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Gessl I, Sakellariou G, Wildner B, Filippou G, Mandl P, D'Agostino MA, Navarro-Compán V. Systematic literature review to inform the EULAR recommendations for the use of imaging in crystal-induced arthropathies in clinical practice. Ann Rheum Dis 2024:ard-2023-225247. [PMID: 38702175 DOI: 10.1136/ard-2023-225247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 04/02/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE To summarise current data regarding the use of imaging in crystal-induced arthropathies (CiAs) informing a European Alliance of Associations for Rheumatology task force. METHODS We performed four systematic searches in Embase, Medline and Central on imaging for diagnosis, monitoring, prediction of disease severity/treatment response, guiding procedures and patient education in gout, calcium pyrophosphate dihydrate deposition (CPPD) and basic calcium phosphate deposition (BCPD). Records were screened, manuscripts reviewed and data of the included studies extracted. The risk of bias was assessed by validated instruments. RESULTS For gout, 88 studies were included. Diagnostic studies reported good to excellent sensitivity and specificity of dual-energy CT (DECT) and ultrasound (US), high specificity and lower sensitivity for conventional radiographs (CR) and CT. Longitudinal studies demonstrated sensitivity to change with regard to crystal deposition by US and DECT and inflammation by US and structural progression by CR and CT. For CPPD, 50 studies were included. Diagnostic studies on CR and US showed high specificity and variable sensitivity. There was a single study on monitoring, while nine assessed the prediction in CPPD. For BCPD, 56 studies were included. There were two diagnostic studies, while monitoring by CR and US was assessed in 43 studies, showing a reduction in crystal deposition. A total of 12 studies with inconsistent results assessed the prediction of treatment response. The search on patient education retrieved two studies, suggesting a potential role of DECT. CONCLUSION This SLR confirmed a relevant and increasing role of imaging in the field of CiAs.
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Affiliation(s)
- Irina Gessl
- Division of Rheumatology, Internal Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Garifallia Sakellariou
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy
| | | | - Georgios Filippou
- Rheumatology, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Peter Mandl
- Division of Rheumatology, Internal Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Maria Antonietta D'Agostino
- Rheumatology Department, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy
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Larsen K, Guma J, Mehannek R, Guma M. Acute Inflammatory Arthropathy and Hypercalcemia Leading to a Diagnosis of Primary Hyperparathyroidism in a Patient With Known Sarcoidosis. Cureus 2023; 15:e41110. [PMID: 37519519 PMCID: PMC10382643 DOI: 10.7759/cureus.41110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Calcium pyrophosphate deposition disease (CPPD) is a crystal-induced arthropathy characterized by calcium pyrophosphate crystal deposition in joints and soft tissues. The diagnosis is suggested by the presence of chondrocalcinosis on x-ray but is most often diagnosed by synovial fluid analysis (SFA). CPPD is associated with aging and metabolic disorders such as hyperparathyroidism. In this case, we present an 87-year-old woman with known sarcoidosis who presented with acute arthropathy, hypercalcemia, and radiographic evidence of CPPD. Her hypercalcemia had been attributed to her sarcoidosis in the past without a full workup. Hypercalcemia in the setting of suspected CPPD led to a full workup for hypercalcemia and ultimately led to a diagnosis of primary hyperparathyroidism. This case highlights the importance of a complete evaluation for hypercalcemia in the setting of CPPD, even when another disease, such as sarcoidosis, could explain hypercalcemia. Ultimately, CPPD aided in diagnosing hyperparathyroidism in our patient with known sarcoidosis.
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Affiliation(s)
- Kalee Larsen
- Internal Medicine, New York Medical College at Saint Michael's Medical Center, Newark, USA
| | - Jenna Guma
- Internal Medicine, Cooper University Hospital, Camden, USA
| | - Rime Mehannek
- Internal Medecine, New York Medical College at Saint Michael's Medical Center, Newark, USA
| | - Michael Guma
- Internal Medicine/Rheumatology, New York Medical College at Saint Michael's Medical Center, Newark, USA
- Internal Medicine/Rheumatology, Hackensack University Medical Center, Hackensack, USA
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3
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Murahashi M, Ntege EH, Higa M, Maruyama N, Kawano T, Shimizu Y, Nakamura H. Management of temporomandibular joint diseases: a rare case report of coexisting calcium pyrophosphate crystal deposition and synovial chondromatosis. BMC Oral Health 2022; 22:662. [PMID: 36587200 PMCID: PMC9805689 DOI: 10.1186/s12903-022-02695-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/22/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The coexistence of calcium pyrophosphate dihydrate crystal deposition (CPP) and synovial chondromatosis (SC) in the temporomandibular joint (TMJ) is rarely reported. CPP disease (CPPD) is complex arthritis synonymous with excessive pyrophosphate production and variable aberrations in mineral and organic phase metabolism of the joint cartilage, leading to local inundated CPP and crystal deposition of partially deciphered predispositions. Meanwhile, SC is a rare benign synovial joint proliferative disease of unclear etiology and has a low risk of malignant transformation. However, SC manifests severe joint disability and dysfunction because of connective tissue metaplasia of the synovial membrane, which forms cartilaginous nodules with or without calcifications or ossifications. These nodules often detach and form intra-articular loose bodies and very rarely within extraarticular spaces. CASE PRESENTATION We report the case of a 61-year-old man to expand the body of literature on these unusual coexisting arthropathies of the TMJ. The patient presented to our hospital in 2020 with complaints of pain in the right TMJ and trismus for over 6 months. Radiographic assessments of the TMJ provided a preoperative provisional diagnosis of SC. However, the histopathology of the open biopsy revealed tumor-like lesions comprising several deposits of rhomboid and rod-shaped crystals that displayed positive birefringence in polarized light, confirming a coexistence of CPPD. A second-stage operation was performed for the complete removal of the loose bodies and chalk-like lesions including synovectomy. No evidence of recurrence was recorded after a follow-up of nearly 1.5 years. CONCLUSIONS Isolated CPPD and SC of the TMJ are prevalent in the literature however, monoarticular coexistence of these diseases is rare, due to the lack of consistency in the diagnostic criteria in clinical practice. Moreover, optimal treatment depends on several considerations. This report delineated the molecular etiopathology and underscored the need for continued deciphering of the causal mechanisms of coexisting CPPD and SC of the TMJ. In addition, the importance of confirmatory testing for accurate diagnosis, and appropriate management of these diseases were discussed.
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Affiliation(s)
- Makoto Murahashi
- Department of Oral and Maxillofacial Surgery, Chubu Tokushukai Hospital, 801 Higa, Kitanakagusuku, Nakagami-gun, Okinawa-ken 901-2393 Japan ,grid.267625.20000 0001 0685 5104Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nakagami, Nishihara, Okinawa 903-0215 Japan
| | - Edward Hosea Ntege
- grid.267625.20000 0001 0685 5104Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nakagami, Nishihara, Okinawa 903-0215 Japan ,grid.267625.20000 0001 0685 5104Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nakagami, Nishihara, Okinawa 903-0215 Japan
| | - Masaru Higa
- Department of Oral and Maxillofacial Surgery, Chubu Tokushukai Hospital, 801 Higa, Kitanakagusuku, Nakagami-gun, Okinawa-ken 901-2393 Japan
| | - Nobuyuki Maruyama
- Department of Oral and Maxillofacial Surgery, Chubu Tokushukai Hospital, 801 Higa, Kitanakagusuku, Nakagami-gun, Okinawa-ken 901-2393 Japan ,grid.267625.20000 0001 0685 5104Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nakagami, Nishihara, Okinawa 903-0215 Japan
| | - Toshihiro Kawano
- grid.267625.20000 0001 0685 5104Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nakagami, Nishihara, Okinawa 903-0215 Japan
| | - Yusuke Shimizu
- grid.267625.20000 0001 0685 5104Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nakagami, Nishihara, Okinawa 903-0215 Japan
| | - Hiroyuki Nakamura
- grid.267625.20000 0001 0685 5104Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nakagami, Nishihara, Okinawa 903-0215 Japan
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Sirotti S, Becce F, Sconfienza LM, Terslev L, Naredo E, Zufferey P, Pineda C, Gutierrez M, Adinolfi A, Serban T, MacCarter D, Mouterde G, Zanetti A, Scanu A, Möller I, Novo-Rivas U, Largo R, Sarzi-Puttini P, Abhishek A, Choi HK, Dalbeth N, Pascart T, Tedeschi SK, D'Agostino MA, Iagnocco A, Keen HI, Scirè CA, Filippou G. Reliability and Diagnostic Accuracy of Radiography for the Diagnosis of Calcium Pyrophosphate Deposition: Performance of the Novel Definitions Developed by an International Multidisciplinary Working Group. Arthritis Rheumatol 2022; 75:630-638. [PMID: 36122187 DOI: 10.1002/art.42368] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/07/2022] [Accepted: 09/13/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To assess the reliability and diagnostic accuracy of new radiographic imaging definitions developed by an international multidisciplinary working group for identification of calcium pyrophosphate deposition (CPPD). METHODS Patients with knee osteoarthritis scheduled for knee replacement were enrolled. Two radiologists and 2 rheumatologists twice assessed radiographic images for presence or absence of CPPD in menisci, hyaline cartilage, tendons, joint capsule, or synovial membrane, using the new definitions. In case of disagreement, a consensus decision was made and considered for the assessment of diagnostic performance. Histologic examination of postsurgical specimens under compensated polarized light microscopy was the reference standard. Prevalence-adjusted bias-adjusted kappa values were used to assess reliability, and diagnostic performance statistics were calculated. RESULTS Sixty-seven patients were enrolled for the reliability study. The interobserver reliability was substantial in most of the assessed structures when considering all 4 readers (κ range 0.59-0.90), substantial to almost perfect among radiologists (κ range 0.70-0.91), and moderate to almost perfect among rheumatologists (κ range 0.46-0.88). The intraobserver reliability was substantial to almost perfect for all the observers (κ range 0.70-1). Fifty-one patients were included in the accuracy study. Radiography demonstrated an overall specificity of 92% for CPPD, but sensitivity remained low for all sites and for the overall diagnosis (54%). CONCLUSION The new radiographic definitions of CPPD are highly specific against the gold standard of histologic diagnosis. When the described radiographic findings are present, these definitions allow for a definitive diagnosis of CPPD, rather than other calcium-containing crystal depositions; however, a negative radiographic finding does not exclude the diagnosis.
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Affiliation(s)
- Silvia Sirotti
- Rheumatology Department, Luigi Sacco University Hospital and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Luca M Sconfienza
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, and IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Esperanza Naredo
- Rheumatology Department, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Pascal Zufferey
- Rheumatology Department, University of Lausanne, CHUV, Lausanne, Switzerland
| | - Carlos Pineda
- Division of Rheumatology, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | - Marwin Gutierrez
- Division of Rheumatology, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | - Antonella Adinolfi
- Rheumatology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Teodora Serban
- Rheumatology Department, Ospedale La Colletta, ASL3 Genovese, Genoa, Italy
| | - Daryl MacCarter
- Rheumatology Department, North Valley Hospital, Whitefish, Montana
| | - Gael Mouterde
- Rheumatology Department, CHU Montpellier, Montpellier University, Montpellier, France
| | - Anna Zanetti
- Società Italiana di Reumatologia, Epidemiology Research Unit, Milan, Italy
| | - Anna Scanu
- Department of Neurosciences, Physical Medicine and Rehabilitation School, University of Padova, Padova, Italy
| | - Ingrid Möller
- Instituto Poal de Reumatologia, University of Barcelona, Barcelona, Spain
| | - Ulrike Novo-Rivas
- Department of Radiology, Hospital Universitario Fundación Jiménez Diáz, Universidad Autónoma, Madrid, Spain
| | - Raquel Largo
- Joint and Bone Research Unit, Rheumatology Department, IIS-Fundación Jiménez Diáz, Universidad Autónoma, Madrid, Spain
| | - Piercarlo Sarzi-Puttini
- Rheumatology Department, Luigi Sacco University Hospital and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | | | - Hyon K Choi
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Nicola Dalbeth
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Tristan Pascart
- Rheumatology Department, Groupe Hospitalier de l'Institut Catholique de Lille, Lille Catholic University, Lille, France
| | - Sara K Tedeschi
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston
| | - Maria-Antonietta D'Agostino
- Rheumatology Department, Università Cattolica del Sacro Cuore, Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Department of Clinical and Biological Sciences, Università degli Studi di Torino, Turin, Italy
| | - Helen I Keen
- School of Medicine, The University of Western Australia, Murdoch, Perth, Australia
| | - Carlo A Scirè
- Società Italiana di Reumatologia, Epidemiology Research Unit, and School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Georgios Filippou
- IRCCS Istituto Ortopedico Galeazzi, Rheumatology Department, Milan, Italy
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Krekeler M, Baraliakos X, Tsiami S, Braun J. High prevalence of chondrocalcinosis and frequent comorbidity with calcium pyrophosphate deposition disease in patients with seronegative rheumatoid arthritis. RMD Open 2022; 8:rmdopen-2022-002383. [PMID: 35701012 PMCID: PMC9198698 DOI: 10.1136/rmdopen-2022-002383] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/21/2022] [Indexed: 11/05/2022] Open
Abstract
Background The crystal-induced calcium pyrophosphate deposition disease (CPPD) clinically appearing as pseudogout differs from the mere radiographic finding of chondrocalcinosis (CC) but may cause symptoms resembling rheumatoid arthritis (RA). Objective To study the prevalence of CPPD and CC in rheumatic diseases focusing on differences between seropositive and seronegative RA. Patients and methods In a retrospective study design, we analysed records and radiographs of consecutive new patients presenting to our centre between January 2017 and May 2020. 503 patients were identified based on expert diagnoses: 181 with CPPD, 262 with RA, 142 seropositive (54.2%) and 120 seronegative RA, gout (n=30) and polymyalgia rheumatica (n=30), mean symptom duration <1 year in almost all patients. Results The majority of patients had only one rheumatological diagnosis (86.9%). Most patients with CPPD (92.6%) had radiographic CC, primarily in the wrists. The prevalence of CC was higher in seronegative (32.3%) than in seropositive RA (16.6%), respectively (p<0.001). Patients with CPPD were older (p<0.001) and had acute attacks more frequently than patients with RA (p<0.001), who had symmetric arthritis more often (p=0.007). The distribution pattern of osteoarthritic changes in radiographs of hands and wrists differs between patients with RA and CPPD. CC was present in more than one joint in 73.3% of patients with CPPD, 9.6% with seropositive and 18.7% with seronegative RA. Discussion CPPD and CC were more frequent in seronegative versus seropositive RA. Symmetry of arthritis and acuteness of attacks differentiated best between CPPD and RA but localisation of joint involvement did not. Co-occurrence of both diseases was frequently observed.
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Affiliation(s)
- Martin Krekeler
- Rheumazentrum Ruhrgebiet, Ruhr Universität Bochum, Bochum, Germany
| | | | - Styliani Tsiami
- Rheumazentrum Ruhrgebiet, Herne, Germany.,Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany
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Drosos AA, Pelechas E, Voulgari PV. A Patient with Symmetrical Polyarthritis. The Value of Conventional Radiography for a Correct Diagnosis. Rheumatol Ther 2022; 9:771-779. [PMID: 35113362 PMCID: PMC8964890 DOI: 10.1007/s40744-022-00426-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/20/2022] [Indexed: 11/01/2022] Open
Abstract
PURPOSE OF REVIEW Among the imaging modalities for the investigation of articular damage of patients with peripheral inflammatory arthropathies, conventional radiography (CR) is the mostly used. Other imaging modalities such as the musculoskeletal ultrasonography, magnetic resonance imaging, and dual-energy computed tomography scans are often used depending on a patient's clinical needs. RECENT FINDINGS With the publication of new classification criteria for rheumatoid arthritis (RA), spondyloarthropathies, polymyalgia rheumatica, and others, many physicians are not using any of the above imaging techniques because they believe that by relying only on the classification criteria of a disease the diagnosis can be an easy task. We present a patient with peripheral symmetrical polyarthritis involving the small joints of the hands, diagnosed and treated as RA and we discuss the role of imaging, especially the use of CR as an initial screening tool for the evaluation of the articular manifestations and joint damage, and its further usefulness in order to reach a definitive correct diagnosis.
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Affiliation(s)
- Alexandros A Drosos
- Department of Internal Medicine, Medical School, Rheumatology Clinic, University of Ioannina, 45110, Ioannina, Greece.
| | - Eleftherios Pelechas
- Department of Internal Medicine, Medical School, Rheumatology Clinic, University of Ioannina, 45110, Ioannina, Greece
| | - Paraskevi V Voulgari
- Department of Internal Medicine, Medical School, Rheumatology Clinic, University of Ioannina, 45110, Ioannina, Greece
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Abstract
This review highlights outcomes for patients with calcium pyrophosphate deposition (CPPD) reported in prior studies and underscores challenges to assessing outcomes of this condition. Prior clinical studies of interventions for CPPD focused on joint damage and calcification on imaging tests, joint pain, swelling, and inflammatory biomarkers. Qualitative interviews with patients with CPPD and healthcare providers additionally identified flares, overall function, and use of analgesic medications as important outcomes. Imaging evidence of joint damage and calcification is likely to be outcomes in future clinical studies of CPPD, though reliability and sensitivity to change in CPPD require further testing for several imaging modalities. Challenges to outcome measurement in CPPD include questions of attribution of signs and symptoms to CPPD versus co-existing forms of arthritis, lack of therapies to prevent or dissolve calcium pyrophosphate crystal deposition, absence of validated patient- or physician-reported CPPD outcome measures, and scarcity of large cohorts in which to study outcomes of different clinical presentations of CPPD.
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Affiliation(s)
- Ken Cai
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Rheumatology, Westmead Hospital, Westmead, Australia
| | - Sara K Tedeschi
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA.
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Pfeil A. Calcium pyrophosphate crystal deposition in Gitelman syndrome: which joint is affected? Rheumatology (Oxford) 2021; 61:2211-2212. [PMID: 34554234 DOI: 10.1093/rheumatology/keab705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Alexander Pfeil
- Department of Internal Medicine III, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
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9
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Sirotti S, Gutierrez M, Pineda C, Clavijo-Cornejo D, Serban T, Dumitru A, Scanu A, Adinolfi A, Scirè CA, Sarzi Puttini P, D'Agostino MA, Keen HI, Terslev L, Iagnocco A, Filippou G. Accuracy of synovial fluid analysis compared to histology for the identification of calcium pyrophosphate crystals: an ancillary study of the OMERACT US Working Group - CPPD subgroup. Reumatismo 2021; 73:106-110. [PMID: 34342211 DOI: 10.4081/reumatismo.2021.1403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/15/2021] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to evaluate the accuracy of synovial fluid analysis in the identification of calcium pyrophosphate dihydrate crystals compared to microscopic analysis of joint tissues as the reference standard. This is an ancillary study of an international, multicentre cross-sectional study performed by the calcium pyrophosphate deposition disease (CPPD) subgroup of the OMERACT Ultrasound working group. Consecutive patients with knee osteoarthritis (OA) waiting for total knee replacement surgery were enrolled in the study from 2 participating centres in Mexico and Romania. During the surgical procedures, synovial fluid, menisci and hyaline cartilage were collected and analysed within 48 hours from surgery under transmitted light microscopy and compensated polarised light microscopy for the presence/absence of calcium pyrophosphate crystals. All slides were analysed by expert examiners on site, blinded to other findings. A dichotomic score (absence/ presence) was used for scoring both synovial fluid and tissues. Microscopic analysis of knee tissues was considered the gold standard. Sensitivity, specificity, accuracy, positive and negative predictive values of synovial fluid analysis in the identification of calcium pyrophosphate crystals were calculated. 15 patients (53% female, mean age 68 yo ± 8.4) with OA of grade 3 or 4 according to Kellgren-Lawrence scoring were enrolled. 12 patients (80%) were positive for calcium pyrophosphate crystals at the synovial fluid analysis and 14 (93%) at the tissue microscopic analysis. The overall diagnostic accuracy of synovial fluid analysis compared with histology for CPPD was 87%, with a sensitivity of 86% and a specificity of 100%, the positive predictive value was 100% and the negative predictive value was 33%. In conclusion synovial fluid analysis proved to be an accurate test for the identification of calcium pyrophosphate dihydrate crystals in patients with advanced OA.
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Affiliation(s)
- S Sirotti
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy; Rheumatology Department, Luigi Sacco University Hospital, Milan.
| | - M Gutierrez
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City.
| | - C Pineda
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City.
| | - D Clavijo-Cornejo
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City.
| | - T Serban
- Rheumatology Department, Ospedale La Colletta, ASL3 Genovese, Genoa.
| | - A Dumitru
- Department of Pathology, "Carol Davila University of Medicine and Pharmacy", Bucharest.
| | - A Scanu
- Department of Medicine-DIMED, Rheumatology Unit, University of Padova.
| | - A Adinolfi
- Rheumatology Department, ASST Grande Ospedale Metropolitano Niguarda, Milano.
| | - C A Scirè
- Società Italiana di Reumatologia, Epidemiology Research Unit, Milan.
| | - P Sarzi Puttini
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy; Rheumatology Department, Luigi Sacco University Hospital, Milan.
| | - M-A D'Agostino
- Rheumatology Department, Università Cattolica del Sacro Cuore, Policlinico Universitario Agostino Gemelli IRCSS, Roma.
| | - H I Keen
- School of Medicine, The University of Western Australia, Murdoch, Perth.
| | - L Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University, Copenhagen.
| | - A Iagnocco
- Academic Rheumatology Centre, Department of Clinical and Biological Sciences, Università degli Studi di Torino.
| | - G Filippou
- Rheumatology Department, Luigi Sacco University Hospital, Milan.
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