We appreciate the interest shown by Drs. Buchanan and Kean in our case.1 As mentioned in the text, elevated levels of lipids in the serum and/or synovial fluid are unusual in Maltese-cross crystal-associated arthritis (only 2 of 13 reported cases). The references cited in our text suggest that the lipid-containing crystals are formed in the synovial fluid by various proposed but unproven mechanisms. They are not the product of an abnormal lipid concentration in the serum. The rareness of this entity is corroborated by one of us (I.R.) who has been examining synovial fluid for crystals for over 15 years and has never seen this form of crystal before.
Reference
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