Calcium pyrophosphate deposition disease mimicking polymyalgia rheumatica: A prospective followup study of predictive factors for this condition in patients presenting with polymyalgia symptoms

Abstract

Objective. To assess the characteristics of calcium pyrophosphate deposition disease (CPDD) with proximal involvement mimicking polymyalgia rheumatica (PMR), and to identify the best predictive factors for the presence of a clinical pattern of CPDD in patients presenting with polymyalgia symptoms. Methods. Patients diagnosed with either PMR or CPDD at the Rheumatology Division of Hospital Meixoeiro (Vigo, Spain) over a 7-year period (1997-2003) were prospectively followed for at least 12 months. Results. The study group comprised 118 patients with PMR features and 112 patients with CPDD. Eighty-two of the 118 patients with PMR manifestations were diagnosed as having pure PMR, and 36 met the diagnostic criteria for both PMR and CPDD. Patients with CPDD mimicking PMR were older (P ‫؍‬ 0.02) and had peripheral arthritis more frequently (P ‫؍‬ 0.004) than those with pure PMR. Radiologic osteoarthritic changes in the hands and knees, including more advanced radiologic grade of knee osteoarthritis, and tendinous calcifications were more frequent in patients with PMR/CPDD (P < 0.001). The best predictive factors for the occurrence of this atypical pattern of CPDD in a patient presenting with PMR features were the age at diagnosis and the presence of tibiofemoral osteoarthritis, tendinous calcifications, and ankle arthritis. Conclusion. Involvement of proximal joints may be the clinical presentation of CPDD. CPDD should be included in the spectrum of diseases mimicking PMR. The presence of tibiofemoral osteoarthritis, tendinous calcifications, and ankle arthritis are clues that may alert the clinician to the presence of CPDD in an elderly patient presenting with PMR manifestations.

Crowned Dens Syndrome as an Initial Manifestation of Crystalline Deposition Disease

“…A previous medical history of crystalline deposition disease in other joints is crucial information for the clinician to suspect CDS (1,2,(5)(6)(7)(8). Although the present case had never experienced acute crystalline arthritis before admission, an X-ray of her wrist, elbow, shoulder and knee joints revealed significant calcium deposits.…”

“…In addition to the neck pain and fever, if morning stiffness in the shoulder girdle or jaw claudication is present, CDS may also mimic polymyalgia rheumatica (PMR) or giant cell arteritis (GCA) (7,8). Despite the fact that our patient presented with high fever and posterior neck pain with inflammatory reactions, we did not perform a lumbar puncture because she lacked the symptoms of consciousness disturbance, neck stiffness or Kernig's sign.…”

“…A cervical CT scan is the golden standard for the diagnosis of CDS owing to its capability to detect calcium deposits around the odontoid process (1,2,(5)(6)(7)(8). Moreover, a CT scan is helpful for ruling out other causes of neck pain, such as fractures and primary or metastatic tumors.…”

Treatment and management of pseudogout: insights for the clinician

“…It is often a considerable challenge for the clinician to distinguish older patients with pure PMR from others presenting with polymyalgia symptoms resembling this condition. Recent work in a large number of patients indicates that CPPD arthropathy should also be included in the wide spectrum of diseases mimicking classical PMR [Pego-Reigosa et al 2005]. Knee OA, tendinous calcifications and episodic ankle arthritis are proposed as the variables that predict those older patients with PMR features who really have an atypical pattern of CPPD arthropathy [Pego-Reigosa et al 2005].…”

A case of polymyalgia rheumatica and ankylosing spondylitis coexistence

“…Pego-Reigosa ve ark. [12] ise kalsiyum pirofosfat hastalığının polimyalji bulguları verdiği ve tibiofemoral osteoartrit, tendinöz kalsifikasyonlar ve ayak bileğinde artritin birlikteliğinde kalsiyum pirofosfat depo hastalığı yönünden araştırılması gerektiğini belirttiler.…”