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Ea HK, Gauffenic A, Nguyen QD, Pham NG, Olivier O, Frochot V, Bazin D, Le NH, Marty C, Ostertag A, Cohen-Solal M, Laredo JD, Richette P, Bardin T. Calcium Pyrophosphate Dihydrate Crystal Deposition in Gouty Tophi. Arthritis Rheumatol 2020; 73:324-329. [PMID: 32909692 DOI: 10.1002/art.41515] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/25/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The coexistence of calcium pyrophosphate dihydrate (CPPD) and monosodium urate monohydrate crystals in gouty tophi has rarely been reported. We undertook this study to investigate CPPD crystal deposits in a series of surgically removed gouty tophi and to identify factors associated with these deposits. METHODS Twenty-five tophi from 22 gout patients were analyzed using polarized light microscopy, field emission scanning electron microscopy (FESEM), and μ Fourier transform infrared (μFTIR) spectroscopy. RESULTS Tophi consisted of multiple lobules separated by fibrous septa and surrounded by a foreign-body giant cell reaction. CPPD crystal aggregates were identified in 9 of 25 tophi from 6 patients. CPPD crystals were dispersed or highly compacted, localized at the edge or inside the tophus lobules, with some lobules completely filled with crystals. Both monoclinic and triclinic CPPD crystal phases were identified using FESEM and μFTIR. Compared to patients without CPPD, those with CPPD-containing tophi were older (mean 60.5 years versus 47.2 years; P = 0.009), and had longer-term gout duration (mean 17.0 years versus mean 9.0 years; P < 0.05) and tophi duration (mean 10.0 years versus mean 4.6 years; P < 0.01). None of the patients had radiographic chondrocalcinosis of the knee or wrist. CONCLUSION CPPD crystal formation seems to be a late and frequent event of tophus maturation, occurring more frequently with aging, and could contribute to the speed of tophus dissolution and the apparent persistence of tophus sometimes observed even after effective, long-lasting urate-lowering therapy.
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Affiliation(s)
- Hang-Korng Ea
- Université de Paris, INSERM UMR 1132, Hôpital Lariboisière, AP-HP, Paris, France
| | - Alan Gauffenic
- Université de Paris, INSERM UMR 1132, Hôpital Lariboisière, AP-HP, Paris, France
| | - Quang Dinh Nguyen
- Vien Gut Medical Center and French-Vietnamese Research Center on Gout and Chronic Diseases, Ho Chi Minh City, Vietnam
| | - Nhu G Pham
- Vien Gut Medical Center and French-Vietnamese Research Center on Gout and Chronic Diseases, Ho Chi Minh City, Vietnam
| | - Océane Olivier
- Université de Paris, INSERM UMR 1132, Hôpital Lariboisière, AP-HP, Paris, France
| | - Vincent Frochot
- Hôpital Tenon and Sorbonne Université, UMR S1155, Paris, France
| | - Dominique Bazin
- Institut de Chimie Physique, Université Paris-Saclay, CNRS UMR 8000, Orsay, France
| | - Nghia H Le
- Vien Gut Medical Center and French-Vietnamese Research Center on Gout and Chronic Diseases, Ho Chi Minh City, Vietnam
| | - Caroline Marty
- Université de Paris, INSERM UMR 1132, Hôpital Lariboisière, AP-HP, Paris, France
| | - Agnès Ostertag
- Université de Paris, INSERM UMR 1132, Hôpital Lariboisière, AP-HP, Paris, France
| | - Martine Cohen-Solal
- Université de Paris, INSERM UMR 1132, Hôpital Lariboisière, AP-HP, Paris, France
| | | | - Pascal Richette
- Université de Paris, INSERM UMR 1132, Hôpital Lariboisière, AP-HP, Paris, France
| | - Thomas Bardin
- Université de Paris, INSERM UMR 1132, Hôpital Lariboisière, AP-HP, Paris, France, and Vien Gut Medical Center and French-Vietnamese research center on gout and chronic diseases, Ho Chi Minh City, Vietnam
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Yates KA, Yoshida K, Xu C, Lyu H, Norvang V, Solomon DH, Tedeschi SK. Acute Calcium Pyrophosphate Crystal Arthritis Flare Rate and Risk Factors for Recurrence. J Rheumatol 2019; 47:1261-1266. [PMID: 31676701 DOI: 10.3899/jrheum.190778] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Little is known about acute calcium pyrophosphate (CPP) crystal arthritis flare rates and risk factors for recurrence. We characterized flares and determined the rate and predictors of acute CPP crystal arthritis flares in an academic medical center cohort. METHODS We performed a retrospective cohort study among a random sample of patients with acute CPP crystal arthritis identified in the Partners HealthCare electronic medical record, 1991-2017. Flare was defined as self-limited, acute-onset synovitis with synovial fluid CPP crystals and/or chondrocalcinosis, not better explained by another cause. We calculated incidence rates (IR) for acute CPP crystal arthritis flare among all subjects and by sex. We estimated HR for recurrent flare using univariate Cox models that accounted for within-person correlated data. RESULTS We identified 70 patients with acute CPP crystal arthritis with a total of 111 flares. Recurrent flares occurred in 24% of patients; half of flares occurred in a previously unaffected joint. The acute CPP crystal arthritis flare rate was 11.4 per 100 person-years overall (95% CI 8.2-15.4), 14.2 in women (95% CI 9.6-0.1), and 7.1 in men (95% CI 3.4-13.0). Cancer (HR 2.98, 95% CI 1.33-6.68) and chronic kidney disease (HR 2.92, 95% CI 1.10-7.76) were associated with a higher rate for recurrent flare. CONCLUSION Recurrent flares occurred in about one-fourth of patients with acute CPP crystal arthritis and often occurred in previously unaffected joints. The acute CPP crystal arthritis flare rate was twice as high in women as in men.
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Affiliation(s)
- Katherine A Yates
- From the Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,K.A. Yates, MD, Department of Medicine, Vanderbilt University School of Medicine; K. Yoshida, MD, ScD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; C. Xu, MS, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; H. Lyu, MD, PhD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; V. Norvang, MD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; D.H. Solomon, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; S.K. Tedeschi, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School
| | - Kazuki Yoshida
- From the Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,K.A. Yates, MD, Department of Medicine, Vanderbilt University School of Medicine; K. Yoshida, MD, ScD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; C. Xu, MS, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; H. Lyu, MD, PhD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; V. Norvang, MD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; D.H. Solomon, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; S.K. Tedeschi, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School
| | - Chang Xu
- From the Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,K.A. Yates, MD, Department of Medicine, Vanderbilt University School of Medicine; K. Yoshida, MD, ScD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; C. Xu, MS, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; H. Lyu, MD, PhD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; V. Norvang, MD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; D.H. Solomon, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; S.K. Tedeschi, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School
| | - Houchen Lyu
- From the Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,K.A. Yates, MD, Department of Medicine, Vanderbilt University School of Medicine; K. Yoshida, MD, ScD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; C. Xu, MS, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; H. Lyu, MD, PhD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; V. Norvang, MD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; D.H. Solomon, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; S.K. Tedeschi, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School
| | - Vibeke Norvang
- From the Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,K.A. Yates, MD, Department of Medicine, Vanderbilt University School of Medicine; K. Yoshida, MD, ScD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; C. Xu, MS, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; H. Lyu, MD, PhD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; V. Norvang, MD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; D.H. Solomon, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; S.K. Tedeschi, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School
| | - Daniel H Solomon
- From the Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,K.A. Yates, MD, Department of Medicine, Vanderbilt University School of Medicine; K. Yoshida, MD, ScD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; C. Xu, MS, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; H. Lyu, MD, PhD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; V. Norvang, MD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; D.H. Solomon, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; S.K. Tedeschi, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School
| | - Sara K Tedeschi
- From the Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA. .,K.A. Yates, MD, Department of Medicine, Vanderbilt University School of Medicine; K. Yoshida, MD, ScD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; C. Xu, MS, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; H. Lyu, MD, PhD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; V. Norvang, MD, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital; D.H. Solomon, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School; S.K. Tedeschi, MD, MPH, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School.
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