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Less Common Arthropathies

C. Hyperlipoproteinemia and Arthritis
  • Robert F. Spiera

Abstract

  • Several recognized heritable disorders of lipid metabolism result in a variety of clinical phenotypes, each of which may be associated with distinct musculoskeletal manifestations.

  • Tendinous xanthomas are associated most often with the type II and type III hyperlipoproteinemias, known respectively as familial hypercholesterolemia and familial dysbetalipoproteinemia.

  • Tendinous xanthomas characteristically occur on the dorsum of the hands over the digit extensor tendons, or on the heels at the Achilles tendon insertions.

  • Osseous xanthomas, observed occasionally in type III hyperlipoproteinemia, can predispose patients to pathologic fractures, particularly in long bones.

  • An episodic, acute, migratory inflammatory arthritis occurs in up to 50% of homozygotes with type II hyperlipoproteinemia. The joints are erythematous, warm, and swollen, and acute-phase reactants are elevated.

  • ■ Gout can be associated with hypertriglyceridemia in types I, IV, and V hyperlipoproteinemia.

Keywords

Primary Biliary Cirrhosis Familial Hypercholesterolemia Heritable Disorder Gouty Tophus Retrocalcaneal Bursa 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Fredrickson DS, Levy RI, Lees RS. Fat transport in lipoproteins: an integrated approach to mechanisms and disorders. N Engl J Med 1967;276:34–42, 94-103, 148-156, 215-225, 273-281.PubMedCrossRefGoogle Scholar
  2. 2.
    Fahey JJ, Stark HH, Donovan WE, Drennan DB. Xanthoma of the Achilles tendon. J Bone Joint Surg Am 1973;55A:1197–1211.Google Scholar
  3. 3.
    Yaghami I. Intra-and extraosseous xanthomata associated with hyperlipidemia. Radiology 1978;128:49–54.Google Scholar
  4. 4.
    Shapiro R, Fallat RW, Tsang RC, Glueck CJ. Achilles tendinitis and tenosynovitis. Am J Dis Child 1974;128: 486–490.PubMedGoogle Scholar
  5. 5.
    Glueck CJ, Levy R, Fredrickson DS. Acute tendinitis and arthritis. A presenting symptom of familial type II hyperlipoproteinemia. JAMA 1968;206:2895–2897.0PubMedCrossRefGoogle Scholar
  6. 6.
    Bardin T, Kuntz D. Primary hyperlipidemias and xanthomatosis. In: Klippel JH, Dieppe P (eds). Rheumatology. London: Times Mirror International Publishers Limited; 1994;27.1–27.4.Google Scholar
  7. 7.
    Siegelman SS, Schlossberg I, Becker NH, Sachs BA. Hyperlipoproteinemia with skeletal lesions. Clin Orthop 1972;87:228–232.PubMedGoogle Scholar
  8. 8.
    Truswell AS, Pfister PJ. Cerebrotendinous xanthomatosis. Br Med J 1972;1:353–354.PubMedGoogle Scholar
  9. 9.
    Shulman RS, Bhattacharyya AK, Connor WE, Fredrickson DS. Beta-sitosterolemia and xanthomatosis. N Engl J Med 1976;294:482–483.PubMedCrossRefGoogle Scholar
  10. 10.
    Rooney PJ, Third J, Madkour MM, Spencer D, Dick WC. Transient polyarthritis associated with familial hyperbetal lipoproteinemia. Q J Med 1978;47:249–259.PubMedGoogle Scholar
  11. 11.
    Mathon G, Gagne C, Brun D, Lupien PJ, Moorjani S. Articular manifestations of familial hypercholesterolemia. Ann Rheum Vis 1985;44:599–602.Google Scholar
  12. 12.
    Welin L, Larsson B, Svardsudd K, Tibblin G. Serum lipids, lipoproteins and musculoskeletal disorders among 50-and 60-year-old men. Scand J Rheumatol 1977;1: 7–12.Google Scholar
  13. 13.
    Struthers GR, Scott DL, Bacon PA, Walton KW. Musculoskeletal disorders in patients with hyperlipidemia. Ann Rheum Dis 1983;42:519–523.PubMedGoogle Scholar
  14. 14.
    Wysenbeek AJ, Shani E, Beigel Y. Musculoskeletal manifestations in patients with hypercholesterolemia. J Rheumatol 1989;16:643–645.PubMedGoogle Scholar
  15. 15.
    Klemp P, Halland AM, Majoos FL, Steyn K. Musculoskeletal manifestations in hyperlipidemia: a controlled study. Ann Rheum Dis 1993;52:44–48.PubMedCrossRefGoogle Scholar
  16. 16.
    Khachadurian AK. Migratory polyarthritis in familial hypercholesterolemia (type II hyperlipoproteinemia). Arthritis Rheum 1968;11:385–393.PubMedCrossRefGoogle Scholar
  17. 17.
    Rimon D, Cohen L. Hypercholesterolemic (type II hyperlipoproteinemic) arthritis. Rheumatology 1989;16:703–705.Google Scholar
  18. 18.
    Buckingham RB, Bole GG, Bassett DR. Polyarthritis associated with type IV hyperlipoproteinemia. Arch Intern Med 1975;135:286–290.PubMedCrossRefGoogle Scholar
  19. 19.
    Lazarevic MB, Skosey JL, Vitic J, et al. Cholesterol crystals in synovial and bursal fluid. Semin Arthritis Rheum 1993;23:99–103.PubMedCrossRefGoogle Scholar
  20. 20.
    Schumacher HR, Michaels R. Recurrent tendinits and Achilles tendon nodule with positively birefringent crystals in a patient with hyperlipoprotenemia. J Rheumatol 1989;16:1387–1389.PubMedGoogle Scholar
  21. 21.
    Solomon DH, Avorn J, Stürmer T, Glynn RJ, Mogun H, Schneeweiss S. Cardiovascular outcomes in new users of coxibs and nonsteroidal antiinflammatory drugs. Arthritis Rheum 2006;54:1378–1389.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2008

Authors and Affiliations

  • Robert F. Spiera
    • 1
  1. 1.Department of Medicine/RheumatologyMount Sinai School of MedicineUSA

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