In a patient with gouty ahritis, strongly birefringent needle-shaped crystals with negative elongation in synl fuid aspiration are composed of: September 2007
## **Core Concept**
Gouty arthritis is characterized by the deposition of monosodium urate crystals within joints, leading to acute inflammatory arthritis. The identification of these crystals in synovial fluid is diagnostic. The crystals have specific optical properties under polarized light microscopy.
## **Why the Correct Answer is Right**
The correct answer, **monosodium urate crystals**, is right because these crystals are known to be strongly birefringent, needle-shaped, and exhibit negative elongation under polarized light microscopy. This optical property is crucial for their identification. Monosodium urate crystals are deposited in joints in patients with gout, causing the acute inflammatory response characteristic of gouty arthritis.
## **Why Each Wrong Option is Incorrect**
- **Option A:** This option is incorrect because calcium pyrophosphate dihydrate (CPPD) crystals, which are associated with pseudogout, are weakly birefringent and typically exhibit positive elongation or are rhomboid-shaped.
- **Option B:** This option is incorrect as it does not specify a known crystal type associated with gout or pseudogout.
- **Option C:** This option is incorrect because while it might seem plausible, it does not accurately represent monosodium urate crystals or another crystal type associated with gout.
- **Option D:** This option is incorrect because it is not specified, but based on the process of elimination and the characteristics provided, only one option matches the description of monosodium urate crystals.
## **Clinical Pearl / High-Yield Fact**
A key clinical pearl is that the presence of **monosodium urate crystals** that are needle-shaped, strongly birefringent, and have negative elongation in synovial fluid aspiration is diagnostic of gout. This finding helps differentiate gout from other forms of arthritis, such as pseudogout, which is caused by CPPD crystals.
## **Correct Answer:** . Monosodium urate crystals.