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Vol. 4. Núm. S2.
Monográfico: Infección y patologías microcristalinas
Páginas 45-49 (Octubre 2008)
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Vol. 4. Núm. S2.
Monográfico: Infección y patologías microcristalinas
Páginas 45-49 (Octubre 2008)
Infección y patologías microcristalinas
DOI: 10.1016/S1699-258X(08)76168-0
Acceso a texto completo
Diagnóstico de artropatía microcristalina
Diagnosis of Microcrystalline Arthropathy
Visitas
...
Eliseo Pascuala,??
Autor para correspondencia
pascual_eli@gva.es

Correspondencia: Dr. E. Pascual. Servicio de Reumatología. Hospital General Universitario de Alicante, Maestro Alonso, s/n. 03010 Alicante. España.
, Francisca Siverab
a Sección de Reumatología. Hospital General Universitario de Alicante. Cátedra de Medicina (Reumatología). Universidad Miguel Hernández. Alicante. España
b Sección de Reumatología. Hospital General Universitario de Alicante. Alicante. España
Información del artículo

Tanto la gota como la artropatía por cristales de pirofosfato cálcico dihidratado (PFCD) son enfermedades producidas por depósito de cristales; el hallazgo de cristales de urato monosódico (UMS) o PFCD en líquido sinovial, o en tofos en el caso de la gota, permite un diagnóstico inequívoco de una u otra. A pesar de disponer de procedimientos tan simples y fiables, persiste el hábito de diagnosticar estas enfermedades según se presente un cuadro clínico considerado suficientemente típico, e hiperuricemia en la gota o condrocalcinosis en la artritis por PFCD. Sin embargo, en ambas enfermedades las presentaciones consideradas típicas pueden deberse a otras causas, y sobre todo las presentaciones clínicamente menos compatibles con gota o artropatía por PFCD no son raras y quedan sin diagnosticar, a no ser que se investigue de manera sistemática la posible presencia de cristales en los líquidos sinoviales obtenidos de todas las artropatías pendientes de diagnóstico. Finalmente, la precisión del diagnóstico clínico depende de los conocimientos y la experiencia del médico que la efectúa. El diagnóstico por la clínica que practican reumatólogos expertos en estas enfermedades autoriza a otros con menos conocimientos a enfocar el problema de la misma manera, pero con un margen de error todavía mayor.

Palabras clave:
Gota
Artropatía por pirofosfato cálcico
Líquido sinovial

Both gout and calcium pyrophosphate dihydrate (CPPD) arthropathies are crystal deposit diseases; finding monosodium urate (MSU) or CPPD crystals in a synovial fluid sample, or in a tophi in the case of gout, provide a definitive, unequivocal diagnosis. Despite having such a simple and precise diagnostic test, in both crystal arthitides there is the accepted habit of approaching their diagnosis on clinical grounds (accompanied by hyperuricemia for gout, or chondrocalcinosis for the CPPD related arthropathy). Typical clinical presentations suggesting crystal arthitides may be due to other causes, and more important, less typical presentations, which are not uncommon, will pass undiagnosed unless crystals are systematically searched for in a synovial fluid sample from all undiagnosed arthropathies. Finally the precision of a clinical diagnosis made by an expert rheumatologist is higher than that of a less experienced or less specialized physician, and by approaching the diagnosis of the crystal arthritides on clinical grounds, expert rheumatologists support the inaccurate approach of other physicians with a wider margin of error.

Key words:
Gout
Calcium pyrophosphate arthropathy
Sinovial
El Texto completo está disponible en PDF
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Copyright © 2008. Elsevier España S.L. Barcelona
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