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2001-1015.aug02
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/CS0 cs 0 0 0 1 scn
/GS1 gs
/TT0 1 Tf
0.18359 Tw 10 0 0 10 54 713.1616 Tm
(count, serum chemistries, and serum lipid profile. Serum)Tj
0.02859 Tw 0 -1.2 TD
(uric acid was elevated at 8.0 mg/dl \(normal 2.4\2267.0 mg/dl\).)Tj
0.0406 Tw T*
[(Rheumatoid factor \(RF\) was negative. )54.8 (Aspiration biopsy of)]TJ
0.05321 Tw T*
(the nodule was performed and thick creamy-white material)Tj
0.02 Tc 0.72839 Tw T*
(was obtained. Examination under polarized light)Tj
0 Tc 0.3737 Tw T*
(microscopy revealed noninflammatory fluid with many)Tj
0.1834 Tw T*
(cholesterol crystals in clumps resembling tophi, both rod)Tj
0.17599 Tw T*
(shaped and typical flat, rectangular crystals with notched)Tj
0.02049 Tw T*
[(corners \(Figure 1B\). )54.8 (At followup 3 months later)39.8 (, the nodule)]TJ
-0.00011 Tc 0.02499 Tw T*
(was stable in size.)Tj
0 Tc 0.0518 Tw 1.2 -1.2 Td
(Cholesterol crystals are occasionally detected in chronic)Tj
-0.00011 Tc 0.0769 Tw -1.2 -1.2 Td
[(rheumatoid, osteoarthritis, or bursal ef)17.7 (fusions)]TJ
0 Tc 0 Tw 6.5 0 0 6.5 239.0507 584.4615 Tm
[(10,1)56.7 (1)]TJ
0.0769 Tw 10 0 0 10 253.3069 581.1616 Tm
(, but have)Tj
0.0027 Tc 0.3723 Tw -19.9307 -1.2 Td
(not been commonly described as tophaceous deposits.)Tj
0.02 Tc 0.3938 Tw T*
(Although subcutaneous nodules may occur in many)Tj
0.0043 Tc 0.37061 Tw T*
(diseases, such as systemic lupus erythematosus, lupus)Tj
0.0199 Tc 0.5479 Tw T*
[(profundus, scleroderma, rheumatic fever)39.8 (, pancreatic)]TJ
0.0162 Tc 0.3587 Tw T*
(disease, various vasculitides, amyloidosis, necrobiosis)Tj
0 Tc 0.3634 Tw T*
(lipoidica diabeticorum, multicentric reticulohistiocytosis,)Tj
0.18111 Tw T*
(and some bacterial, viral and fungal infections)Tj
0 Tw 6.5 0 0 6.5 250.0661 500.4616 Tm
(1)Tj
0.1812 Tw 10 0 0 10 253.3161 497.1616 Tm
(, subcuta-)Tj
0.0704 Tw -19.9316 -1.2 Td
(neous olecranon nodules are most commonly seen in asso-)Tj
0.0762 Tw T*
[(ciation with rheumatoid arthritis and gout. )17.8 (The factors that)]TJ
0.0209 Tw T*
(lead to cholesterol crystal deposition in subcutaneous tissue)Tj
0.1281 Tw T*
[(are unclear; however)39.8 (, it has been speculated that repeated)]TJ
0.06599 Tw T*
(microtrauma to the skin can result in release of cholesterol)Tj
0.0726 Tw T*
(molecules from destroyed cell membrane lipids, leading to)Tj
0.1183 Tw T*
(cholesterol tophus formation)Tj
0 Tw 6.5 0 0 6.5 171.3298 416.4616 Tm
(7)Tj
0.1183 Tw 10 0 0 10 174.5798 413.1616 Tm
(. Local biosynthesis can also)Tj
0.1273 Tw -12.058 -1.2 Td
(be a factor in cholesterol accumulation)Tj
0 Tw 6.5 0 0 6.5 215.565 404.4616 Tm
(9,12)Tj
0.1095 Tw 10 0 0 10 226.9399 401.1616 Tm
[(. The )-17.8 (inflamma-)]TJ
0.1758 Tw -17.294 -1.2 Td
(tory capacity of cholesterol crystals is probably minimal,)Tj
0.0004 Tc 0.3746 Tw T*
(although synovitis has been observed in rabbits when)Tj
0.0081 Tc 0.3669 Tw T*
(cholesterol crystals are injected intraarticularly)Tj
0 Tw 6.5 0 0 6.5 260.4131 368.4616 Tm
[(10,1)56.7 (1,13,14)]TJ
0 Tc 10 0 0 10 291.5013 365.1616 Tm
(.)Tj
0.14619 Tw -23.7501 -1.2 Td
(Neither our patient nor the reported cases had a systemic)Tj
0.2177 Tw T*
[(lipid disorder)39.8 (, and indeed the presence of synovial fluid)]TJ
0.07809 Tw T*
(cholesterol crystals does not seem to bear a relationship to)Tj
0.02499 Tw T*
(serum lipoprotein abnormalities)Tj
0 Tw 6.5 0 0 6.5 182.2368 320.4616 Tm
(10)Tj
10 0 0 10 188.7368 317.1616 Tm
(.)Tj
-0.0191 Tw -12.2737 -1.2 Td
(Local factors possibly played a role in our patient and the)Tj
-0.00011 Tc 0.14011 Tw -1.2 -1.2 Td
(previously described cases. Fam, )Tj
/TT1 1 Tf
0 Tc 0.14 Tw [-0.4 (et al)]TJ
/TT0 1 Tf
16.2788 0 Td
(reported 2 patients)Tj
0.0759 Tw -16.2788 -1.2 Td
(with nodules, one at the lateral malleolus and one near the)Tj
0.1355 Tw T*
(5th metatarsophalangeal joint. Chronic trauma from boots)Tj
0.2921 Tw T*
(possibly contributed to the nodules in both patients by)Tj
-0.0136 Tw T*
(causing local tissue breakdown)Tj
0 Tw 6.5 0 0 6.5 178.2679 248.4616 Tm
(6,7)Tj
-0.0136 Tw 10 0 0 10 186.3928 245.1616 Tm
(. One of the patients devel-)Tj
0.0397 Tw -13.2393 -1.2 Td
(oped the nodule only a few months after beginning to wear)Tj
0.00121 Tw T*
(heavy safety boots and experienced resolution of the nodule)Tj
0.0199 Tc 0.4353 Tw T*
(after changing footwear)Tj
0 Tc 0 Tw 6.5 0 0 6.5 162.7999 212.4616 Tm
(7)Tj
0.0199 Tc 0.4353 Tw 10 0 0 10 166.1799 209.1616 Tm
(. Szachnowske and Bridges)Tj
0 Tc 0.14011 Tw -11.218 -1.2 Td
(described 2 men with nodules over the extensor forearms)Tj
-0.006 Tw T*
(and felt the nodule distribution was consistent with repeated)Tj
0.0002 Tc 0.3748 Tw T*
[(injury)64.9 (, given their farming occupation)]TJ
0 Tc 0 Tw 6.5 0 0 6.5 220.8721 176.4616 Tm
(8)Tj
0.0002 Tc 0.3748 Tw 10 0 0 10 224.1235 173.1616 Tm
(. Lanting, )Tj
/TT1 1 Tf
4.8623 0 Td
(et al)Tj
/TT0 1 Tf
0 Tc 0.11591 Tw -21.8747 -1.2 Td
(described 2 patients with subcutaneous nodules)Tj
0 Tw 6.5 0 0 6.5 249.4618 164.4616 Tm
(9)Tj
-0.00011 Tc 0.09821 Tw 10 0 0 10 252.7118 161.1616 Tm
[(. The )-17.7 (first)]TJ
0 Tc 0.09039 Tw -19.8712 -1.2 Td
(developed a nodule on her 5th finger while using crutches)Tj
-0.0341 Tw T*
[(and eventually had a nodule excision. )17.8 (The 2nd patient devel-)]TJ
-0.03371 Tw T*
[(oped nodules on his elbow and both feet. )17.8 (The elbow location)]TJ
0.2205 Tw 26.4 58.8 Td
(was felt to be a usual site for mechanical pressure, and)Tj
-0.00011 Tc 0.0069 Tw T*
(footwear was felt to be a contributing factor for the forefoot)Tj
0 Tc 0.33459 Tw T*
(nodules. He experienced resolution of his nodule after)Tj
0.00459 Tw T*
[(changing footwear)54.9 (. Our patient developed a nodule over the)]TJ
-0.00011 Tc 0.1069 Tw T*
(left elbow region after working for many years as a crane)Tj
0 Tc 0.02229 Tw T*
[(operator in a steel mill. )17.8 (The olecranon area is susceptible to)]TJ
0.1882 Tw T*
(repeated microtrauma and we suspect our patient experi-)Tj
-0.00571 Tw T*
(enced chronic trauma due to his occupation operating heavy)Tj
0 Tw T*
[(machinery)64.9 (.)]TJ
0.09731 Tw 1.2 -1.2 Td
(Both MSU and cholesterol crystals may be rod shaped,)Tj
0.00101 Tw -1.2 -1.2 Td
(and we did not perform a chemical analysis on the aspirated)Tj
0.02 Tc 0.369 Tw T*
(material, such as uricase digestion, nor did we use)Tj
0 Tc 0.20261 Tw T*
(DeGalantha stain. Despite this, we are confident the rod)Tj
0.0425 Tw T*
(shaped crystals are not MSU, given the cystic nature of the)Tj
0.0183 Tw T*
(tophus, lack of clumping of rods, as would be expected in a)Tj
0.1599 Tw T*
(gouty tophus, and abundance of typical plate-like choles-)Tj
0.2834 Tw T*
(terol crystals. Joint, bursa, and nodule/tophus aspiration)Tj
0.1093 Tw T*
(with a careful analysis of the aspirated material remains a)Tj
-0.01981 Tw T*
(most useful and often diagnostic procedure in the evaluation)Tj
0.02499 Tw T*
(of patients with rheumatological conditions.)Tj
/TT2 1 Tf
-0.00011 Tc 0 Tw 0 -2.4 TD
(REFERENCES)Tj
/TT0 1 Tf
0 Tc 0.0249 Tw 8 0 0 8 325 451.1616 Tm
[(1.)-875 (Moore, CP)110.8 (, )17.7 (W)39.8 (illkens RF)79.8 (. )17.7 (The subcutaneous nodule: its significance)]TJ
1.675 -1.25 Td
[(in the diagnosis of rheumatic disease. Semin )54.8 (Arthritis Rheum)]TJ
0 Tw 0 -1.25 TD
(1977;7:63-79.)Tj
0.02499 Tw -1.675 -1.25 Td
[(2.)-875 (Leisen JCC, )54.9 (Austad ED, Bluhm GB, et al. )17.8 (The tophus in calcium)]TJ
-0.00011 Tc 1.675 -1.25 Td
[(pyrophosphate deposition disease. JAMA)-220.2 (1980;244:171)36.8 (1-2.)]TJ
-1.675 -1.25 Td
[(3.)-875.1 (Ling D, Murphy )17.7 (W)110.7 (A, Kyriakos M. )17.7 (T)69.7 (ophaceous pseudogout. )54.8 (AJR)]TJ
0 Tc 1.675 -1.25 Td
(Am J Roentgenol 1982;138:162-5.)Tj
-1.675 -1.25 Td
[(4.)-875 (Schumacher HR, Miller JL, Ludivico C, et al. Erosive arthritis)]TJ
1.675 -1.25 Td
[(associated with apatite crystal deposition. )54.8 (Arthritis Rheum)]TJ
0 Tw T*
(1981;24:31-7.)Tj
-0.00011 Tc 0.02499 Tw -1.675 -1.25 Td
[(5.)-875.1 (Reginato )54.8 (AJ, Ferreiro JL, Barbazan C, et al. )54.8 (Arthropathy and )]TJ
0 Tc 1.675 -1.25 Td
[(cutaneous calcinosis in hemodialysis oxalosis. )54.8 (Arthritis Rheum)]TJ
0 Tw T*
(1986;29:1387-96.)Tj
0.02499 Tw -1.675 -1.25 Td
[(6.)-875 (Fam )54.9 (AG, Sugai M, Gertner E, et al. Cholesterol \223tophus\224. )54.9 (Arthritis)]TJ
1.675 -1.25 Td
(Rheum 1983;26:1525-8.)Tj
-1.675 -1.25 Td
[(7.)-875 (Fam )54.9 (AG. Subcutaneous cholesterol crystal deposition and tophus)]TJ
1.675 -1.25 Td
[(formation. )54.9 (Arthritis Rheum 1989;32:1)36.8 (190-1.)]TJ
-1.675 -1.25 Td
[(8.)-875 (Szachnowske P)110.8 (,)0.1 ( Bridges )54.8 (AJ. Subcutaneous cholesterol nodules. )]TJ
1.675 -1.25 Td
(J Rheumatol 1994;21:2391-2.)Tj
-0.00011 Tc -1.675 -1.25 Td
[(9.)-875.1 (Lanting PJH, Baaren JV)128.8 (, Festen JJM, et al. )17.7 (T)69.7 (ophus-like cholesterol)]TJ
0 Tc 1.675 -1.25 Td
(nodules in two patients with rheumatoid disease. J Rheumatol)Tj
0 Tw T*
(1995;22:338-41.)Tj
0.02499 Tw -2.175 -1.25 Td
[(10.)-875 (Ettlinger RE, Hunder GG. Synovial ef)17.8 (fusions containing cholesterol)]TJ
2.175 -1.25 Td
[(crystals; Report of 12 patients and review)64.9 (. Mayo Clin Proc)]TJ
0 Tw T*
(1979;54:366-74.)Tj
0.02499 Tw -2.1381 -1.25 Td
[(1)36.9 (1.)-875 (Rull M. Calcium crystal-associated diseases and miscellaneous)]TJ
2.1381 -1.25 Td
(crystals. Curr Opin Rheumatol 1997;9:274-9.)Tj
-0.00011 Tc -2.175 -1.25 Td
[(12.)-875.1 (Newcombe DS, Cohen )54.8 (AS. Chylous synovial ef)17.7 (fusion in )]TJ
0 Tc 2.175 -1.25 Td
[(rheumatoid arthritis. )54.9 (Am J Med 1965;38:156-64.)]TJ
-2.175 -1.25 Td
[(13.)-875 (Zuckner J, Uddin J, Gantner GE Jr)39.8 (, et al. Cholesterol crystals in)]TJ
2.175 -1.25 Td
[(synovial fluid. )54.9 (Ann Intern Med 1964;60:436-46.)]TJ
-2.175 -1.25 Td
[(14.)-875 (Bland JH, Gierthy JF)79.8 (, Suhre ED. Cholesterol in connective tissue of)]TJ
2.175 -1.25 Td
(joints. Scand J Rheumatol 1974;3:199-203.)Tj
ET
0 0 0 0 scn
468 770 90 -25 re
f*
/CS0 CS 0 0 0 1 SCN
54 54 m
558 54 l
S
BT
0 0 0 1 scn
/TT1 1 Tf
8 0 0 8 54.5 35.9844 Tm
[(Kelley and )17.7 (Agudelo: Cholester)36.8 (ol crystal nodules)]TJ
0 Tw 60.9375 -0.0313 Td
(1799)Tj
ET
0 0 0 0 scn
/GS0 gs
102.25 59.08 407.5 -10.83 re
f*
0.5 w
102.25 59.08 407.5 -10.83 re
S
Q
Q
q
0 0 612 792 re
W n
BT
0 g
/GS2 gs
/T1_0 8 Tf
120.092 51 Td
(Personal non-commercial use only. The Journal of Rheumatology Copyright\
\251 2002. All rights reserved.)Tj
ET
Q
BT
0 g
/GS2 gs
/T1_1 1 Tf
10 0 0 10 540 17 Tm
( )Tj
0 0.48627 0.77255 rg
/GS2 gs
-7.22298 0 Td
(www.jrheum.org)Tj
0 g
/GS2 gs
-16.72996 0 Td
(Downloaded on March 28, 2024 from )Tj
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