Calcium pyrophosphate deposition disease: The role of imaging in their detection and in differential diagnosis of crystal arthropathies

Catelli, Antonio; Venetucci, Pietro; Castaldo, Anna; Loiudice, Giovanni; Tarulli, Filippo Rosati; Carpiniello, Mariapaola; Angelis, Mariateresa De; Corvino, Antonio

doi:10.1016/j.radcr.2020.07.012

Cited by 6 publications

(5 citation statements)

References 11 publications

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“…Chronic CPPD is more difficult to diagnose than acute CPPD because it commonly lacks a clinically apparent effusion and unequivocal inflammatory signs, mimicking osteoarthritis [12]. Imaging features of CPPD often appear late, necessitating a clinical diagnosis based on joint distribution and absence of features of other types of arthritis [14,15].…”

Section: Musculoskeletal Presentations Of Hppmentioning

confidence: 99%

Reducing diagnostic delay in hypophosphatasia: a case series of 14 patients presenting to general rheumatology

2023

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Objectives Hypophosphatasia (HPP) is a rare genetic metabolic bone disease that can cause chronic pain and fractures. Its hallmark is a persistently low serum ALP. HPP is now recognised by many osteoporosis specialists, but other specialists, such as rheumatologists and primary care physicians, may be less aware of this condition, causing diagnostic delay and possible harm to these patients. Our objective was to highlight features that can reduce this delay. Methods We retrospectively analysed 14 patients that presented with musculoskeletal pain to general rheumatology clinic at St. George's Hospital and were subsequently diagnosed with HPP. Results Median diagnostic delay was 13 years. All patients had an ALP below reference range for age and gender, with lowest mean ALP of 16 IU/L. All but one patient were women with median age of 51 years. Most common presentation was peripheral joint pain in 85.7% of patients. This was due to early-onset CPPD (calcium pyrophosphate deposition disease) in 71.4% of patients, osteoarthritis in 50%, or bursitis in 50%. Axial pain was reported in 64% of patients due to osteoarthritis or spinal stenosis. Fifty percent of patients had a history of long bone pain. Fifty percent had previous fracture(s). A total of 28.6% of patients had psoriatic arthritis, of which 1 patient had spondyloarthropathy, and 4 patients also had enthesitis. Conclusion Patients with HPP can present to rheumatology with musculoskeletal pain, and if a persistently low ALP is confirmed, this may reduce the diagnostic delay of this rare disease. Similar to other rheumatologic patients, musculoskeletal pain in HPP was noted in peripheral joints and in the spine with almost a third of patients having psoriatic arthritis. Pain was also noted in the long bones, a feature consistent with metabolic bone disease. The diagnosis of HPP was also more likely in those patients with a personal or family history of dental disease or arthritis.

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Section: Musculoskeletal Presentations Of Hppmentioning

confidence: 99%

Reducing diagnostic delay in hypophosphatasia: a case series of 14 patients presenting to general rheumatology

2023

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“…Due to the association of CPPD with metabolic diseases, the levels of calcium, phosphorus, magnesium, iron, alkaline phosphatase, ferritin, thyroid hormones, and ceruloplasmin should be determined in each patient with a recent diagnosis of CPPD [7,[30][31][32].…”

Section: Diagnosis Of Cppdmentioning

confidence: 99%

Pyrophosphate arthropathy — a literature review

Suszek,

Marcicka,

Męczyńska

et al. 2023

Rheumatology Forum

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Joint diseases associated with calcium pyrophosphate crystals (calcium pyrophosphate dihydrate deposition disease, CPPD) are classified as crystallopathies. They clinically present as chondrocalcinosis, acute or chronic arthritis. The main risk factors are age, injuries and degenerative changes in the joints. One or more joints may be affected. Knees, wrists and shoulders are the most com-monly affected joints. CPPD may be primary or secondary, and may be associated with hemochromatosis, hyperparathyroidism, hypothyroidism, and hypomagnesemia. Treatment is mainly symptomatic, most commonly using non-steroidal anti-inflammatory drugs, colchicine, or glucocorticoids.

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“…We ask whether "osteoarthritis" is a valid universal descriptor of jointassociated dry bone features, absent of histological evaluations that allow visualizing of living cells, additional sub-classifying observations (Blom et al, 2004;Junker et al, 2016;Roelofs et al, 2020;van Lent et al, 2004), or analytical assessment of their unique biochemical properties (Xu et al, 2017). Furthermore, depending on the location of a given individual boney feature, is "osteophyte-like" a more appropriate general descriptor, given that features on dry bone can represent (a) enthesophyte (Lawler et al, 2019); (b) osteophyte (Roelofs et al, 2020); (c) pyrophosphate (pseudogout, chondrocalcinosis, Gibson & Roenigk, 1972;Woodard et al, 1982;Heimann et al, 1990;De Haan & Andreasen, 1992;Frank et al, 2002;Forsyth et al, 2007;Miksanek & Rosenthal, 2015;Bertram et al, 2019;Catelli et al, 2020;Henschen et al, 2020); (d) postdevelopmental boney remnant (Lawler et al, companion in this issue); (e) calcified fibrous remnant; (f) exostosis (Gambardella et al, 1975;Gee & Doige, 1970;Jacobson & Kirberger, 1996;Owens, 1982); (g) neoplasm (Kim et al, 2005;Owens, 1982;Scherrer et al, 2005;Valentine et al, 2002); (h) developmental or mechanical multi-tissue impingement (not well-researched in dogs); or (i) idiopathic? It must be recognized that underlying or incipient pathophysiology, and therefore the individual, population, and phylogenetic implications across these differential diagnoses, can be variable (Henschen et al, 2020;Litwic et al, 2013;Miksanek & Rosenthal, 2015;Roelofs et al, 2020;…”

Section: Observed Pathology and Non-metric Multidimensional Scalingmentioning

confidence: 99%

The nature of coxofemoral joint pathology across family Canidae

Lawler

Tangredi

Becker

et al. 2021

The Anatomical Record

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We evaluated coxofemoral joints from museum specimens of: Vulpes lagopus; Vulpes vulpes; Vulpes velox; Nyctereutes procyonoides; Urocyon cinereoargenteus; Aenocyon [Canis] dirus; Canis latrans; Canis lupus lupus; Canis lupus familiaris; C. l. familiaris × latrans; and Canis dingo. Acetabular components included: fossa; articular surface; medial and lateral articular margins; and periarticular surfaces. Acetabular components variably revealed: osteophyte‐like features; varying appearance of articular margin rims (especially contour changes); rough bone surfaces (especially fossa and articular surface); and surface wear. Proximal femoral components included: articular surface; articular margin; periarticular surfaces; and joint capsule attachment. Femoral components variably revealed: rough bone surface; bone loss; articular margin osteophyte‐like features; caudal post‐developmental mineralized prominence; and enthesophytes along the joint capsule attachment. Non‐metric multidimensional scaling was used to analyze right–left asymmetric relationships between observed traits, across taxa. Significantly different acetabular trait asymmetry involved only C. latrans—C. l. familiaris; V. vulpes—N. procyonoides, and U. cinereoargenteus—N. procyonoides. There were no significant lateralized differences in proximal femoral traits involving modern canids, ancient and modern C. l. familiaris, or modern vulpines. Thus, the observations were strongly bilateral. We hypothesized high similarity of traits across taxa. The data confirm the hypothesis and strongly suggest broad and deep morphological and mechanistic conservation that almost certainly pre‐existed (at least) all modern canids. Further zoological studies are needed to evaluate phylogenic implications in greater detail.

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Calcium pyrophosphate deposition disease: The role of imaging in their detection and in differential diagnosis of crystal arthropathies

Cited by 6 publications

References 11 publications

Reducing diagnostic delay in hypophosphatasia: a case series of 14 patients presenting to general rheumatology

Reducing diagnostic delay in hypophosphatasia: a case series of 14 patients presenting to general rheumatology

Pyrophosphate arthropathy — a literature review

The nature of coxofemoral joint pathology across family Canidae

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