患者中有10例患有类风湿关节炎，病程中位数为12年。1例患者患有强直性脊柱炎，另1例患有髂耻滑囊炎，无其他关节疾病。这些滑液通常浑浊，呈白色或黄色，质地浓稠。测定滑液中胆固醇浓度时，其高于血清水平。肿胀的关节和滑囊对单纯穿刺或皮质类固醇注射反应不佳，但对手术滑膜切除术反应良好。未发现滑液中胆固醇结晶的积聚与既往关节内皮质类固醇治疗、血清脂蛋白异常、关节内出血或全身性动脉硬化之间存在关联。结果表明，局部因素在滑液胆固醇结晶的形成中最为重要，但确切机制尚不清楚。滑液中胆固醇结晶的存在提示存在严重的持续性滑膜炎，了解这一点可能有助于诊断和制定治疗方案。
