Hyperlipidemia (also spelled “hyperlipidaemia”) is a general term for higher than normal fat and cholesterol levels in the blood.  Hyperlipoproteinemia is the term for elevated cholesterol and triglyceride lipoprotein levels in the plasma. A lipoprotein is a lipid bound to proteins and transported in the plasma. Low density lipoproteins (LDLs) and high-density lipoproteins (HDLs) are the familiar components you may recognize from your cholesterol test results.

Hyperlipoproteinemia is categorized into five major subtypes.  These disorders can result in xanthomatous collections in soft tissue and tendons, resulting in the rheumatic manifestations we are discussing here. Of the five subtypes, type II is most commonly associated with Xanthoma-induced tendinitis, although type IV is also mentioned.

If a cell has too much cholesterol, it can link cholesterol with a fatty acid by a chemical ester bond, making cholesterol ester. Cells identified as macrophages may fill up with cholesterol ester, become foam cells and get greatly enlarged.  These cholesterol ester laden foam cells have an inflammatory action that causes the tendonitis.

The path that lipids take and the transformations they go through on the way to your tendons bear a great deal of similarity to the process of Atherosclerosis (5). The point is that if you have TX, you are also at a high risk for coronary heart disease.

The relationship between rheumatic symptoms and TX is not common knowledge in clinical circles and is poorly documented or not mentioned at all in many medical texts. It is my hope that this article will advance the understanding of this syndrome for both it’s victims and the medical community as well.
Confirming a Diagnosis

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