13 Newer methods for aiding clinical diagnosis include magnetic resonance imaging and ultrasonography, 14 and optical tomography 15 which, like radiography, can reveal damage to the bone and/or cartilage but yield little or no data on the presence of associated crystals and the compositional changes in the synovial fluid.įrequent discrepancies between symptoms and the results of radiographic examinations have been reported. Although the three principal crystal arthropathies may be distinguished radiologically there is an appreciable overlap between them and there are no exclusive hallmarks to allow an absolute diagnosis. Many radiological features that would previously have been dismissed as degenerative changes are now known to be manifestations or modifications of OA as a result of the influence of crystal deposition. Currently, the diagnosis of OA is primarily based on overall clinical impression (history, physical examination and decision trees) and radiographic findings. Misdiagnosis of OA can lead to unnecessary or inappropriate treatment, both of which can cause psychological stress to the patient. The accurate diagnosis of OA is the first important step in ensuring appropriate management of the disease. They usually involve intra-articular injection of steroids and non-steroidal anti-inflammatory drugs. 6–8 Hence, currently available pharmacological therapies treat only the symptoms and help to reduce pain and to maintain or improve function. 4,5 To date, despite many studies, no treatment is known to change the course of symptomatic OA. Surgical interventions to correct altered biomechanics of large joints such as partial or total knee and hip joint replacement are the most common and effective treatments for severely damaged joints by OA. Altogether, the joint feels stiff and sore. Spurs grow out from the edge of the bone, and synovial fluid increases. In osteoarthritis, the cartilage becomes worn away. 2 As a result, it incurs significant economic, social and psychological costs. The prevalence of OA increases indefinitely with age, because the condition is not reversible. 1 Today, osteoarthritis (OA) is the most common cause of damage to knee and hip joints with a final common pathway of cartilage degeneration and bone damage ( Fig. Introduction According to a recent report by a major healthcare insurer in Ireland, after heart bypass, the second most expensive treatment was knee replacement, and the third most common treatment was hip replacement. Her research interests include analytical method development and novel sample clean-up techniques. She has worked in the pharmaceutical industry both in the UK and in Ireland. She has a BSc in Analytical Science and a PhD in Biopharmaceutical Analysis. He has an MSc in Pharmacy and a PhD in Pharmacognosy from Lviv Medical University, Ukraine and a further MSc in Pharmaceutical Science from Tallaght Institute of Technology in Ireland.ĭr Gillian McMahon is head of the Bioanalytical Chemistry & Diagnostics Research Group and a lecturer in analytical chemistry in the School of Chemical Sciences at Dublin City University. The purpose of this Critical Review is to present an overview of some of the main analytical tools employed in the detection of BCP to date and the potential of emerging technologies such as atomic force microscopy ( AFM) and Raman microspectroscopy for this purpose.ĭr Alexander Yavorskyy is a postdoctoral researcher in the Bioanalytical Chemistry & Diagnostics Research Group where his focus is the development of methods for detection and quantification of basic calcium phosphate crystals in synovial fluid. Routine analysis of joint crystals still relies almost exclusively on the use of optical microscopy, which has limited applicability for BCP crystal identification due to limited resolution and the inherent subjectivity of the technique. The detection of BCP crystals in the synovial fluid of patients with OA is fraught with challenges due to the submicroscopic size of BCP, the complex nature of the matrix in which they are found and the fact that other crystals can co-exist with them in cases of mixed pathology. Clinically, osteoarthritis (OA) is characterised by joint pain, stiffness after immobility, limitation of movement and, in many cases, the presence of basic calcium phosphate (BCP) crystals in the joint fluid.
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