Swan A, Chapman B, Heap P, Seward H, Dieppe P
Rheumatology Unit, Bristol Royal Infirmary, United Kingdom.
Ann Rheum Dis. 1994 Jul;53(7):467-70. doi: 10.1136/ard.53.7.467.
To investigate the hypothesis that synovial fluid (SF) from patients with osteoarthritis (OA) may contain calcium phosphate crystals that are either too small, or too few in number to be identified by conventional light microscopy techniques.
Twelve SF from 11 patients with established knee OA, five SF from patients with rheumatoid arthritis (RA), and two control samples of SF from patients with pseudogout were subjected to an enzyme/hypochlorite extraction procedure. The patients with OA and RA had no radiographic evidence of chondrocalcinosis, or SF crystals on polarised light microscopy. Extracted material was examined and analysed by analytical electron microscopy (AEM) and x ray powder diffraction (XRD).
Mineral was found in 11 of 12 OA samples, ranging from 2-120 micrograms/ml SF. Analytical electron microscopy revealed calcium pyrophosphate dihydrate (CPPD) crystals in five (confirmed by XRD in three) and basic calcium phosphates (BCP) in eight (five on XRD). Two samples with confirmed CPPD contained some rods with a mean length below 100 nm. The majority of BCP clusters were also less than 100 nm in diameter. BCP was detected in 1/5 RA samples. Control samples contained CPPD crystals of the expected size range of 0.42-17.9 microns.
The data indicate that many OA SF may contain CPPD or BCP crystals which are too small or too few in number to be identified by conventional techniques. Crystal deposition is not an 'on-off' phenomenon in OA.
探讨骨关节炎（OA）患者滑液（SF）中可能含有磷酸钙晶体的假说，这些晶体要么太小，要么数量太少，无法用传统光学显微镜技术识别。
对11例确诊为膝骨关节炎患者的12份滑液、类风湿关节炎（RA）患者的5份滑液以及假性痛风患者的2份对照滑液样本进行酶/次氯酸盐提取程序。OA和RA患者在偏振光显微镜下均无软骨钙质沉着或滑液晶体的影像学证据。提取的材料通过分析电子显微镜（AEM）和X射线粉末衍射（XRD）进行检查和分析。
在12份OA样本中的11份中发现了矿物质，范围为2-120微克/毫升滑液。分析电子显微镜显示5份样本中有二水焦磷酸钙（CPPD）晶体（3份经XRD证实），8份样本中有碱性磷酸钙（BCP）（5份经XRD证实）。两份经证实含有CPPD的样本中含有一些平均长度低于100纳米的棒状晶体。大多数BCP簇的直径也小于100纳米。在1/5的RA样本中检测到BCP。对照样本中含有预期尺寸范围为0.42-17.9微米的CPPD晶体。
数据表明，许多OA滑液可能含有CPPD或BCP晶体，这些晶体太小或数量太少，无法用传统技术识别。晶体沉积在OA中不是一种“全或无”的现象。
