Rapid crystalline arthritis treatment requires recognition of various disease types

Mar 13, 2024

Eisenberger N. Let’s be crystal clear: The sharp facts of crystal arthritis. Presented at: Rheumatology Nurses Society annual conference; August 2-5, 2023 (hybrid meeting).

Eisenberger N. Let’s be crystal clear: The sharp facts of crystal arthritis. Presented at: Rheumatology Nurses Society annual conference; August 2-5, 2023 (hybrid meeting).

AUSTIN, Texas — Although gout is the most common, the ability to recognize, diagnose and treat other types of crystalline arthritis can make all the difference for patients, noted a speaker at the 2023 Rheumatology Nurses Society conference.

“The initial [gout] presentation, which we have all probably seen, is that podagra, that big, hot, red toe,” Nancy Eisenberger, MSN, FNP-C, a nurse practitioner at Arthritis, Rheumatic and Bone Disease Associates in New Jersey, and a member of the RNS board of directors, told attendees at the meeting. “It is pretty severe.”

In addition to the big toe, gout also commonly emerges at the instep, wrist, ankle and finger joints, as well as in the knees, she added. At first presentation, it is typical for only one joint to be implicated.

In addition to discussing the likely presentation, Eisenberger also listed the potential risk factors for the disease, such as male sex, obesity, alcohol consumption, diuretic medication and a family history of gout.

“Other medical conditions [are implicated], such as congestive heart failure, hypertension, insulin resistance, metabolic syndrome, as well as diabetes and impaired kidney function,” Eisenberger said.

On the topic of other crystalline diseases, Eisenberger recommended keeping an eye open for pseudogout.

“Pseudogout we see quite often in our more mature patients,” Eisenberger said. “It looks like the patient is wearing a blown-up office glove.”

When it appears, pseudogout typically will present in large or medium joints, Eisenberger said. Although standard gout usually appears at night, pseudogout can appear gradually or suddenly. Additionally, pseudogout impacts 4% to 7% of adults in the United States, and of those patients, 50% will develop radiographic changes, according to Eisenberger.

“There are different causes for pseudogout,” she said.

Along with hyperparathyroidism and osteoarthritis, patients with hemochromatosis are also at a greater risk.

“Hemochromatosis patients are at higher risk as well, and again, hemochromatosis alone gives you joint pain and osteoarthritis, but pseudoarthritis can show with that,” Eisenberger said.