II. Monosodium Urate (MSU) Crystals: Gout

  1. Needle-shaped
  2. Frequently intracellular
  3. Strongly negatively birefringent

III. Calcium Pyrophosphate Dihydrate (CPPD): Pseudogout

  1. Rod or rhomboidal shaped
  2. Weakly positive birefringent

IV. Basic Calcium Phosphate (BCP): Calcific periarthritis

  1. Description
    1. Clumps and globules
    2. Non-birefringent
  2. Conditions
    1. Chronic BCP Arthritis
    2. Milwaukee Shoulder-knee syndrome
    3. Mixed BCP-CPPD disease (See above)
    4. Osteoarthritis
    5. Metastatic calcinosis

V. Calcium Oxalate

  1. Description
    1. Variable bipyramidal morphology
    2. Strongly positively birefringent
  2. Conditions
    1. Chronic dialysis Arthritis
    2. Arthritis of primary oxalosis

VI. Cholesterol Crystals or Lipid Microspheres

  1. Description
    1. Flat, rectangular plates
    2. Notched corners, maltese crosses
    3. Strongly negative birefringent
  2. Conditions
    1. Chronic inflammatory Arthritis
    2. Acute Polyarthritis

VII. Cryoglobulin Crystals: Paraproteinemias

  1. Polygonal Shaped
  2. Positively birefringent

VIII. Other Crystals

  1. Corticosteroid Crystals: Arthritis flare post injection
    1. Birefringent Crystals
  2. Cystine Crystals: Cystinosis
  3. Xanthine Crystals: Xanthinuria
  4. Charcot-Leyden Crystals: Hypereosinophilic syndromes
  5. Aluminum phosphate: Hemodialysis
  6. Talc from exam gloves (Artifact)
  7. Apatite (Stained by Alizarin red S)

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