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Braun J, Krekeler M, Kiltz U. [First classification criteria for diseases caused by calcium pyrophosphate deposition (CPPD)-Translation, explanation and assessment]. Z Rheumatol 2024; 83:306-315. [PMID: 38381191 PMCID: PMC11058609 DOI: 10.1007/s00393-024-01482-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 02/22/2024]
Abstract
AIM For diseases caused by calcium pyrophosphate deposition (CPPD), validated classification criteria were previously lacking. In this article the recently developed and validated classification criteria are translated, explained, and assessed. METHODS In recent years a multinational research group developed classification criteria for CPPD disease with the support by the European Alliance of Associations for Rheumatology (EULAR) and the American College of Rheumatology (ACR), following an established method. The developed criteria were finally validated in an independent cohort. The translation and annotation of the new first classification criteria were carried out in an iterative procedure in consensus with the authors. RESULTS The presence of a crowned dens syndrome or calcium pyrophosphate crystals in the synovial fluid in patients with pain, swelling or sensitivity of the joints (entry criterion) is sufficient for the classification as CPPD disease, where the symptoms cannot be completely explained by another rheumatic disease (exclusion criterion). If these symptoms are not present, a count of more than 56 points based on weighted criteria comprised of clinical features and the results of laboratory and imaging investigations can be included for classification as a CPPD disease. These criteria had a sensitivity of 92.2% and a specificity of 87.9% in the derivation cohorts (190 CPPD cases and 148 mimics), whereas the sensitivity was 99.2% and the specificity 92.5% in the validation cohorts (251 CPPD cases and 162 mimics). CONCLUSION The ACR/EULAR classification criteria 2023 of a CPPD disease will facilitate clinical research in this field. The use in the clinical routine will show how practical the criteria are.
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Affiliation(s)
- Jürgen Braun
- Rheumatologisches Versorgungszentrum Steglitz, Berlin, Deutschland.
- Ruhr Universität Bochum, Bochum, Deutschland.
| | | | - Uta Kiltz
- Ruhr Universität Bochum, Bochum, Deutschland.
- Rheumazentrum Ruhrgebiet, Claudiusstr. 45, 44649, Herne, Deutschland.
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2
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Codes-Méndez H, Sainz L, Park HS, Corominas H, Diaz-Torne C. Application of the 2023 ACR/EULAR classification criteria for calcium pyrophosphate deposition disease in a seronegative rheumatoid arthritis cohort. RMD Open 2024; 10:e004173. [PMID: 38626930 DOI: 10.1136/rmdopen-2024-004173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Affiliation(s)
| | - Luis Sainz
- Rheumatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Hye Sang Park
- Rheumatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Hèctor Corominas
- Rheumatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Cesar Diaz-Torne
- Rheumatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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3
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Kise T, Yokogawa N, Miyoshi Y, Utsunomiya M, Nagai Y, Shimada K. Synovial fluid crystal analysis with compensated polarization using a gout analyser in clinical practice. Mod Rheumatol 2024; 34:646-648. [PMID: 37329305 DOI: 10.1093/mr/road060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/17/2023] [Accepted: 06/13/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To validate the gout analyzer as a clinical method of synovial fluid crystal analysis. METHODS Thirty knee synovial fluid samples with suspected calcium pyrophosphate (CPP) crystals were analyzed. Within 48 hours after collection, each non-centrifuged sample was examined blindly and independently by one or more rheumatologists in the following order: 1) with an optical microscope under ordinary light, 2) with the same microscope under compensated polarization provided by a gout analyzer, and 3) with a fully equipped compensated polarized microscope with a rotating stage as the gold standard. As a reference, laboratory technicians analyzed fresh, centrifuged synovial fluid using a gout analyzer. RESULTS Of the 30 samples analyzed, CPP and monosodium urate (MSU) crystals were detected in 11 and four, non-centrifuged samples, respectively, using a fully equipped compensated polarized microscope. The rheumatologists' detection rate of crystals in the non-centrifuged synovial fluid under ordinary light and with a gout analyzer was 73.3% and 80%, respectively. The laboratory technicians' detection rate in fresh centrifuged synovial fluid using a gout analyzer was 100%. CONCLUSION A gout analyzer may be used to diagnose gout and calcium pyrophosphate deposition disease definitively if a fully equipped compensated polarized microscope is unavailable.
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Affiliation(s)
- Takayasu Kise
- Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Naoto Yokogawa
- Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Yuji Miyoshi
- Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Masako Utsunomiya
- Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Yoshiki Nagai
- Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Kota Shimada
- Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
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4
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Bély M, Apáthy Á. Crystal induced arthropathies-a comparative study of 40 patients with apatite rheumatism, chondrocalcinosis and primary synovial chondromatosis. Pathol Oncol Res 2024; 30:1611454. [PMID: 38505147 PMCID: PMC10949224 DOI: 10.3389/pore.2024.1611454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/16/2024] [Indexed: 03/21/2024]
Abstract
Introduction: Apatite rheumatism (AR), chondrocalcinosis (Ch-C), and primary synovial chondromatosis (prSynCh) are regarded as distinct clinical entities. The introduction of the non-staining technique by Bély and Apáthy (2013) opened a new era in the microscopic diagnosis of crystal induced diseases, allowing the analysis of MSU (monosodium urate monohydrate) HA (calcium hydroxyapatite), CPPD (calcium pyrophosphate dihydrate) crystals, cholesterol, crystalline liquid lipid droplets, and other crystals in unstained sections of conventionally proceeded (aqueous formaldehyde fixed, paraffin-embedded) tissue samples. The aim of this study was to describe the characteristic histology of crystal deposits in AR, Ch-C, and prSynCh with traditional stains and histochemical reactions comparing with unstained tissue sections according to Bély and Apáthy (2013). Patients and methods: Tissue samples of 4 with apatite rheumatism (Milwaukee syndrome), 16 with chondrocalcinosis, and 20 with clinically diagnosed primary synovial chondromatosis were analyzed. Results and conclusion: Apatite rheumatism, chondrocalcinosis, and primary synovial chondromatosis are related metabolic disorders with HA and CPPD depositions. The authors assume that AR and Ch-C are different stages of the same metabolic disorder, which differ from prSynCh in amorphous mineral production, furthermore in the production of chondroid, osteoid and/or bone. prSynCh is a defective variant of HA and CPPD induced metabolic disorders with reduced mineralization capabilities, where the deficient mineralization is replaced by chondroid and/or bone formation. The non-staining technique of Bély and Apáthy proved to be a much more effective method for the demonstration of crystals in metabolic diseases than conventional stains and histochemical reactions.
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Affiliation(s)
- Miklós Bély
- Department of Pathology, Hospital of the Order of the Brothers of Saint John of God in Budapest, Budapest, Hungary
| | - Ágnes Apáthy
- Department of Rheumatology, St. Margaret Clinic, Budapest, Hungary
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5
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Hirata R, Ide N, Motomura S, Tago M. Pseudogout in the sternoclavicular joint initially presenting with cervical pain. BMJ Case Rep 2023; 16:e258581. [PMID: 38086569 PMCID: PMC10728927 DOI: 10.1136/bcr-2023-258581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Affiliation(s)
- Risa Hirata
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Noriko Ide
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - So Motomura
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Masaki Tago
- Department of General Medicine, Saga University Hospital, Saga, Japan
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6
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De Azevedo SM, Pichel RC, Freitas E, Campar A, Marinho A, Mendonça T. Orthostatic hypotension as an unusual presentation of spinal calcium pyrophosphate deposition disease: case report and review of literature. Rom J Intern Med 2023; 61:212-215. [PMID: 37671719 DOI: 10.2478/rjim-2023-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Indexed: 09/07/2023]
Abstract
Calcium pyrophosphate crystal deposition disease (CPPD), also known as pseudogout, with spinal involvement, is associated with clinical manifestations of acute nerve compression or chronic spinal stenosis. Precipitation of crystals of calcium pyrophosphate dihydrate in connective tissues can lead to acute inflammatory arthritis, degenerative chronic arthropathies, and radiographic evidence of cartilage calcification. We present a case of an 87-year-old woman, with unstudied chronic polyarthralgia and symptomatic orthostatic hypotension. It were documented acute calcium pyrophosphate deposition wrist arthritis, and cervical CT and MRI was suggestive of spinal involvement of CPPD. Workup excluded other causes of OH. Surgical approach could be indicated to minimize the symptoms, but it was contra-indicated due to the patient's performance status, so histological diagnosis was not possible. Muscle atrophy played an important part in the rapid progression of this insidious chronic disease. Conservative and symptomatic treatment achieve scarce short-term clinical improvement. Spinal involvement of CPPD was thought to be rare but recent studies show a higher prevalence than expected. We call for attention to the extent of structural changes that may occur when not early diagnosed nor treated. High clinical suspicion is required and this is, to our knowledge, the first report of orthostatic hypotension as a presentation of CPPD.
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Affiliation(s)
- Sofia Moura De Azevedo
- Internal Medicine Service, Centro Hospitalar Universitário de Santo António. Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - Rita Carrilho Pichel
- Medical Oncology Service, Centro Hospitalar Universitário de Santo António. Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - Egídio Freitas
- Dermatology Service, Centro Hospitalar Universitário de Santo António. Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - Ana Campar
- Clinical Immunology Unit, Centro Hospitalar Universitário de Santo António. Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - António Marinho
- Clinical Immunology Unit, Centro Hospitalar Universitário de Santo António. Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - Teresa Mendonça
- Internal Medicine Service, Centro Hospitalar Universitário de Santo António. Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
- Clinical Immunology Unit, Centro Hospitalar Universitário de Santo António. Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
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7
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Takeuchi Y, Yoshikawa R, Mitsui Y, Iwasaka M, Matsuda M, Hamasaki A. Differences in the Optical Response of MSU and CPP Crystals During Magnetic Orientation: Possibility of Diagnosing Gout and Pseudogout. Bioelectromagnetics 2023; 44:204-210. [PMID: 37157157 DOI: 10.1002/bem.22444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 03/07/2023] [Accepted: 03/31/2023] [Indexed: 05/10/2023]
Abstract
Pseudogout is crystalline arthritis. It has a similar clinical picture to that of gout, and it is difficult to distinguish the two diseases using conventional analysis methods. However, it is important to identify the different crystals responsible for these two cases because the treatment strategies are different. In a previous study, we reported magnetic orientation of monosodium urate (MSU) crystals, which are the causative agent of gout, at the permanent magnet level. In this study, we investigated the effect of an applied magnetic field on calcium pyrophosphate (CPP) crystals, which are the causative agent of pseudogout, and the difference in the magnetic responses of CPP and MSU crystals. We found that the CPP crystals were oriented in a magnetic field on milli-Tesla order because of the anisotropy of the diamagnetic susceptibility. In addition, the CPP crystals exhibited different anisotropic magnetic properties from those of MSU crystals, which led to a characteristic difference between the orientations of the two crystals. That is, we found that the causative agents of gout and pseudogout responded differently to a magnetic field. This report suggests that the discrimination between CPP and MSU by optical measurements is possible by application of magnetic fields appropriately. © 2023 Bioelectromagnetics Society.
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Affiliation(s)
| | | | - Yoshifuru Mitsui
- Graduate School of Science and Engineering, Kagoshima University, Kagoshima, Japan
| | | | | | - Atom Hamasaki
- Faculty of Science, Shinshu University, Matsumoto, Japan
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8
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Dalbeth N, Tedeschi SK. Calcium pyrophosphate deposition disease moves into the spotlight. Lancet Rheumatol 2023; 5:e497-e499. [PMID: 38251492 DOI: 10.1016/s2665-9913(23)00188-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/05/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Nicola Dalbeth
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand.
| | - Sara K Tedeschi
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
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9
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Loret A, Jacob C, Mammou S, Bigot A, Blasco H, Audemard-Verger A, Schwartz IV, Mulleman D, Maillot F. Joint manifestations revealing inborn metabolic diseases in adults: a narrative review. Orphanet J Rare Dis 2023; 18:239. [PMID: 37563694 PMCID: PMC10416490 DOI: 10.1186/s13023-023-02810-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 07/06/2023] [Indexed: 08/12/2023] Open
Abstract
Inborn metabolic diseases (IMD) are rare conditions that can be diagnosed during adulthood. Patients with IMD may have joint symptoms and the challenge is to establish an early diagnosis in order to institute appropriate treatment and prevent irreversible damage. This review describes the joint manifestations of IMD that may be encountered in adults. The clinical settings considered were arthralgia and joint stiffness as well as arthritis. Unspecific arthralgias are often the first symptoms of hereditary hemochromatosis, chronic low back pain may reveal an intervertebral disc calcification in relation with alkaptonuria, and progressive joint stiffness may correspond to a mucopolysaccharidosis or mucolipidosis. Gaucher disease is initially revealed by painful acute attacks mimicking joint pain described as "bone crises". Some IMD may induce microcrystalline arthropathy. Beyond classical gout, there are also gouts in connection with purine metabolism disorders known as "enzymopathic gouts". Pyrophosphate arthropathy can also be part of the clinical spectrum of Gitelman syndrome or hypophosphatasia. Oxalate crystals arthritis can reveal a primary hyperoxaluria. Destructive arthritis may be indicative of Wilson's disease. Non-destructive arthritis may be seen in mevalonate kinase deficiency and familial hypercholesterolemia.
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Affiliation(s)
- Amaury Loret
- Department of Internal Medicine, University Hospital of Tours, Tours, France.
- Department of Rheumatology, University Hospital of Tours, Tours, France.
- Department of Internal Medicine, Hôpital Bretonneau, 2 Boulevard Tonnellé, CHRU de Tours, Tours cedex, 37044, France.
| | - Claire Jacob
- Department of Internal Medicine, University Hospital of Tours, Tours, France
| | - Saloua Mammou
- Department of Rheumatology, University Hospital of Tours, Tours, France
| | - Adrien Bigot
- Department of Internal Medicine, University Hospital of Tours, Tours, France
| | - Hélène Blasco
- Biochemistry laboratory, University Hospital of Tours, Tours, France
- UMR INSERM 1253, Tours, France
- Reference center for inherited metabolic diseases, Tours, France
| | | | - Ida Vd Schwartz
- Medical Genetics Service/Genetics Department, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre - RS, Brazil
| | - Denis Mulleman
- Department of Rheumatology, University Hospital of Tours, Tours, France
| | - François Maillot
- Department of Internal Medicine, University Hospital of Tours, Tours, France
- UMR INSERM 1253, Tours, France
- Reference center for inherited metabolic diseases, Tours, France
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10
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Slouma M, Dhifallah M, Dhahri R, Msolli L, Metoui L, Gharsallah I, Louzir B. Febrile neck pain: a tale of the crowned dens. Clin Rheumatol 2023; 42:1217-1218. [PMID: 36602645 DOI: 10.1007/s10067-022-06499-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Maroua Slouma
- Department of Rheumatology, Military Hospital, 1007, Tunis, Tunisia
- University of Tunis El Manar, Tunis, Tunisia
| | - Malek Dhifallah
- Department of Rheumatology, Military Hospital, 1007, Tunis, Tunisia.
- University of Tunis El Manar, Tunis, Tunisia.
| | - Rim Dhahri
- Department of Rheumatology, Military Hospital, 1007, Tunis, Tunisia
- University of Tunis El Manar, Tunis, Tunisia
| | - Lamjed Msolli
- University of Tunis El Manar, Tunis, Tunisia
- Department of Radiology, Military Hospital, Tunis, Tunisia
| | - Leila Metoui
- Department of Rheumatology, Military Hospital, 1007, Tunis, Tunisia
- University of Tunis El Manar, Tunis, Tunisia
| | - Imen Gharsallah
- Department of Rheumatology, Military Hospital, 1007, Tunis, Tunisia
- University of Tunis El Manar, Tunis, Tunisia
| | - Bassem Louzir
- University of Tunis El Manar, Tunis, Tunisia
- Department of Internal Medicine, Military Hospital, Tunis, Tunisia
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11
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Oliviero F, Mandell BF. Synovial fluid analysis: Relevance for daily clinical practice. Best Pract Res Clin Rheumatol 2023; 37:101848. [PMID: 37429800 DOI: 10.1016/j.berh.2023.101848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/19/2023] [Indexed: 07/12/2023]
Abstract
Synovial fluid analysis can provide a prompt and definite diagnosis of crystal-induced arthritis, the most common acute inflammatory arthritis and a cause of chronic arthritis that may mimic rheumatoid, psoriatic, or peripheral spondyloarthritis. In many patients the diagnosis of gout or calcium pyrophosphate arthritis cannot be made with certainty without synovial fluid analysis. Additional information from fluid analysis can assist the clinician in honing the differential diagnosis of non-crystalline arthritis.
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Affiliation(s)
- Francesca Oliviero
- Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Padova, Italy.
| | - Brian F Mandell
- Department Rheumatologic and Immunologic Diseases, Chairman Department of Academic Medicine. Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio, USA.
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12
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Bashir M, Sherman KA, Solomon DH, Rosenthal A, Tedeschi SK. Cardiovascular Disease Risk in Calcium Pyrophosphate Deposition Disease: A Nationwide Study of Veterans. Arthritis Care Res (Hoboken) 2023; 75:277-282. [PMID: 34523251 PMCID: PMC8918431 DOI: 10.1002/acr.24783] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 07/13/2021] [Accepted: 09/09/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Calcium pyrophosphate deposition (CPPD) disease represents a common crystalline arthritis with a range of manifestations. Our goal was to investigate risks for cardiovascular events in patients with CPPD. METHODS We performed a retrospective matched cohort analysis in the Veterans Health Administration Corporate Data Warehouse, 2010-2014. CPPD was defined by ≥1 International Classification of Diseases, Ninth Revision codes for chondrocalcinosis or calcium metabolism disorder. CPPD patients were age- and sex-matched to approximately 4 patients without codes for CPPD; we excluded patients with a cardiovascular event during the 365 days prior to the index date. Demographic information, traditional cardiovascular risk factors, medications, and health care utilization were assessed at baseline. The primary outcome was a major adverse cardiovascular event (MACE: myocardial infarction, acute coronary syndrome, coronary revascularization, stroke, or death). Secondary outcomes included individual components of MACE. Cox proportional hazards models estimated fully adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs). RESULTS We identified 23,124 CPPD patients matched to 86,629 non-CPPD patients with >250,000 person-years of follow-up. The study population was 96% male, mean age was 78 years, and 75% were White. The frequency of traditional cardiovascular risk factors was similar between the 2 cohorts. CPPD was not significantly associated with risk for MACE (HR 0.98 [95% CI 0.94-1.02]) in fully adjusted models, though risks of myocardial infarction, acute coronary syndrome, and stroke were significantly higher in the CPPD cohort compared to the non-CPPD cohort. CONCLUSION CPPD did not confer an increased risk for MACE, a composite end point including all-cause mortality. Our results propose CPPD as a novel risk factor for MACE components, including myocardial infarction, acute coronary syndrome, and stroke.
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Affiliation(s)
- Maaman Bashir
- 1. Division of Rheumatology, Medical College of Wisconsin, Milwaukee, USA
| | | | - Daniel H. Solomon
- 3. Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital, Boston, USA
| | - Ann Rosenthal
- 1. Division of Rheumatology, Medical College of Wisconsin, Milwaukee, USA
- 4. Division of Rheumatology, Department of Medicine, Zablocki VA Medical Center, Milwaukee, USA
| | - Sara K. Tedeschi
- 3. Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital, Boston, USA
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13
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Tedeschi SK, Yoshida K, Huang W, Solomon DH. Confirming Prior and Identifying Novel Correlates of Acute Calcium Pyrophosphate Crystal Arthritis. Arthritis Care Res (Hoboken) 2023; 75:283-288. [PMID: 34397174 PMCID: PMC8847549 DOI: 10.1002/acr.24770] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/30/2021] [Accepted: 08/12/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To investigate previously identified and novel correlates of acute calcium pyrophosphate (CPP) crystal arthritis among well-characterized cases. METHODS In this case-control study, we identified cases of acute CPP crystal arthritis using a validated algorithm (positive predictive value 81%) applied in the Partners HealthCare electronic health record (EHR). Cases were matched to general patient controls on the year of first EHR encounter and index date. Prespecified potential correlates included sex, race, and comorbidities and medications previously associated with CPP deposition/acute CPP crystal arthritis in the literature. We estimated odds ratios (ORs) and 95% confidence intervals using conditional logistic regression models adjusted for demographic characteristics, comorbidities, medications prescribed in the past 90 days, health care utilization, and multimorbidity score. RESULTS We identified 1,697 cases matched to 6,503 controls. Mean ± SD age was 73.7 ± 11.8 years, 56.7% were female, 80.8% were White, and 10.3% were Black. All prespecified covariates were more common in cases than controls. Osteoarthritis (OR 3.08), male sex (OR 1.35), rheumatoid arthritis (OR 2.09), gout (OR 2.83), proton pump inhibitors (OR 1.94), loop diuretics (OR 1.60), and thiazides (OR 1.46) were significantly associated with acute CPP crystal arthritis after full adjustment. Black race was associated with lower odds for acute CPP crystal arthritis compared to White race (OR 0.47). CONCLUSION Using a validated algorithm to identify nearly 1,700 patients with acute CPP crystal arthritis, we confirmed important correlates of this acute manifestation of CPP deposition. This is the first study to report higher odds for acute CPP crystal arthritis among males.
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Affiliation(s)
- Sara K. Tedeschi
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Kazuki Yoshida
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Weixing Huang
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
| | - Daniel H. Solomon
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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14
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Tedeschi SK, Pascart T, Latourte A, Godsave C, Kundakci B, Naden RP, Taylor WJ, Dalbeth N, Neogi T, Perez-Ruiz F, Rosenthal A, Becce F, Pascual E, Andres M, Bardin T, Doherty M, Ea HK, Filippou G, FitzGerald J, Guitierrez M, Iagnocco A, Jansen TL, Kohler MJ, Lioté F, Matza M, McCarthy GM, Ramonda R, Reginato AM, Richette P, Singh JA, Sivera F, So A, Stamp LK, Yinh J, Yokose C, Terkeltaub R, Choi H, Abhishek A. Identifying Potential Classification Criteria for Calcium Pyrophosphate Deposition Disease: Item Generation and Item Reduction. Arthritis Care Res (Hoboken) 2022; 74:1649-1658. [PMID: 33973414 PMCID: PMC8578594 DOI: 10.1002/acr.24619] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/24/2021] [Accepted: 04/06/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Classification criteria for calcium pyrophosphate deposition (CPPD) disease will facilitate clinical research on this common crystalline arthritis. Our objective was to report on the first 2 phases of a 4-phase process for developing CPPD classification criteria. METHODS CPPD classification criteria development is overseen by a 12-member steering committee. Item generation (phase I) included a scoping literature review of 5 literature databases and contributions from a 35-member combined expert committee and 2 patient research partners. Item reduction and refinement (phase II) involved a combined expert committee meeting, discussions among clinical, imaging, and laboratory advisory groups, and an item-rating exercise to assess the influence of individual items toward classification. The steering committee reviewed the modal rating score for each item (range -3 [strongly pushes away from CPPD] to +3 [strongly pushes toward CPPD]) to determine items to retain for future phases of criteria development. RESULTS Item generation yielded 420 items (312 from the literature, 108 from experts/patients). The advisory groups eliminated items that they agreed were unlikely to distinguish between CPPD and other forms of arthritis, yielding 127 items for the item-rating exercise. Fifty-six items, most of which had a modal rating of +/- 2 or 3, were retained for future phases. As numerous imaging items were rated +3, the steering committee recommended focusing on imaging of the knee and wrist and 1 additional affected joint for calcification suggestive of CPP crystal deposition. CONCLUSION A data- and expert-driven process is underway to develop CPPD classification criteria. Candidate items comprise clinical, imaging, and laboratory features.
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Affiliation(s)
- Sara K. Tedeschi
- Division of Rheumatology, Inflammation and Immunity,
Brigham and Women’s Hospital and Harvard Medical School, Boston, United
States
| | - Tristan Pascart
- Department of Rheumatology, Lille Catholic University,
Lille, France
| | - Augustin Latourte
- Department of Rheumatology, Centre Viggo Petersen,
Hôpital Lariboisière, Université de Paris, Paris, France
| | - Cattleya Godsave
- Department of Academic Rheumatology, University of
Nottingham, Nottingham, United Kingdom
| | - Burak Kundakci
- Department of Academic Rheumatology, University of
Nottingham, Nottingham, United Kingdom
| | - Raymond P. Naden
- Department of Medicine, Auckland City Hospital, Auckland,
New Zealand
| | | | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland,
New Zealand
| | - Tuhina Neogi
- Section of Rheumatology, Boston University School of
Medicine, Boston, MA, United States
| | - Fernando Perez-Ruiz
- Osakidetza, OSI EE-Cruces, Cruces University Hospital,
Biocruces-Bizkaia Health Research Institute and University of the Basque Country,
Basque Country, Spain
| | - Ann Rosenthal
- Department of Rheumatology, Medical College of
Wisconsin, Milwaukee, United States
| | - Fabio Becce
- Department of Radiology, Lausanne University Hospital,
Lausanne, Switzerland
| | - Eliseo Pascual
- Department of Rheumatology, Hospital General
Universitario de Alicante, Alicante Institute of Sanitary and Biomedical Research,
Alicante, Spain
| | - Mariano Andres
- Department of Rheumatology, Hospital General
Universitario de Alicante, Alicante Institute of Sanitary and Biomedical Research,
Alicante, Spain
| | - Thomas Bardin
- Department of Rheumatology, Centre Viggo Petersen,
Hôpital Lariboisière, Université de Paris, Paris, France
| | - Michael Doherty
- Department of Academic Rheumatology, University of
Nottingham, Nottingham, United Kingdom
| | - Hang-Korng Ea
- Department of Rheumatology, Centre Viggo Petersen,
Hôpital Lariboisière, Université de Paris, Paris, France
| | - Georgios Filippou
- Division of Rheumatology, Luigi Sacco University
Hospital, Milan, Italy
| | - John FitzGerald
- Greater Los Angeles VA Healthcare Service and Division
of Rheumatology, David Geffen School of Medicine, University of California-Los
Angeles, Los Angeles, United States
| | - Marwin Guitierrez
- Division of Musculoskeletal and Rheumatic Disorders,
Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Dipartimento Scienze
Cliniche e Biologiche, Università degli Studi di Torino, Turin, Italy
| | - Tim L. Jansen
- Department of Rheumatology, VieCuri Medical Center,
Venlo, Noord-Limburg, and University of Twente, Faculty Science & Technology,
Enschede, Netherlands
| | - Minna J. Kohler
- Division of Rheumatology, Allergy, and Immunology,
Massachusetts General Hospital and Harvard Medical School, Boston, United
States
| | - Frédéric Lioté
- Department of Rheumatology, Centre Viggo Petersen,
Hôpital Lariboisière, Université de Paris, Paris, France
| | - Mark Matza
- Division of Rheumatology, Allergy, and Immunology,
Massachusetts General Hospital and Harvard Medical School, Boston, United
States
| | | | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine-DIMED,
University of Padova, Padova, Italy
| | | | - Pascal Richette
- Department of Rheumatology, Centre Viggo Petersen,
Hôpital Lariboisière, Université de Paris, Paris, France
| | - Jasvinder A. Singh
- Division of Rheumatology, University of Alabama at
Birmingham, and Birmingham Veterans Affairs Medical Center, Birmingham, United
States
| | - Francisca Sivera
- Department of Rheumatology, Hospital General
Universitario Elda, Elda, Spain, and Departamento de Medicina, Universidad Miguel
Hernandez, Elche, Spain
| | - Alexander So
- Department of Musculoskeletal Medicine, University
Hospital of Lausanne, Lausanne, Switzerland
| | - Lisa K. Stamp
- Division of Medicine, University of Otago, Christchurch,
New Zealand
| | - Janeth Yinh
- Division of Rheumatology, Allergy, and Immunology,
Massachusetts General Hospital and Harvard Medical School, Boston, United
States
| | - Chio Yokose
- Division of Rheumatology, Allergy, and Immunology,
Massachusetts General Hospital and Harvard Medical School, Boston, United
States
| | - Robert Terkeltaub
- San Diego VA Healthcare Service, Division of
Rheumatology, Allergy and Immunology, University of California-San Diego, San Diego,
United States
| | - Hyon Choi
- Division of Rheumatology, Allergy, and Immunology,
Massachusetts General Hospital and Harvard Medical School, Boston, United
States
| | - Abhishek Abhishek
- Department of Academic Rheumatology, University of
Nottingham, Nottingham, United Kingdom
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Shiraishi Y, Kanzawa Y, Ishimaru N, Kinami S. Iliopsoas Bursitis Related to Calcium Pyrophosphate Deposition Disease. Intern Med 2021; 60:2515-2516. [PMID: 33583905 PMCID: PMC8381159 DOI: 10.2169/internalmedicine.6789-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yukiko Shiraishi
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Yohei Kanzawa
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Naoto Ishimaru
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Saori Kinami
- Department of General Internal Medicine, Akashi Medical Center, Japan
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16
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Cadiou S, Le Gruyer A, Giguet B, Robin F, Milin M, Guennoc X, Guggenbuhl P, De Saint-Riquier M. Calcium pyrophosphate deposition (CPPD) in a liver transplant patient: are hypomagnesemia, tacrolimus or both guilty? A case-based literature review. Rheumatol Int 2021; 42:1105-1112. [PMID: 33709178 DOI: 10.1007/s00296-021-04828-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/01/2021] [Indexed: 12/21/2022]
Abstract
Calcium pyrophosphate deposition (CPPD) can be induced by a persistent hypomagnesemia. Tacrolimus is an immunosuppressive treatment especially used in organ transplant, potentially inducer of hypomagnesemia by renal loss. A 53-year-old man, liver transplant 10 months earlier, developed an acute peripheral oligoarthritis of wrist, hip and elbow with fever, associated with acute low back pain. Synovial fluid was sterile, and revealed calcium pyrophosphate crystals. Spinal imaging showed inflammatory changes. Magnesium blood level was low at 0.51 mmol/l, with high fractional excretion in favor of renal loss. Tacrolimus was changed for everolimus, proton pump inhibitor was stopped, and magnesium oral supplementation was started. After 8 months follow-up and slow prednisone tapering, he did not relapse pain. Persistent hypomagnesemia is a rare secondary cause of CPPD. In this entity, drug liability should be investigated such as tacrolimus in organ transplant patient.
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Affiliation(s)
- Simon Cadiou
- Department of Rheumatology, Rennes University Hospital, Rennes 1 University, 35000, Rennes, France.
| | - Antonia Le Gruyer
- Department of Hepato-Gastroenterology, Saint-Brieuc Hospital, 22000, Saint-Brieuc, France
| | - Baptiste Giguet
- Department of Hepato-Gastroenterology, Rennes Univsersity Hospital, Rennes 1 University, 35000, Rennes, France
| | - François Robin
- Department of Rheumatology, Rennes University Hospital, Rennes 1 University, 35000, Rennes, France
| | - Morgane Milin
- Department of Rheumatology, Saint-Brieuc Hospital, 22000, Saint-Brieuc, France
| | - Xavier Guennoc
- Department of Rheumatology, Saint-Brieuc Hospital, 22000, Saint-Brieuc, France
| | - Pascal Guggenbuhl
- Department of Rheumatology, Rennes University Hospital, Rennes 1 University, 35000, Rennes, France
- CHU Rennes, University of Rennes 1, INSERM, Institut NUMECAN (Nutrition Metabolisms and Cancer), UMR INSERM U 1241, 35000, Rennes, France
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17
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Gumucio R, Azuaga AB, Isern-Kebschull J, Ramirez J, Frade-Sosa B, Guañabens N. A Case Report of Exuberant Chondrocalcinosis of the Ankle: An Unusual Presentation. J Clin Rheumatol 2021; 27:e30-e31. [PMID: 33347036 DOI: 10.1097/rhu.0000000000001224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Cipolletta E, Di Matteo A, Scanu A, Isidori M, Di Battista J, Punzi L, Grassi W, Filippucci E. Biologics in the treatment of calcium pyrophosphate deposition disease: a systematic literature review. Clin Exp Rheumatol 2020; 38:1001-1007. [PMID: 32359034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/17/2020] [Indexed: 06/11/2023]
Abstract
The main aim of this systematic literature review (SLR) was to summarise the evidence in the use of biological therapies in calcium pyrophosphate deposition disease (CPPD). We performed a SLR using PubMed, Embase and Cochrane databases. Only studies reporting the efficacy of biologics in CPPD were selected. The search resulted in 83 articles; 11 were further evaluated in the SLR. Seventy-six patients were included: 2 received infliximab, whereas 74 anakinra. Anakinra was used in refractory disease (85.1%) or in patients with contraindications to standard treatments (23.0%). Clinical response to anakinra was observed in 80.6% of patients with acute and 42.9% of those with chronic CPPD. Short-term treatment was well tolerated and adverse events were reported in 4.1% of the cases. This review provides evidence in favour of the use of anakinra as a therapeutic option in patients with CPPD, especially in acute refractory CPPD or when standard treatments are contraindicated.
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Affiliation(s)
- Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Carlo Urbani Hospital, Jesi, Ancona, Italy.
| | - Andrea Di Matteo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Carlo Urbani Hospital, Jesi, Ancona, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Universityof Leeds, UK
| | - Anna Scanu
- Rheumatology Unit, Department of Medicine-DIMED, University of Padua, Italy
| | - Martina Isidori
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Carlo Urbani Hospital, Jesi, Ancona, Italy
| | - Jacopo Di Battista
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Carlo Urbani Hospital, Jesi, Ancona, Italy
| | - Leonardo Punzi
- Rheumatology Unit, Centre for Gout and Metabolic Bone and Joint Diseases, SS Giovanni e Paolo Hospital, Venice, Italy
| | - Walter Grassi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Carlo Urbani Hospital, Jesi, Ancona, Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Carlo Urbani Hospital, Jesi, Ancona, Italy
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19
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Lozano Morillo F, de la Cámara Fernández I, Rabadán Rubio E. Constitutional Syndrome and Fever in a Patient with Atypical Presentation of Calcium Pyrophosphate Deposition Disease. Reumatol Clin (Engl Ed) 2020; 16:366-367. [PMID: 30057294 DOI: 10.1016/j.reuma.2018.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 06/03/2018] [Accepted: 06/25/2018] [Indexed: 06/08/2023]
Affiliation(s)
| | | | - Elena Rabadán Rubio
- Servicio de Reumatología, Hospital Universitario 12 de Octubre, Madrid, España
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20
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Oduyale O, Bailey A, MacKenzie J, Oni J, Karaba S, Auster M, Ponor IL. Two Birds, One Stone-An Odd Case of Oligoarthritis. Am J Med 2020; 133:679-681. [PMID: 31678353 DOI: 10.1016/j.amjmed.2019.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/11/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Oluseye Oduyale
- Department of Medicine, Johns Hopkins University School of Medicine and Johns Hopkins Bayview Medical Center, Baltimore, Md
| | - Allison Bailey
- Department of Medicine, Johns Hopkins University School of Medicine and Johns Hopkins Bayview Medical Center, Baltimore, Md
| | - James MacKenzie
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine and Johns Hopkins Bayview Medical Center, Baltimore, Md
| | - Julius Oni
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine and Johns Hopkins Bayview Medical Center, Baltimore, Md
| | - Sara Karaba
- Department of Medicine, Johns Hopkins University School of Medicine and Johns Hopkins Bayview Medical Center, Baltimore, Md
| | - Martin Auster
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine and Johns Hopkins Bayview Medical Center, Baltimore, Md
| | - I Lucia Ponor
- Department of Medicine, Johns Hopkins University School of Medicine and Johns Hopkins Bayview Medical Center, Baltimore, Md.
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21
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Falkowski AL, Jacobson JA, Kalia V, Meyer NB, Gandikota G, Yosef M, Thiele RG. Cartilage icing and chondrocalcinosis on knee radiographs in the differentiation between gout and calcium pyrophosphate deposition. PLoS One 2020; 15:e0231508. [PMID: 32298308 PMCID: PMC7162505 DOI: 10.1371/journal.pone.0231508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/24/2020] [Indexed: 12/27/2022] Open
Abstract
Objective To determine if findings of “cartilage icing" and chondrocalcinosis on knee radiography can differentiate between gout and calcium pyrophosphate deposition (CPPD). Methods IRB-approval was obtained and informed consent was waived for this retrospective study. Electronic medical records from over 2.3 million patients were searched for keywords to identify subjects with knee aspiration-proven cases of gout or CPPD. Radiographs were reviewed by two fellowship-trained musculoskeletal radiologists in randomized order, blinded to the patients’ diagnoses. Images were evaluated regarding the presence or absence of cartilage icing, chondrocalcinosis, tophi, gastrocnemius tendon calcification, and joint effusion. Descriptive statistics, sensitivity, specificity, positive and negative predictive values, and accuracy were calculated. Results From 49 knee radiographic studies in 46 subjects (31 males and 15 females; mean age 66±13 years), 39% (19/49) showed gout and 61% (30/49) CPPD on aspiration. On knee radiographs, cartilage icing showed a higher sensitivity for CPPD than gout (53–67% and 26%, respectively). Chondrocalcinosis also showed a higher sensitivity for CPPD than gout (50–57% versus 5%), with 95% specificity and 94% positive predictive value for diagnosis of CPPD versus gout. Soft tissue tophus-like opacities were present in gout at the patellar tendon (5%, 1/19) and at the popliteus groove in CPPD (15%, 4/27). Gastrocnemius tendon calcification was present in 30% (8/27) of subjects with CPPD, and 5% (1/19) of gout. Conclusion In subjects with joint aspiration-proven crystal disease of the knee, the radiographic finding of cartilage icing was seen in both gout and CPPD. Chondrocalcinosis (overall and hyaline cartilage) as well as gastrocnemius tendon calcification positively correlated with the diagnosis of CPPD over gout.
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Affiliation(s)
- Anna L. Falkowski
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
- * E-mail:
| | - Jon A. Jacobson
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Vivek Kalia
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Nathaniel B. Meyer
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Girish Gandikota
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Matheos Yosef
- Michigan Institute for Clinical & Health Research (MICHR), Ann Arbor, MI, United States of America
| | - Ralf G. Thiele
- Department of Rheumatology, University of Rochester, Rochester, New York, United States of America
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22
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Ramonda R, Cristiani B, Oliviero F, Felicetti M, Ortolan A, Iaccarino L. Severe Abdominal Pain as a Manifestation of Pseudogout in Pubic Symphysis. J Clin Rheumatol 2020; 26:e30-e31. [PMID: 32073523 DOI: 10.1097/rhu.0000000000000781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Roberta Ramonda
- From the Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
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Rougé-Labriet H, Berujon S, Mathieu H, Bohic S, Fayard B, Ravey JN, Robert Y, Gaudin P, Brun E. X-ray Phase Contrast osteo-articular imaging: a pilot study on cadaveric human hands. Sci Rep 2020; 10:1911. [PMID: 32024864 PMCID: PMC7002527 DOI: 10.1038/s41598-020-58168-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 01/07/2020] [Indexed: 01/14/2023] Open
Abstract
X-ray Phase Contrast Imaging (PCI) is an emerging modality whose availability in clinics for mammography and lung imaging is expected to materialize within the coming years. In this study, we evaluate the PCI Computed Tomography (PCI-CT) performances with respect to current conventional imaging modalities in the context of osteo-articular disorders diagnosis. X-ray PCI-CT was performed on 3 cadaveric human hands and wrists using a synchrotron beam. Conventional CT, MRI and Ultrasound were also performed on these three samples using routine procedures as well as research protocols. Six radiologists and rheumatologists independently evaluated qualitatively and semi quantitatively the 3D images' quality. Medical interpretations were also made from the images. PCI-CT allows the simultaneous visualization of both the high absorbing and the softer tissues. The 6 reader evaluations characterized PCI-CT as a visualization tool with improved performances for all tissue types (significant p-values), which provides sharper outlines and clearer internal structures than images obtained using conventional modalities. The PCI-CT images contain overall more information, especially at smaller scales with for instance more visible micro-calcifications in our chondrocalcinosis case. Despite a reduced number of samples used, this pilot study highlights the possible medical benefits of PCI for osteo-articular disorders evaluation. Although PCI-CT is not yet available in hospitals, the improved visualization capabilities demonstrated so far and the enhanced tissue measurement quality let suggest strong diagnosis benefits for rheumatology in case of a widespread application of PCI.
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Affiliation(s)
- Hélène Rougé-Labriet
- Novitom SAS, R-D, Grenoble, 38000, France
- Inserm UA7 Strobe, Université Grenoble Alpes, Grenoble, 38000, France
| | | | - Hervé Mathieu
- Université Grenoble Alpes, IRMaGe, Grenoble, 38000, France
| | - Sylvain Bohic
- Inserm UA7 Strobe, Université Grenoble Alpes, Grenoble, 38000, France
- ESRF, the European Synchrotron, Grenoble, 38000, France
| | | | - Jean-Noel Ravey
- Centre Hospitalier Universitaire Grenoble-Alpes, Hopital Sud, Echirolles, 38434, France
| | - Yohann Robert
- Centre Hospitalier Universitaire Grenoble-Alpes, Hopital Sud, Echirolles, 38434, France
| | - Philippe Gaudin
- Centre Hospitalier Universitaire Grenoble-Alpes, Hopital Sud, Echirolles, 38434, France
| | - Emmanuel Brun
- Inserm UA7 Strobe, Université Grenoble Alpes, Grenoble, 38000, France.
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Paalanen K, Rannio K, Rannio T, Asikainen J, Hannonen P, Sokka T. Prevalence of calcium pyrophosphate deposition disease in a cohort of patients diagnosed with seronegative rheumatoid arthritis. Clin Exp Rheumatol 2020; 38:99-106. [PMID: 31140401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 04/09/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES We aimed to characterise the clinical and radiographical phenotype of calcium pyrophosphate dihydrate deposition (CPPD) disease in patients initially diagnosed with seronegative RA, and to increase the awareness that CPPD disease can be falsely diagnosed as seronegative rheumatoid arthritis (RA). METHODS Altogether 435 early seronegative RA patients were clinically diagnosed in a single rheumatology centre and scheduled for a 10-year follow-up. All clinical data were collected and reviewed. CPPD-related arthritis was suspected if a patient had typical radiographical findings and suitable clinical pattern of CPPD or calcium pyrophosphate crystals were found in the synovial fluid. These patients are the subjects of this study. RESULTS Among 435 seronegative RA patients, 17 patients (3.9%) (baseline mean age 71.2 years, 82% women) with CPPD disease were identified. CPPD resembling clinical patterns in these patients were: chronic CPP crystal inflammatory arthritis (9 patients), acute CPP crystal arthritis (6 patients) and OA with CPPD (2 patients). All had typical radiographical findings of CPPD: Chondrocalcinosis (CC) of triangular fibrocartilage (17 patients [100%]), CC of knee (9 patients [53%]), CC or narrowing of metacarpophalangeal joints (7 patients [41.2%]), CC of metatarsophalangeal joints (4 patients [23.5%]), CC of symphysis pubis (1 patient [5.8%]), CC of glenohumeral joint (1 patient [5.8%]) and scapholunate advanced collapse (5 patients [29.4%]). None of these patients developed typical RA-like erosions. CONCLUSIONS CPPD disease can mimic seronegative RA at baseline and is important in the differential diagnosis of seronegative arthritis at baseline and during follow-up. The prevalence of CPPD patients in our early seronegative RA patients was 3.9%, the percentage was 7.0% among patients ≥60 years at baseline.
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Affiliation(s)
- Kirsi Paalanen
- Department of Rheumatology, Central Hospital of Central Finland, Jyväskylä, Finland.
| | - Katja Rannio
- Department of Radiology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Tuomas Rannio
- Department of Rheumatology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Juha Asikainen
- Department of Rheumatology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Pekka Hannonen
- Department of Rheumatology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Tuulikki Sokka
- Department of Rheumatology, Central Hospital of Central Finland, Jyväskylä, Finland
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25
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Ujihara T, Yamamoto K, Kitaura T, Katanami Y, Kutsuna S, Takeshita N, Hayakawa K, Ohmagari N. Calcium Pyrophosphate Deposition Disease Involving a Lumbar Facet Joint Following Urinary Tract Infection. Intern Med 2019; 58:1787-1789. [PMID: 30799353 PMCID: PMC6630135 DOI: 10.2169/internalmedicine.2099-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
A 75-year-old woman was admitted with urosepsis due to Escherichia coli infection. After improvement with a ureteral stent and antimicrobial agent, she complained of back pain and showed elevated inflammation marker levels. Arthralgia and arthritis of multiple peripheral joints were noted, and radiography indicated cartilage calcification. Magnetic resonance imaging revealed lumbar facet joint effusion. Her symptoms improved with nonsteroidal anti-inflammatory drug administration. Thus, she was diagnosed with calcium pyrophosphate deposition (CPPD)-related facet joint arthritis (FJA) rather than infectious FJA. CPPD-related FJA is an important differential diagnosis in elderly individuals with a risk of CPPD disease who complain of back pain.
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Affiliation(s)
- Tetsuro Ujihara
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
- Department of Gastroenterology, New Tokyo Hospital, Japan
| | - Kei Yamamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Tsuyoshi Kitaura
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Yuichi Katanami
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Nozomi Takeshita
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Kayoko Hayakawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
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Slostad JA, Wild EM, Anderson CM, Ingram C. Intractable Neck Pain in a Patient With Newly Diagnosed AML: An Underrecognized Cause of a Treatable Syndrome. J Pain Symptom Manage 2019; 57:e3-e5. [PMID: 30316808 DOI: 10.1016/j.jpainsymman.2018.10.490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 10/28/2022]
MESH Headings
- Aged
- Atlanto-Axial Joint/diagnostic imaging
- Chondrocalcinosis/complications
- Chondrocalcinosis/diagnosis
- Chondrocalcinosis/drug therapy
- Diagnosis, Differential
- Humans
- Leukemia, Myeloid, Acute/complications
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/drug therapy
- Male
- Neck Pain/diagnosis
- Neck Pain/drug therapy
- Neck Pain/etiology
- Pain, Intractable/diagnosis
- Pain, Intractable/drug therapy
- Pain, Intractable/etiology
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Affiliation(s)
- Jessica A Slostad
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Ellen M Wild
- Center for Palliative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Cory Ingram
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA; Center for Palliative Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Oliosi E, Pointeau O, Dacheux C, Souchon L, Dhôte R, Mourad JJ, Le Jeune S. [A muscular calcium pyrophosphate deposition pseudo-abscess: An atypical localization of chondrocalcinosis]. Rev Med Interne 2018; 40:211-213. [PMID: 30348464 DOI: 10.1016/j.revmed.2018.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 09/17/2018] [Accepted: 09/21/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Chondrocalcinosis results from calcium pyrophosphate crystals deposition in the joints. We report an exceptional case of aseptic psoas abscess with a deposition of calcium pyrophosphate crystals. CASE REPORT A 92-year-old man presented to our department for an acute onset of inflammatory pain in the left hip. Computed tomography detected a coxofemoral arthritis and multiple intramuscular collections located in the iliopsoas muscle and the gluteus minimus. A sample of the fluid was obtained with a guided aspiration, and its analysis revealed an inflammatory liquid with no bacteria but numerous calcium pyrophosphate crystals. The final diagnosis was thus a muscular calcium pyrophosphate deposition pseudo-abscess, associated with a hip arthritis. CONCLUSION Hip chondrocalcinosis is unusual, and the association with intramuscular deposition of calcium pyrophosphate crystals seems extremely rare as we found only four other published cases. A microcrystalline arthritis could have spread from the coxofemoral joint through the iliopsoas bursa and into the muscle. However, the imaging aspect with an abscess and a predominant muscular injury might suggest a mechanism of crystal formation originating directly within the muscle. The outcome was always favourable even if some patients required surgery.
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Affiliation(s)
- E Oliosi
- Service de médecine interne, hôpital Avicenne, AP-HP, 93000 Bobigny, France
| | - O Pointeau
- Service de médecine, centre hospitalier de Mamoudzou, 97600 Mamoudzou, Mayotte.
| | - C Dacheux
- Service d'orthopedie, hôpital Avicenne, AP-HP, 93000 Bobigny, France
| | - L Souchon
- Service de médecine interne, hôpital Avicenne, AP-HP, 93000 Bobigny, France
| | - R Dhôte
- Service de médecine interne, hôpital Avicenne, AP-HP, 93000 Bobigny, France
| | - J-J Mourad
- Service de médecine interne, hôpital Avicenne, AP-HP, 93000 Bobigny, France
| | - S Le Jeune
- Service de médecine interne, hôpital Avicenne, AP-HP, 93000 Bobigny, France
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Rigsbee CA, Sizemore TC, Lohr KM. Severe calcium pyrophosphate dihydrate deposition disease of the metacarpophalangeal joints. BMJ Case Rep 2018; 2018:bcr-2018-226132. [PMID: 30269092 PMCID: PMC6169684 DOI: 10.1136/bcr-2018-226132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a case of calcium pyrophosphate deposition disease (CPPD) with an unusual presentation of severe chondrocalcinosis with atypical large burden deposited in the metacarpophalangeal joints as well as more typical deposition in wrists and knees as demonstrated on plain radiographs. A 77-year-old African-American woman 1-year status post parathyroidectomy for hyperparathyroidism initially presented to the rheumatology clinic to treat suspected rheumatoid arthritis given her pattern of joint involvement but was found to have CPPD. The patient’s history is notable for end-stage renal disease which complicates medical management. This case illustrates radiographic findings of CPPD and explores the challenges of treating CPPD in the setting of comorbid conditions.
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Affiliation(s)
- Cody A Rigsbee
- Medicine/Rheumatology, University of Kentucky, Lexington, Kentucky, USA
| | - Travis C Sizemore
- Medicine/Rheumatology, University of Kentucky, Lexington, Kentucky, USA
| | - Kristine M Lohr
- Medicine/Rheumatology, University of Kentucky, Lexington, Kentucky, USA
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29
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Williams CJ, Qazi U, Bernstein M, Charniak A, Gohr C, Mitton-Fitzgerald E, Ortiz A, Cardinal L, Kaell AT, Rosenthal AK. Mutations in osteoprotegerin account for the CCAL1 locus in calcium pyrophosphate deposition disease. Osteoarthritis Cartilage 2018; 26:797-806. [PMID: 29578045 PMCID: PMC6293976 DOI: 10.1016/j.joca.2018.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 03/08/2018] [Accepted: 03/10/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Mutations on chromosomes 5p (CCAL2) and 8q (CCAL1) have been linked to familial forms of calcium pyrophosphate deposition disease (CPDD). Mutations in the ANKH gene account for CCAL2, but the identity of CCAL1 has been elusive. Recently, a single Dutch kindred with a mutation in the Tumor Necrosis Factor Receptor Super Family member 11B (TNFRSF11B) gene coding for osteoprotegerin (OPG) was described as a gain-of-function mutation. Affected family members had premature generalized osteoarthritis (PGOA) and CPDD. As the TNFRSF11B gene is on 8q, we sought additional evidence that TNFRSF11B was CCAL1, and investigated potential disease mechanisms. DESIGN DNA from two novel PGOA/CPDD families was screened for sequence variants in the TNFRSF11B gene. Mutations were verified by genotype analysis of affected and unaffected family members. We also investigated effects of normal and mutant OPG on regulators of CPP crystal formation in porcine cartilage. RESULTS The identical TNFRSF11B mutation described in the Dutch family was present in two novel PGOA/CPDD families. ANKH was normal in affected patient fibroblasts. Exogenous OPG did not alter ANKH mRNA or protein levels, affect translocation of ANKH to the membrane, nor increase [pyrophosphate (PPi)] or other key regulators of CPDD. CONCLUSION We have firmly established the identity of CCAL1 as TNFRSF11B (OPG). Our findings suggest that this mutation produces disease in an ANKH-independent manner via novel mechanisms not primarily targeting cartilage. This work rationalizes further investigation of OPG pathway components as potential druggable targets for CPDD.
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Affiliation(s)
- C J Williams
- Cooper Medical School of Rowan University, Camden, NJ, United States
| | - U Qazi
- John T Mather Memorial Hospital-SUNY Stony Brook, Port Jefferson, NY, United States
| | - M Bernstein
- John T Mather Memorial Hospital-SUNY Stony Brook, Port Jefferson, NY, United States
| | - A Charniak
- John T Mather Memorial Hospital-SUNY Stony Brook, Port Jefferson, NY, United States
| | - C Gohr
- Medical College of Wisconsin and the Zablocki VA Medical Center, Milwaukee, WI, United States
| | - E Mitton-Fitzgerald
- Medical College of Wisconsin and the Zablocki VA Medical Center, Milwaukee, WI, United States
| | - A Ortiz
- Cooper Medical School of Rowan University, Camden, NJ, United States
| | - L Cardinal
- John T Mather Memorial Hospital-SUNY Stony Brook, Port Jefferson, NY, United States
| | - A T Kaell
- John T Mather Memorial Hospital-SUNY Stony Brook, Port Jefferson, NY, United States
| | - A K Rosenthal
- Medical College of Wisconsin and the Zablocki VA Medical Center, Milwaukee, WI, United States.
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Moreno Martinez MJ, Moreno Ramos MJ, Linares Ferrando LF. Sacroiliitis due to calcium pyrophosphate deposition disease. Reumatol Clin (Engl Ed) 2018; 14:175-176. [PMID: 28087263 DOI: 10.1016/j.reuma.2016.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/14/2016] [Accepted: 11/23/2016] [Indexed: 06/06/2023]
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Abstract
This is a rare case of tuberculosis (TB) complicated with pseudogout of the wrist joint in a non-immunocompromised 84-year-old female with a history of pulmonary tuberculosis. She was diagnosed with extrapulmonary tuberculosis of the wrist based on a polymerase chain reaction (PCR) study and synovial fluid aspiration in which the cytology was positive for acid-fast bacilli. Calcium pyrophosphate was also positive. We must be careful not to miss articular tuberculosis as it may mimic common inflammatory arthritis, such as pseudogout of the wrist. Even if the patient is positive for calcium pyrophosphate, this does not exclude the possibility of articular tuberculosis.
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Affiliation(s)
- Kenya Watanabe
- Department of Orthopedics, Nagano Prefectural Suzaka Hospital, Japan
| | - Yoshitaka Yamazaki
- Department of Infectious Diseases, Nagano Prefectural Suzaka Hospital, Japan
| | - Mariko Sugawara
- Department of Infectious Diseases, Nagano Prefectural Suzaka Hospital, Japan
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Abstract
Monoarticular arthritis is inflammation characterized by joint pain, swelling, and sometimes periarticular erythema. Although chronic causes are seen, the onset is often acute. An infected joint can quickly lead to permanent damage, making it a medical emergency. However, acute gout presenting as monoarticular arthritis is often so uncomfortable it requires urgent attention. Monoarticular crystalline arthritis is common and a septic joint is a medical emergency so it is no surprise that these diagnoses come to mind with complaint of inflammation in 1 joint. However, there are many causes of monoarticular arthritis that clinicians must consider.
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Affiliation(s)
- Namrata Singh
- Division of Immunology: Rheumatology and Allergy, Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, C 42 GH, Iowa City, IA 52242, USA; Division of Immunology: Rheumatology and Allergy, Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, C 42 GH, Iowa City, IA 52242, USA
| | - Scott A Vogelgesang
- Division of Immunology: Rheumatology and Allergy, Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, C 42 GH, Iowa City, IA 52242, USA; Division of Immunology: Rheumatology and Allergy, Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, C 42 GH, Iowa City, IA 52242, USA.
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Yoshida H. Tenosynovitis due to pseudogout. N Z Med J 2016; 129:84-85. [PMID: 27977656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 93-year-old woman acutely developed fever associated with pain and swelling around her left wrist. Physical examination revealed fusiform symmetric swelling of the entire digits, digits held in partial flexion, tenderness along the flexor tendon sheath and pain along the tendon with passive digits extension. Gram stain of collected fluid showed the presence of calcium pyrophosphate dihydrate crystals.
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Affiliation(s)
- Hirofumi Yoshida
- Department of General Internal Medicine, Rakuwakai Otowa Hospital, Otowachinji-cho 2, Yamashina-ku, Kyoto, Japan
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35
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Affiliation(s)
- T Horino
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kohasu, Okoh-cho, Nankoku, Kochi 783-8505, Japan.
- Laboratory of Anatomy, Department of Biomedical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan.
| | - T Matsumoto
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kohasu, Okoh-cho, Nankoku, Kochi 783-8505, Japan
- Laboratory of Anatomy, Department of Biomedical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Y Terada
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kohasu, Okoh-cho, Nankoku, Kochi 783-8505, Japan
- Laboratory of Anatomy, Department of Biomedical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - O Ichii
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kohasu, Okoh-cho, Nankoku, Kochi 783-8505, Japan
- Laboratory of Anatomy, Department of Biomedical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
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Abstract
Calcium pyrophosphate dihydrate deposition (CPDD) disease has characteristic radiographic features including soft tissue calcification, joint space narrowing, bone sclerosis, subchondral cyst formation without osteophyte formation, and large intraosseous geodes. Triangular fibrocartilage calcification is frequently found and isolated scapho-trapezio-trapezoid (STT) arthritis is specific for CPDD. Distal radio-ulnar (DRUJ), isolated midcarpal joint and piso-triquetral joint involvement also occur. 127 patients were reviewed. Seventy-eight had symptomatic STT joint arthritis, for which 36 underwent surgery. Twenty-two patients had a SLAC wrist deformity for which ten underwent surgery. Eight patients had isolated midcarpal arthritis for which three midcarpal arthrodeses, two four-bone arthrodeses and two carpal tunnel releases were performed. Nineteen patients had a generalized arthritis and seven of the patients underwent surgery: fourcorner arthrodesis+scaphoidectomy (one case), carpal tunnel relaease (two cases) extensor synovectomy (two cases) and trigger finger release (two cases).
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Affiliation(s)
- P Saffar
- Institut Français de Chirurgie de la Main, Paris, France.
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37
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Affiliation(s)
- Ann K Rosenthal
- From the Division of Rheumatology, Department of Medicine, Medical College of Wisconsin (A.K.R., L.M.R.), and the Department of Medicine, Zablocki Veterans Affairs Medical Center (A.K.R.) - both in Milwaukee
| | - Lawrence M Ryan
- From the Division of Rheumatology, Department of Medicine, Medical College of Wisconsin (A.K.R., L.M.R.), and the Department of Medicine, Zablocki Veterans Affairs Medical Center (A.K.R.) - both in Milwaukee
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Marx C, Tamborrini G. [Rheumatology 9: calcium pyrophosphate dihydrate disease in Down syndrome]. Praxis (Bern 1994) 2016; 105:595-597. [PMID: 27167486 DOI: 10.1024/1661-8157/a002334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Christian Marx
- 1 UltrasoundCenter, Rheumatologie, Bethesda-Spital Basel
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Filippou G, Adinolfi A, Cimmino MA, Scirè CA, Carta S, Lorenzini S, Santoro P, Sconfienza LM, Bertoldi I, Picerno V, Di Sabatino V, Ferrata P, Galeazzi M, Frediani B. Diagnostic accuracy of ultrasound, conventional radiography and synovial fluid analysis in the diagnosis of calcium pyrophosphate dihydrate crystal deposition disease. Clin Exp Rheumatol 2016; 34:254-260. [PMID: 26886247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 10/26/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To assess the diagnostic performance of ultrasound (US), x-rays, and microscopic analysis of synovial fluid (SF) for calcium pyrophosphate dihydrate crystal deposition disease (CPPD) using histology as a reference standard. METHODS We enrolled consecutive patients with osteoarthritis waiting to undergo knee replacement surgery. Each patient underwent US of the knee, focusing on menisci and the hyaline cartilage, the day before surgery. During surgery, SF, menisci and condyles were retrieved and examined microscopically. For the meniscus and cartilage microscopic analysis, 8 samples were collected from each specimen and knee radiographs, performed up to 3 months before surgery, were also assessed. A dichotomous score was given for the presence/absence of CPP for each method. Microscopic findings of the specimens were considered the reference standard. All the procedures followed were in accordance with the ethical standards of the local responsible committee. RESULTS 42 patients (14 males) were enrolled. All patients underwent US, 34 had eligible radiographs and 32 had SF analysis. 25 patients (59.5%) were positive for CPP at US, 15 (44.1%) at X-ray and 14 (43.7%) at SF. Sensitivity and specificity values were 96% and 87% for US, 75% and 93% for radiography and 77% and 100% for SF respectively. There were no statistically significant differences between the diagnostic performance across single tests. CONCLUSIONS US proved to be at least as accurate as SF analysis for the diagnosis of CPPD. US, which is feasible and harmless, could be considered the first exam of choice for CPPD diagnosis.
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Affiliation(s)
- Georgios Filippou
- Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Italy.
| | - Antonella Adinolfi
- Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Italy
| | - Marco A Cimmino
- Academic Unit of Clinical Rheumatology and Research Laboratory, Dipartimento di Medicina Interna, University of Genova, Italy
| | - Carlo A Scirè
- Epidemiology Unit, Italian Society for Rheumatology, Milano, Italy
| | - Serafino Carta
- Department of Medicine, Surgery and Neurosciences, Orthopaedics Section, University of Siena, Italy
| | - Sauro Lorenzini
- Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Italy
| | - Pierpaolo Santoro
- Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Italy
| | - Luca M Sconfienza
- Servizio di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese; and Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Italy
| | - Ilaria Bertoldi
- Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Italy
| | - Valentina Picerno
- Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Italy
| | - Valentina Di Sabatino
- Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Italy
| | - Paolo Ferrata
- Department of Medicine, Surgery and Neurosciences, Orthopaedics Section, University of Siena, Italy
| | - Mauro Galeazzi
- Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Italy
| | - Bruno Frediani
- Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Italy
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Abstract
We report about an 80-year-old patient, who underwent the extraction of an upper molar tooth because of facial pain. In the course of time the patient developed a maxillary sinusitis in presence of an ectopic tooth. Given that the patient got fever, neck pain and -stiffness, a purulent meningitis was first suspected. The liquor analysis was normal and the CT-scan showed a calcification around the dens axis. We finally diagnosed a “Crowned Dens”-syndrome.
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Affiliation(s)
- Lysann Apicella
- 1 Servizio di Medicina Interna, Ospedale della Beata Vergine, Mendrisio
| | | | - Brenno Balestra
- 1 Servizio di Medicina Interna, Ospedale della Beata Vergine, Mendrisio
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Alaya Z, Osman W, Zaghouani H, Naouar N, Kraiem C, Bouajina E. Une cause rare de cervicalgie fébrile. Pan Afr Med J 2016; 25:61. [PMID: 28250885 PMCID: PMC5321140 DOI: 10.11604/pamj.2016.25.61.9315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 06/26/2016] [Indexed: 11/11/2022] Open
Abstract
Une cervicalgie fébrile est souvent secondaire à une méningite ou à une spondylodiscite, exceptionnellement à une arthropathie microcristalline. Nous en rapportons un cas. Un homme de 81 ans sans antécédents particuliers est hospitalisé pour cervicalgie fébrile. Les diagnostics initialement évoqués étaient ceux de méningite et de spondylodiscite. L'examen a montré une raideur globale du rachis cervical. L'IRM rachidienne a montré une anomalie de signal de l'articulation atloïdo-axoïdienne se réhaussant après injection de gadolinium avec une hypertrophie synoviale associée à un aspect irrégulier et hétérogène de la dent de l'axis. Les coupes tomodensitométriques atlo-axoïdiennes montraient des calcifications péri-odontoïdales confirmant le diagnostic de syndrome de dent couronnée (SDC). L'évolution était favorable sous AINS. Le SDC mérite d'être mieux connu ; il peut mimer de nombreux diagnostics et être responsable de fièvre au long cours.
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Affiliation(s)
- Zeineb Alaya
- Service de Rhumatologie, CHU Farhat Hached, Sousse, Tunisie
| | - Walid Osman
- Service de Chirurgie orthopédique, CHU Sahloul, Sousse, Tunisie
| | | | - Nader Naouar
- Service de Chirurgie orthopédique, CHU Sahloul, Sousse, Tunisie
| | - Chakib Kraiem
- Service d'Imagerie médicale, CHU Farhat Hached, Sousse, Tunisie
| | - Elyès Bouajina
- Service de Rhumatologie, CHU Farhat Hached, Sousse, Tunisie
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McFadden P, Crim A. Comparison of the Effectiveness of Interactive Didactic Lecture Versus Online Simulation-Based CME Programs Directed at Improving the Diagnostic Capabilities of Primary Care Practitioners. J Contin Educ Health Prof 2016; 36:32-37. [PMID: 26954243 DOI: 10.1097/ceh.0000000000000061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Diagnostic errors in primary care contribute to increased morbidity and mortality, and billions in costs each year. Improvements in the way practicing physicians are taught so as to optimally perform differential diagnosis can increase patient safety and lower the costs of care. This study represents a comparison of the effectiveness of two approaches to CME training directed at improving the primary care practitioner's diagnostic capabilities against seven common and important causes of joint pain. METHODS Using a convenience sampling methodology, one group of primary care practitioners was trained by a traditional live, expert-led, multimedia-based training activity supplemented with interactive practice opportunities and feedback (control group). The second group was trained online with a multimedia-based training activity supplemented with interactive practice opportunities and feedback delivered by an artificial intelligence-driven simulation/tutor (treatment group). RESULTS Before their respective instructional intervention, there were no significant differences in the diagnostic performance of the two groups against a battery of case vignettes presenting with joint pain. Using the same battery of case vignettes to assess postintervention diagnostic performance, there was a slight but not statistically significant improvement in the control group's diagnostic accuracy (P = .13). The treatment group, however, demonstrated a significant improvement in accuracy (P < .02; Cohen d, effect size = 0.79). DISCUSSION These data indicate that within the context of a CME activity, a significant improvement in diagnostic accuracy can be achieved by the use of a web-delivered, multimedia-based instructional activity supplemented by practice opportunities and feedback delivered by an artificial intelligence-driven simulation/tutor.
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Affiliation(s)
- Pam McFadden
- Dr. McFadden: Associate Vice President, University of North Texas Health Science Center, Office of Professional and Continuing Education. Dr. Crim: Executive Director, University of North Texas Health Science Center, Office of Professional and Continuing Education
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43
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Guggenbuhl P. [Calcium pyrophosphate arthropathy]. Rev Prat 2015; 65:665. [PMID: 26165103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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44
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Coiffier G, Albert JD. [Gout and and calcium pyrophosphate crystal arthropathies: pathophysiology]. Rev Prat 2015; 65:666-670. [PMID: 26165104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Microcrystalline arthropathies are consecutive to microcrystals formation and deposition within the joint. The formation of monosodium urate crystals depends on many physico-chemical factors: the concentration of uric acid, the temperature and pH. Beyond 60 mg/L (360 µmol/L), uric acid crystallizes in tissues. Chronic hyperuricemia is a necessary condition for the occurrence of gouty arthropathy. The mechanisms of hyperuricemia and inflammatory access and their therapeutic implications are described. Chondrocalcinosis is a radiographic entity characterized by deposits of calcium pyrophosphate crystals (CPP) within the fibrocartilage or hyalin cartilage. CPP arthropathies symptomatology is polymorphic and likely resemble in primary osteoarthritis, pseudo-gout acute attacks, or chronic mono-, oligo- or polyarthritis. Its pathophysiology remains uncompletely understood, although there is growing knowledge on the place of some actors involved in the pathogenesis of chondrocalcinosis, described in the article.
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Guggenbuhl P. [Joint involvement in hemochromatosis]. Rev Prat 2015; 65:678-679. [PMID: 26165109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Albert JD, Coiffier G. [Examination of joint fluid]. Rev Prat 2015; 65:668. [PMID: 26165105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Guggenbuhl P, Chalès G. [From chondrocalcinosis to rheumatism with calcium pyrophosphate dehydrate]. Rev Prat 2015; 65:677-682. [PMID: 26165108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is a joint pathology that affects joints, fibrocartilages and periarticular structures. Chondrocalcinosis refers to CPPD deposits on the X-ray that does not summarize the disease. It willingly affects the knees and the wrists, but all the joints can be affected. There are primitive and secondary forms of the disease to particularly look for in patients less than 50 years. The diagnosis is usually easy with standard radiography, ultrasound and synovial fluid analysis that shows the microcrystals. The therapeutics of the acute attacks are nonspecific and close to those used for acute attacks of gout.
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Bischoff M. [Seeking a cause for monoarthritis. Why does the joint hurt?]. MMW Fortschr Med 2015; 157:16-18. [PMID: 25743285 DOI: 10.1007/s15006-015-2569-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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koné MG, Dossou-Yovo H, Diomandé M, Djaha KJM, Ouattara B, Ouali B, Eti E, Kouakou NM. Pseudo-méningite inaugurale révélatrice d’une chondrocalcinose articulaire. Pan Afr Med J 2015; 20:23. [PMID: 26015843 PMCID: PMC4432809 DOI: 10.11604/pamj.2015.20.23.5911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 12/31/2014] [Indexed: 11/23/2022] Open
Abstract
Le syndrome de la dent couronnée (SDC) est une étiologie peu connue des cervicalgies aiguës. Il est lié le plus souvent à la chondrocalcinose articulaire (CCA), dont il constitue une des localisations atypiques. L'expression clinique du SDC, à type de cervicalgies fébriles, pose en pratique courante, la problématique d’étiologies diverses dont en particulier les infections susceptibles d’égarer le diagnostic. Nous rapportons un cas de SDC révélé par un tableau de pseudo-méningite.
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Affiliation(s)
| | | | | | | | - Baly Ouattara
- Service de Rhumatologie, CHU de Cocody, Abidjan, Côte d'Ivoire
| | - Boubacar Ouali
- Service de Rhumatologie, CHU de Cocody, Abidjan, Côte d'Ivoire
| | - Edmond Eti
- Service de Rhumatologie, CHU de Cocody, Abidjan, Côte d'Ivoire
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Affiliation(s)
- Tomoyoshi Tamura
- Keio University School of Medicine, Emergency and Critical Care Medicine, Japan
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