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Mandl P, D'Agostino MA, Navarro-Compán V, Geßl I, Sakellariou G, Abhishek A, Becce F, Dalbeth N, Ea HK, Filippucci E, Hammer HB, Iagnocco A, de Thurah A, Naredo E, Ottaviani S, Pascart T, Pérez-Ruiz F, Pitsillidou IA, Proft F, Rech J, Schmidt WA, Sconfienza LM, Terslev L, Wildner B, Zufferey P, Filippou G. 2023 EULAR recommendations on imaging in diagnosis and management of crystal-induced arthropathies in clinical practice. Ann Rheum Dis 2024; 83:752-759. [PMID: 38320811 PMCID: PMC11103298 DOI: 10.1136/ard-2023-224771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/30/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE To formulate evidence-based recommendations and overarching principles on the use of imaging in the clinical management of crystal-induced arthropathies (CiAs). METHODS An international task force of 25 rheumatologists, radiologists, methodologists, healthcare professionals and patient research partners from 11 countries was formed according to the EULAR standard operating procedures. Fourteen key questions on the role of imaging in the most common forms of CiA were generated. The CiA assessed included gout, calcium pyrophosphate deposition disease and basic calcium phosphate deposition disease. Imaging modalities included conventional radiography, ultrasound, CT and MRI. Experts applied research evidence obtained from four systematic literature reviews using MEDLINE, EMBASE and CENTRAL. Task force members provided level of agreement (LoA) anonymously by using a Numerical Rating Scale from 0 to 10. RESULTS Five overarching principles and 10 recommendations were developed encompassing the role of imaging in various aspects of patient management: making a diagnosis of CiA, monitoring inflammation and damage, predicting outcome, response to treatment, guided interventions and patient education. Overall, the LoA for the recommendations was high (8.46-9.92). CONCLUSIONS These are the first recommendations that encompass the major forms of CiA and guide the use of common imaging modalities in this disease group in clinical practice.
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Affiliation(s)
- Peter Mandl
- Division of Rheumatology, Department of Internal Medicine 3, Medical University of Vienna, Wien, Austria
| | - Maria Antonietta D'Agostino
- Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Irina Geßl
- Department of Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Garifallia Sakellariou
- Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy
- Università degli Studi di Pavia, Pavia, Italy
| | | | - Fabio Becce
- Department of Medical Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | | | - Emilio Filippucci
- Rheumatology Unit-Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Jesi, Italy
| | - Hilde Berner Hammer
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- University of Oslo Faculty of Medicine, Oslo, Norway
| | - Annamaria Iagnocco
- Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin, Italy
| | - Annette de Thurah
- Rheumatology, Aarhus University Hospital, Aarhus N, Denmark
- Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Esperanza Naredo
- Department of Rheumatology and Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, Madrid, Spain
| | | | - Tristan Pascart
- Department of Rheumatology, Lille Catholic University, Saint-Philibert Hospital, Lomme, France
| | - Fernando Pérez-Ruiz
- Rheumatology Department, Osakidetza, Ezkerraldea-Enkarterri-Cruces, Cruces University Hospital, Biocruces-Bizkaia Health Research Institute and University of the Basque Country, Basque Country, Spain
| | - Irene A Pitsillidou
- EULAR Patient Research Partner, Cyprus League Against Rheumatism, Nicosia, Cyprus
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Juergen Rech
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | | | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Copenhagen University, Copenhagen, Denmark
| | | | - Pascal Zufferey
- Rheumatology, University of Lausanne, CHUV, Lausanne, Switzerland
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Oliviero F, Baggio C, Favero M, Damasco AC, Boscaro C, Tietto D, Albiero M, Doria A, Ramonda R. Synovial Fluid from Patients with Osteoarthritis Shows Different Inflammatory Features Depending on the Presence of Calcium Pyrophosphate Crystals. Int J Mol Sci 2023; 25:393. [PMID: 38203564 PMCID: PMC10778695 DOI: 10.3390/ijms25010393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
The role of calcium pyrophosphate (CPP) crystals in osteoarthritis (OA) is still a matter of debate. With this study we aimed to investigate the inflammatory features of synovial fluid (SF) collected from patients with OA with CPP crystals compared with those without crystals. We also explored the effect of OA SF on monocytes response. SFs were collected from adult patients with OA and subdivided according to the presence of crystals. Local cellular and humoral inflammatory mediators were analysed in the SF samples. The expression levels of IL-1β, IL-18, CASP-1, NLRP3, and GAPDH were measured by RT-PCR in the cells obtained by pelleting the SF samples. For the in vitro study, a monocytic cell line was treated with selected SF samples. SF with CPP crystals showed a significant increase in inflammatory cellular indices and higher levels of IL-1β, IL-8, and caspase-1 transcript with respect to SF without crystals. Higher concentrations of VEGF were also observed in the early stages of the whole OA patients. THP-1 cells stimulated with OA SF released a significant amount of IL-1 β in culture supernatants. This study demonstrated that SF collected from patients with OA shows different inflammatory features depending on the presence of CPP crystals.
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Affiliation(s)
- Francesca Oliviero
- Rheumatology Unit, Department of Medicine—DIMED, University of Padova, 35128 Padova, Italy; (C.B.); (M.F.); (A.C.D.); (A.D.)
| | - Chiara Baggio
- Rheumatology Unit, Department of Medicine—DIMED, University of Padova, 35128 Padova, Italy; (C.B.); (M.F.); (A.C.D.); (A.D.)
| | - Marta Favero
- Rheumatology Unit, Department of Medicine—DIMED, University of Padova, 35128 Padova, Italy; (C.B.); (M.F.); (A.C.D.); (A.D.)
- Medicine Unit 1, Ca’ Foncello Hospital, 31100 Treviso, Italy
| | - Amelia Carmela Damasco
- Rheumatology Unit, Department of Medicine—DIMED, University of Padova, 35128 Padova, Italy; (C.B.); (M.F.); (A.C.D.); (A.D.)
| | - Carlotta Boscaro
- Department of Medicine, University of Padova, 35128 Padova, Italy;
- Experimental Diabetology Lab, Veneto Institute of Molecular Medicine, 35129 Padova, Italy;
| | | | - Mattia Albiero
- Experimental Diabetology Lab, Veneto Institute of Molecular Medicine, 35129 Padova, Italy;
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine—DIMED, University of Padova, 35128 Padova, Italy; (C.B.); (M.F.); (A.C.D.); (A.D.)
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine—DIMED, University of Padova, 35128 Padova, Italy; (C.B.); (M.F.); (A.C.D.); (A.D.)
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Felten R, Widawski L, Spielmann L, Gaillez C, Bao W, Gottenberg JE, Duret PM, Messer L. Impact of hyperuricaemia on patients with psoriatic arthritis treated with secukinumab in the FUTURE 2-5 and MAXIMISE studies. RMD Open 2023; 9:e003428. [PMID: 37945285 PMCID: PMC10649802 DOI: 10.1136/rmdopen-2023-003428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/18/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVES Patients with psoriatic arthritis (PsA) are at a significantly increased risk of hyperuricaemia and development of gout, and those with hyperuricaemia have been found to respond poorly to PsA treatment and have more peripheral and destructive joint damage. We present a comprehensive post hoc analysis using pooled data from the FUTURE 2-5 studies and the MAXIMISE study to further evaluate the impact of hyperuricaemia on clinical presentation/disease severity and response to secukinumab in patients with PsA. METHODS Patients were stratified into two groups based on baseline serum uric acid (SUA) level (threshold of 360 µmol/L). A sensitivity analysis was also performed based on SUA thresholds of 300 µmol/L and 420 µmol/L. Demographics, clinical, radiological characteristics and comorbidities data were collected. RESULTS At baseline, patients with hyperuricaemia were mostly male, reported a higher prevalence of hypertension, with more clinical dactylitis, more psoriasis and more severe skin disease compared with patients with normouricaemia. A similar proportion of patients in the normouricaemic and hyperuricaemic cohorts achieved American College of Rheumatology responses, resolution of enthesitis and dactylitis, inhibition of structural damage progression and improvement in health-related quality of life across all secukinumab doses at week 52. CONCLUSION Patients with PsA and hyperuricaemia have different clinical characteristics from patients with PsA and normouricaemia. Identification of these patients at an early stage may facilitate a personalised treatment approach and improved management of comorbidities. Furthermore, secukinumab provided a rapid and sustained response across all manifestations of PsA up to week 52, irrespective of baseline uricaemia status.
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Affiliation(s)
- Renaud Felten
- Department of Rheumatology, National Reference Centre for Rare East-South-West Autoimmune Systemic Diseases (RESO), Strasbourg University Hospitals, Strasbourg, Grand Est, France
- UPR 3572, Laboratory of Immunopathology and Therapeutic Chemistry, Institute of Molecular and Cellular Biology, Strasbourg, Alsace, France
- Center of Clinical Investigation, Inserm 1434, Strasbourg University Hospitals, Strasbourg, Grand Est, France
| | - Laura Widawski
- Rheumatology Department, Civilian Hospitals Colmar, Colmar, Alsace, France
| | - Lionel Spielmann
- Rheumatology Department, Civilian Hospitals Colmar, Colmar, Alsace, France
| | | | - Weibin Bao
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Jacques-Eric Gottenberg
- Department of Rheumatology, National Reference Centre for Rare East-South-West Autoimmune Systemic Diseases (RESO), Strasbourg University Hospitals, Strasbourg, Grand Est, France
- UPR 3572, Laboratory of Immunopathology and Therapeutic Chemistry, Institute of Molecular and Cellular Biology, Strasbourg, Alsace, France
| | - Pierre-Marie Duret
- Rheumatology Department, Civilian Hospitals Colmar, Colmar, Alsace, France
| | - Laurent Messer
- Rheumatology Department, Civilian Hospitals Colmar, Colmar, Alsace, France
- UMR 7367, Dynamiques Européennes, Strasbourg, Grand Est, France
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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: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [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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5
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Galozzi P, Oliviero F, Scanu A, Lorenzin M, Ortolan A, Favero M, Doria A, Ramonda R. Acute joint swelling in psoriatic arthritis: Flare or "psout"-A 10-year-monocentric study on synovial fluid. Exp Biol Med (Maywood) 2022; 247:1650-1656. [PMID: 35876168 PMCID: PMC9597207 DOI: 10.1177/15353702221110666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Psoriatic arthritis (PsA) is a multifaceted inflammatory disease associated with psoriasis that can affect peripheral joints, entheses, and the axial skeleton with a variable clinical course. Acute episodes of joint swelling in PsA patients can have different causes and require specific treatments. We aimed to describe the acute joint swelling in PsA patients via synovial fluid (SF) analyses, assessing in particular the presence of pathogenic crystals, to determine whether it is a flare or an acute episode of gout ("psout") during the course of the disease. This retrospective study was based on the results of SF analysis of samples collected from unselected adult PsA patients referred to our clinic for acute joint swelling. Demographic characteristics, disease involvement, laboratory findings on SF, and treatment options were recorded and reviewed. Among 5,478 SF samples analyzed in a 10-year time span, 213 complete SF records from PsA patients were evaluated. Overall, after adjustment for the degree of synovial inflammation, significant differences were observed in term of sex (p = 0.0017) and ongoing therapy (p = 0.0246). Non-inflammatory SFs, indeed, were mainly described for female PsA patients under therapy. Regarding serum uric acid levels, there were 19/213 (8.9%) PsA with hyperuricemia (HU), who were older, mostly male, patients with mild articular involvement and rare pathogenic crystals in their SF. Although it is known that the risk of gout is higher among patients with PsA ("psout"), monosodium urate crystals were reported only in 5/213 SFs (2.4%) of our cohort and in 2/19 SFs (10.5%) of HU PsA patients. Moreover, hyperuricemia seems not to modify the SF features in PsA patients. This study results seem to suggest that the convergence of gout and PsA, involving the role of urate crystals, is a more intricate relationship, which needs further insights to be unraveled.
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Affiliation(s)
- Paola Galozzi
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy
| | - Francesca Oliviero
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy
| | - Anna Scanu
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy
| | - Mariagrazia Lorenzin
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy
| | - Augusta Ortolan
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy
| | - Marta Favero
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy,Medicina Interna I, Ca’ Foncello
Hospital, 31100 Treviso, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy,Roberta Ramonda.
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Geneva-Popova M, Popova-Belova S, Popova V, Chompalov K, Batalov A. Assessment of serum and synovial fluid MMP-3 and MPO as biomarkers for psoriatic arthritis and their relation to disease activity indices. Rheumatol Int 2022; 42:1605-1615. [PMID: 35708757 DOI: 10.1007/s00296-022-05159-4] [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: 04/10/2022] [Accepted: 05/25/2022] [Indexed: 11/28/2022]
Abstract
Research on biomarkers for the diagnosis and monitoring of psoriatic arthritis (PsA) is ongoing. The purpose of this study was to assess the potential of serum and synovial fluid matrix metalloproteinase-3 (MMP-3) and myeloperoxidase (MPO) as biomarkers for PsA and their relation to disease activity indices. This case-control study involved 156 psoriatic arthritis patients, 50 gonarthrosis patients, and 30 healthy controls. The target parameters were measured with the enzyme-linked immunosorbent assay (ELISA) kits. Serum MMP-3 and MPO levels were elevated in the PsA patients in comparison to the two control groups (p < 0.001) and distinguished PsA from GoA patients and healthy controls with 100% accuracy. Synovial MMP-3 discriminated PsA from GoA patients irrespective of the presence of crystals (AUC = 1.00). PsA patients with crystals in the synovial fluid had elevated synovial MPO (p < 0.001) and were distinguished from PsA patients without crystals with accuracy of 88.50% and from GoA patients with accuracy of 88.30%. Synovial fluid MPO was positively associated with the following indicators of disease activity: VAS (rs = 0.396); DAPSA (rs = 0.365); mCPDAI (rs = 0.323). Synovial MMP-3 showed a weaker positive association with DAPSA (rs = 0.202) and mCPDAI (rs = 0.223). Our results suggest that serum MMP-3 and MPO could serve as biomarkers for PsA. Synovial fluid MMP-3 showed a potential as a biomarker for PsA versus GoA. Synovial MPO could be utilized as a marker for the presence of crystals in PsA patients.
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Affiliation(s)
- Mariela Geneva-Popova
- Department of Propedeutic of Internal Diseases, Clinic of Rheumatology, Medical University of Plovdiv, University General Hospital "SvetiGeorgi", Plovdiv, Bulgaria.
| | - Stanislava Popova-Belova
- Department of Propedeutic of Internal Diseases, Clinic of Rheumatology, Medical University of Plovdiv, University General Hospital "SvetiGeorgi", Plovdiv, Bulgaria
| | - Velichka Popova
- Clinic of Rheumatology, Medical University of Plovdiv, University General Hospital "Kaspela", Plovdiv, Bulgaria
| | - Kostadin Chompalov
- Department of Rheumatology, Medical University, University General Hospital "St. Georgi", Plovdiv, Bulgaria
| | - Anastas Batalov
- Department of Propedeutic of Internal Diseases, Clinic of Rheumatology, Medical University of Plovdiv, University General Hospital "Kaspela", Plovdiv, Bulgaria
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Assessment of Crystals in the Synovial Fluid of Psoriatic Arthritis Patients in Relation to Disease Activity. Diagnostics (Basel) 2022; 12:diagnostics12051260. [PMID: 35626414 PMCID: PMC9140193 DOI: 10.3390/diagnostics12051260] [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: 04/13/2022] [Revised: 05/08/2022] [Accepted: 05/16/2022] [Indexed: 12/03/2022] Open
Abstract
Background: This study examines the relationship between the presence of crystals in the synovial fluid of patients with psoriatic arthritis (PsA) and disease activity. Methods: The synovial fluid of 156 PsA patients was analyzed and compared to 50 patients with gonarthrosis (GoA). The Leica DM4500P polarization microscope was used for crystal detection. Results: The presence of crystals was observed in 23.71% of PsA patients and none of the GoA patients, p < 0.001. Monosodium urate crystals (67.58%) and calcium pyrophosphate crystals (21.62%) were prevalent. The presence of crystals in the synovial fluid of PsA patients was associated with high disease activity according to the Composite Psoriatic Disease Activity Index (OR = 18.75, 95%; CI: 7.13 to 49.25) and the Disease Activity for Psoriatic Arthritis (OR = 15.96, 95%; CI: 5.76 to 44.23), with severe disability according to the Health Assessment Questionnaire Disability Index (OR = 13.60, 95%; CI: 5.09 to 36.31), and with severe pain on the Visual Analog Scale (OR = 157.25, 95%; CI: 39.50 to 625.94). Conclusion: Our results suggest that synovial fluid examination should be included in the treatment pathway for PsA patients with active disease, to aid in determining whether urate-lowering therapy is required.
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Tripolino C, Ciaffi J, Ruscitti P, Giacomelli R, Meliconi R, Ursini F. Hyperuricemia in Psoriatic Arthritis: Epidemiology, Pathophysiology, and Clinical Implications. Front Med (Lausanne) 2021; 8:737573. [PMID: 34631755 PMCID: PMC8492931 DOI: 10.3389/fmed.2021.737573] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/27/2021] [Indexed: 01/02/2023] Open
Abstract
Psoriatic arthritis (PsA) represents the articular component of the systemic psoriatic disease and the extra-cutaneous disorder most frequently found in patients with psoriasis. Besides the articular involvement, PsA is associated with several metabolic abnormalities such as insulin resistance, hypertension, diabetes and hyperuricemia. Uric acid is the final product of purine metabolism and the etiological substrate of gout. Accumulating evidence highlights the emerging role of hyperuricemia as a major cardiovascular risk factor. Moreover, different studies evaluated the interplay between hyperuricemia and psoriatic disease, suggesting that individuals affected by psoriasis or PsA might present higher serum levels of uric acid and that hyperuricemia might affect severity of clinical manifestations and degree of inflammation in PsA patients. In this review, we focus on the bidirectional relationship between uric acid and PsA, analyzing how uric acid may be involved in the pathogenesis of psoriasis/PsA and how clinical manifestations of PsA and inflammatory mediators are affected by uric acid concentrations. Finally, the effects of anti-rheumatic drugs on uric acid levels and the potential benefit of urate-lowering therapies on psoriasis and PsA were summarized.
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Affiliation(s)
- Cesare Tripolino
- Geriatric Medicine Unit, Department of Medical Functional Area, "San Giovanni di Dio" Hospital, Crotone, Italy
| | - Jacopo Ciaffi
- Medicine and Rheumatology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli (IOR), Bologna, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Roberto Giacomelli
- Unit of Allergology, Immunology, Rheumatology, Department of Medicine, Università Campus Bio-Medico Di Roma, Rome, Italy
| | - Riccardo Meliconi
- Medicine and Rheumatology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli (IOR), Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesco Ursini
- Medicine and Rheumatology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli (IOR), Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
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9
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Zamudio-Cuevas Y, Martínez-Nava GA, Martínez-Flores K, Ventura-Ríos L, Vazquez-Mellado J, Rodríguez-Henríquez P, Pineda C, Franco-Cendejas R, Lozada-Pérez CA, Fernández-Torres J. Synovial fluid analysis for the enhanced clinical diagnosis of crystal arthropathies in a tertiary care institution. Clin Rheumatol 2021; 40:3239-3246. [PMID: 33598809 DOI: 10.1007/s10067-021-05610-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/06/2021] [Accepted: 01/25/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION/OBJECTIVES Few studies have addressed the detection and clinical impact of different crystals in patients with diverse rheumatologic diagnoses in Latin America. The aim of this study was to assess the consistency between the clinical referring diagnosis and the identification of crystals, such as monosodium urate (MSU) and calcium pyrophosphate (CPP), in the synovial fluid (SF) of patients from a Mexican tertiary care institution. METHODS We reviewed the results of 264 SF analyses to identify any changes in diagnosis upon SF analysis. We reported patient medical file data on sex, age, diagnosis, and microscopic SF analysis results. We performed consistency analyses between referring diagnoses and SF findings with McNemar's test. RESULTS The prevalence of MSU crystals in SF was noted in 89.1% of gout cases and 9.09% of cases of calcium pyrophosphate disease (CPPD). CPP crystals were present in 54.5% of CPPD cases, 42.9% of osteoarthritis (OA) cases, and 7.27% of gout cases. Calcium hydroxyapatite (HA) crystals were identified in 5.45% of gout cases, 33.3% of rheumatoid arthritis (RA) cases, 57.1% of OA cases, and 63.6% of CPPD cases. Cholesterol and lipid crystals were present in small proportions in RA cases. Glucocorticoid crystals were observed in 1.85% of gout cases, 44.4% of RA cases, and 42.9% of OA cases. We observed an association of MSU identification with clinical suspicion of gout (P = 0.08), CPP with OA (P = 0.26) and CPPD (P = 0.50). An association was noted between HA and the diagnosis of CPPD (P = 0.84) and OA (P > 0.99). The number of initial diagnoses that changed upon SF analysis was 14.3%. CONCLUSIONS SF analysis has major diagnostic value regarding MSU crystals and gout. Our findings underscore the importance of SF crystal analysis in identifying the prevalence of crystals in the Mexican population. SF analysis provides for better diagnosis of crystal arthropathies and improves the quality of the medical care that the patient receives. Key Points • Synovial fluid analysis in laboratories from developing countries has been scarce. • In some cases, the initial diagnosis is modified after of synovial fluid analysis. • This study confirmed that synovial fluid analysis exhibits major diagnostic value for urate crystals and gout.
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Affiliation(s)
- Yessica Zamudio-Cuevas
- Laboratorio de Líquido Sinovial, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra-Ibarra (INR-LGII), Calzada México-Xochimilco 289, Colonia Arenal de Guadalupe, 14389, Mexico City, Tlalpan, Mexico
| | - Gabriela Angélica Martínez-Nava
- Laboratorio de Líquido Sinovial, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra-Ibarra (INR-LGII), Calzada México-Xochimilco 289, Colonia Arenal de Guadalupe, 14389, Mexico City, Tlalpan, Mexico
| | - Karina Martínez-Flores
- Laboratorio de Líquido Sinovial, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra-Ibarra (INR-LGII), Calzada México-Xochimilco 289, Colonia Arenal de Guadalupe, 14389, Mexico City, Tlalpan, Mexico
| | - Lucio Ventura-Ríos
- Laboratorio de Ultrasonido Músculo-Esquelético Articular, INR-LGII, Mexico City, Mexico
| | - Janitzia Vazquez-Mellado
- Department of Rheumatology, Hospital General de México Eduardo Liceaga, Dr. Balmis 148. Doctores, 06720, México City, Cuauhtémoc, Mexico
| | - Pedro Rodríguez-Henríquez
- Department of Rheumatology, Hospital General Dr. Manuel Gea González, Calzada de Tlalpan 4800, Belisario Domínguez Seccion 16, 14080, Mexico City, Tlalpan, Mexico
| | - Carlos Pineda
- División de Enfermedades Músculo-Esqueléticas y Reumáticas, INR-LGII, Mexico City, Mexico
| | | | | | - Javier Fernández-Torres
- Laboratorio de Líquido Sinovial, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra-Ibarra (INR-LGII), Calzada México-Xochimilco 289, Colonia Arenal de Guadalupe, 14389, Mexico City, Tlalpan, Mexico. .,Biology Department, Facultad de Química, Universidad Nacional Autónoma de México (UNAM), Ciudad Universitaria, 04510, Mexico City, Coyoacán, Mexico.
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A critical review of the available evidence on the diagnosis and clinical features of CPPD: do we really need imaging? Clin Rheumatol 2020; 40:2581-2592. [PMID: 33231775 DOI: 10.1007/s10067-020-05516-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 02/08/2023]
Abstract
Imaging has been playing an important role in the pathogenetic and clinical characterisation of many rheumatic diseases, especially in the most recent years with the advent of many new, highly technological and promising techniques. Calcium pyrophosphate deposition disease (CPPD) benefited also from these new techniques, most of which can readily identify calcium crystals. Nowadays, imaging is used mainly to identify crystals in joints but given the complexity of CPPD, imaging should be used with an "holistic" approach in order to gain insights in the pathogenesis, spectrum of clinical manifestations and natural history of the disease. Furthermore, overlap or association of CPPD with other prevalent diseases of the elderly makes the differential diagnosis challenging. In this review, we provide a critical review of the current knowledge on the use of imaging both for the identification of crystals and for its application in clinical practice as an aid for determining the impact of the disease on patients.Key Points• CPPD is a complex disease with a wide spectrum of clinical manifestations and understanding of pathogenetic mechanisms and clinical phenotypes is essential for correct characterisation• Imaging has made important advances regarding identification of CPPD in recent years, and new, more sophisticated techniques are under investigation• Imaging has the potential to improve our knowledge on pathogenesis and clinical phenotypes of CPPD• Imaging techniques have to be tested thoroughly for reliability, discrimination and sensitivity to change before they can be implemented in clinical trials.
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11
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Pascual E, Sivera F, Andres M. Mixed Crystal Disease: A Tale of 2 Crystals. J Rheumatol Suppl 2020; 47:1158-1159. [PMID: 32739900 DOI: 10.3899/jrheum.191316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Eliseo Pascual
- Department of Medicine, University Miguel Hernandez, Elche; and Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante;
| | - Francisca Sivera
- Department of Medicine, University Miguel Hernandez, and Department of Rheumatology, Hospital General Universitario Elda, Elda
| | - Mariano Andres
- Department of Medicine, University Miguel Hernandez, and ISABIAL, and Department of Rheumatology, Hospital General Universitario Alicante, Alicante, Spain
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12
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Yan JF, Qin WP, Xiao BC, Wan QQ, Tay FR, Niu LN, Jiao K. Pathological calcification in osteoarthritis: an outcome or a disease initiator? Biol Rev Camb Philos Soc 2020; 95:960-985. [PMID: 32207559 DOI: 10.1111/brv.12595] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 12/12/2022]
Abstract
In the progression of osteoarthritis, pathological calcification in the affected joint is an important feature. The role of these crystallites in the pathogenesis and progression of osteoarthritis is controversial; it remains unclear whether they act as a disease initiator or are present as a result of joint damage. Recent studies reported that the molecular mechanisms regulating physiological calcification of skeletal tissues are similar to those regulating pathological or ectopic calcification of soft tissues. Pathological calcification takes place when the equilibrium is disrupted. Calcium phosphate crystallites are identified in most affected joints and the presence of these crystallites is closely correlated with the extent of joint destruction. These observations suggest that pathological calcification is most likely to be a disease initiator instead of an outcome of osteoarthritis progression. Inhibiting pathological crystallite deposition within joint tissues therefore represents a potential therapeutic target in the management of osteoarthritis.
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Affiliation(s)
- Jian-Fei Yan
- Department of Oral Mucosal Diseases, State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, 145 changle xi road, Xi'an, Shaanxi, 710032, China
| | - Wen-Pin Qin
- Department of Oral Mucosal Diseases, State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, 145 changle xi road, Xi'an, Shaanxi, 710032, China
| | - Bo-Cheng Xiao
- Department of Oral Mucosal Diseases, State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, 145 changle xi road, Xi'an, Shaanxi, 710032, China
| | - Qian-Qian Wan
- Department of Oral Mucosal Diseases, State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, 145 changle xi road, Xi'an, Shaanxi, 710032, China
| | - Franklin R Tay
- Department of Oral Mucosal Diseases, State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, 145 changle xi road, Xi'an, Shaanxi, 710032, China.,Department of Endodontics, College of Graduate Studies, Augusta University, 1430, John Wesley Gilbert Drive, Augusta, GA, 30912, U.S.A
| | - Li-Na Niu
- Department of Oral Mucosal Diseases, State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, 145 changle xi road, Xi'an, Shaanxi, 710032, China
| | - Kai Jiao
- Department of Oral Mucosal Diseases, State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, 145 changle xi road, Xi'an, Shaanxi, 710032, China
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13
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14
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Felten R, Duret PM, Gottenberg JE, Spielmann L, Messer L. At the crossroads of gout and psoriatic arthritis: "psout". Clin Rheumatol 2020; 39:1405-1413. [PMID: 32062768 DOI: 10.1007/s10067-020-04981-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/31/2020] [Accepted: 02/07/2020] [Indexed: 12/15/2022]
Abstract
Psoriatic arthritis and gout are frequently encountered conditions sharing a number of common risk factors, which render their independent study difficult. Epidemiological studies have demonstrated a strong link between these diseases, suggesting the presence of underlying, intertwined pathophysiological mechanisms that currently remain unknown. Indeed, sodium urate crystals could play a pathogenic role in psoriasis and psoriatic arthritis. In daily practice, the distinction between psoriatic arthritis associated with hyperuricemia and a gouty arthropathy with psoriasis is complex. Several common pathogenic features suggest a more intricate relationship than their mere coexistence in the same patient. Thus, the concurrence of these two diseases should be seen as a novel overlap syndrome, at the boundary between inflammatory and metabolic rheumatism. The present update aims to clarify the determinants of the link and to define this new nosological entity. Its recognition could have therapeutic implications that appear essential for treatment optimization in a personalized setting.Key Points• What is already known about this subject? Psoriatic arthritis (PsA) and gout have strong interconnections, including comorbidities and pathophysiology. One must note that confounding clinical symptoms and radiological signs of PsA and gout are similar and difficult to differentiate in patients whose radiological lesions become too advanced to be differentiated or with less clearly defined phenotypes.• What does this study add? The pathogenic role of chronic hyperuricemia in the development and maintenance of PsA is based on epidemiological, clinical, and fundamental arguments and hence does not appear fortuitous. These two pathological processes can influence each other.• How might this impact on clinical practice? This new line of thinking regarding the convergence of gout and PsA, involving the role of urate crystals, could prompt a potential new approach to treatment (urate-lowering therapy) among patients with active/refractory PsA.
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Affiliation(s)
- Renaud Felten
- Service de Rhumatologie, Hôpitaux universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg, France. .,Laboratoire d'Immunologie, Immunopathologie et Chimie Thérapeutique, Institut de Biologie Moléculaire et Cellulaire (IBMC), CNRS UPR3572, 15 Rue René Descartes, 67000, Strasbourg, France.
| | - Pierre-Marie Duret
- Service de Rhumatologie, Hôpitaux universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg, France
| | - Jacques-Eric Gottenberg
- Service de Rhumatologie, Hôpitaux universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg, France.,Laboratoire d'Immunologie, Immunopathologie et Chimie Thérapeutique, Institut de Biologie Moléculaire et Cellulaire (IBMC), CNRS UPR3572, 15 Rue René Descartes, 67000, Strasbourg, France
| | - Lionel Spielmann
- Service de Rhumatologie, Hospices Civils de Colmar, 39 Avenue de la Liberté, 68024, Colmar Cedex, France
| | - Laurent Messer
- Service de Rhumatologie, Hospices Civils de Colmar, 39 Avenue de la Liberté, 68024, Colmar Cedex, France
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15
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Experience and satisfaction with a multidisciplinary care unit for patients with psoriasis an psoriatic arthritis. ACTA ACUST UNITED AC 2019; 15:237-241. [DOI: 10.1016/j.reuma.2017.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/04/2017] [Accepted: 07/06/2017] [Indexed: 01/31/2023]
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16
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Northrup EN, Pflederer BR. Calcium pyrophosphate dihydrate crystal deposition disease and MRSA septic arthritis of the atlantoaxial joint in a patient with Tourette syndrome. BMJ Case Rep 2019; 12:12/3/e228102. [PMID: 30904893 DOI: 10.1136/bcr-2018-228102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 45-year-old male patient with Tourette syndrome presented to the emergency department with worsening neck pain and stiffness of 1-week duration. Associated symptoms included headache, hoarse voice, trismus and odynophagia. The patient was haemodynamically stable without fevers or leucocytosis. He exhibited cervical spinal and paraspinal tenderness with very limited range of motion. Erythrocyte sedimentation rate and C reactive protein were elevated, and blood cultures grew methicillin-resistant Staphylococcus aureus (MRSA). Lumbar puncture was unremarkable. CT and MRI of the neck showed calcification of the longus colli, fluid and capsular distention of C1-C2 joints, enhancement of the joint capsule and retropharyngeal oedema suggestive of septic arthritis. Fluid was aspirated from C1 to C2 joint by interventional radiology and showed calcium pyrophosphate crystals and heavy MRSA colonisation, consistent with both pseudogout and septic arthritis of the cervical vertebrae. The patient was started on a 6-week course of daptomycin and showed gradual improvements in neck pain and mobility.
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Affiliation(s)
- Edward Nicholas Northrup
- Department of Medicine, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
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17
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Vladimirov SA, Eliseev MS. Current strategy in the treatment of calcium pyrophosphate crystal deposition disease. RHEUMATOLOGY SCIENCE AND PRACTICE 2019. [DOI: 10.14412/1995-4484-2018-746-752] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The paper considers currently available drugs used to treat calcium pyrophosphate crystal deposition disease. It discusses the advantages and disadvantages of the most widely used drugs, such as nonsteroidal anti-inflammatory drugs, colchicine, glucocorticoids, traditional immunosuppressants, as well as prospects for the use of biologic agents.
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18
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19
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Hu S, Lin C, Tu H. Association between psoriasis, psoriatic arthritis and gout: a nationwide population‐based study. J Eur Acad Dermatol Venereol 2018; 33:560-567. [DOI: 10.1111/jdv.15290] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/27/2018] [Indexed: 02/06/2023]
Affiliation(s)
- S.C.‐S. Hu
- Department of Dermatology College of Medicine Kaohsiung Medical University Kaohsiung Taiwan
- Department of Dermatology Kaohsiung Medical University Hospital Kaohsiung Taiwan
- Department of Medical Research Kaohsiung Medical University Hospital Kaohsiung Taiwan
- Translational Research Center Kaohsiung Medical University Hospital Kaohsiung Medical University Kaohsiung Taiwan
| | - C.‐L. Lin
- Department of Dermatology Kaohsiung Medical University Hospital Kaohsiung Taiwan
- Department of Dermatology Kaohsiung Municipal Hsiao‐Kang Hospital Kaohsiung Taiwan
| | - H.‐P. Tu
- Department of Public Health and Environmental Medicine School of Medicine College of Medicine Kaohsiung Medical University Kaohsiung Taiwan
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20
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Basic calcium phosphate and pyrophosphate crystals in early and late osteoarthritis: relationship with clinical indices and inflammation. Clin Rheumatol 2018; 37:2847-2853. [DOI: 10.1007/s10067-018-4166-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 05/08/2018] [Accepted: 05/31/2018] [Indexed: 12/13/2022]
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21
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Abstract
PURPOSE OF REVIEW Current evidence and accumulated experience for the management of calcium pyrophosphate deposition disease (CPPD) are presented. RECENT FINDINGS Contrary to other rheumatic inflammatory conditions that account for high interest and growing research, advances in treating CPPD are still very limited and mostly derive from those achieved in gout. Once formed, calcium pyrophosphate crystals cannot be dissolved; therefore, management relies on the control of crystal-derived inflammation. Besides classical agents-such as colchicine, glucocorticoids, or NSAIDs-the use of targeted therapies, mostly against interleukin-1, has provided a relevant relief for refractory CPPD patients in recent years. Meanwhile, former enthusiasm about conventional disease-modifying agents such as methotrexate is currently controversial.
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Affiliation(s)
- Mariano Andrés
- Sección de Reumatología, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General Universitario de Alicante, Pintor Baeza 12, 03010, Alicante, Spain. .,Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain.
| | - Francisca Sivera
- Sección de Reumatología, Hospital General Universitario de Elda, Alicante, Spain
| | - Eliseo Pascual
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
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22
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Concurrence of rheumatoid arthritis and calcium pyrophosphate deposition disease: A case collection and review of the literature. Semin Arthritis Rheum 2017; 48:9-11. [PMID: 29338885 DOI: 10.1016/j.semarthrit.2017.11.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/27/2017] [Accepted: 11/27/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Calcium pyrophosphate deposition disease (CPDD) is arthritis caused by calcium pyrophosphate (CPP) crystal deposition in joints. It is commonly associated with aging as well as a handful of metabolic syndromes. Recent epidemiologic studies suggest a positive association of CPDD and rheumatoid arthritis (RA). Yet how these diseases are related remains unclear. We set out to describe 21 well-characterized patients with both diagnoses. METHODS Medical records of patients with both RA and CPDD identified at a single academic practice site were reviewed for age, gender, age of CPDD and RA onset, disease duration, joint involvement, and lab values including rheumatoid factor (RF), cyclic citrullinated peptide antibody (CCP), iron studies, and parathyroid hormone and calcium levels. RESULTS The mean age of CPDD onset was 69.5 ± 11.4 years, with a mean RA age onset of 53.9 ± 16 years, demonstrating a mean lag of 13.4 ± 10.9 years between diagnoses. The majority of RA patients were diagnosed with CPDD based on the presence of radiographic chondrocalcinosis (15/21). The most commonly involved joint was the knee, followed by the wrist, hip, and shoulder. CONCLUSIONS These data show that the diagnosis of RA often precedes the diagnosis of CPDD. This asynchronous presentation taken together with the classic age of onset for CPDD and typical pattern of joint involvement supports the hypothesis that CPDD develops in RA patients through similar processes as those that cause the idiopathic forms of this disease.
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23
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Ankli B, Kyburz D, Hirschmann A, Hügle T, Manigold T, Berger CT, Daikeler T. Calcium pyrophosphate deposition disease: a frequent finding in patients with long-standing erosive gout. Scand J Rheumatol 2017; 47:127-130. [DOI: 10.1080/03009742.2017.1332239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- B Ankli
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - D Kyburz
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - A Hirschmann
- Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - T Hügle
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - T Manigold
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - CT Berger
- Translational Immunology and Medical Outpatient Clinic, Department of Biomedicine and Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - T Daikeler
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
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24
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Kleiber Balderrama C, Rosenthal AK, Lans D, Singh JA, Bartels CM. Calcium Pyrophosphate Deposition Disease and Associated Medical Comorbidities: A National Cross-Sectional Study of US Veterans. Arthritis Care Res (Hoboken) 2017; 69:1400-1406. [PMID: 27898996 DOI: 10.1002/acr.23160] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 11/03/2016] [Accepted: 11/22/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Calcium pyrophosphate deposition disease (CPDD) is a common cause of acute and chronic arthritis, yet there are few large epidemiologic studies of CPDD. We sought to characterize CPDD in the national Veterans Affairs (VA) population. METHODS Using data from the Department of VA Corporate Data Warehouse, patients with International Classification of Diseases, Ninth Revision, codes for CPDD seen at any VA medical center from 2010 through 2014 were matched by age and sex with control patients without CPDD. We used multivariate analysis to compare the prevalence and odds ratios (ORs) of various comorbidities, substance use, medication exposures, and arthroplasties among patients with and without CPDD. RESULTS We identified 25,157 patients with CPDD, yielding a point prevalence of 5.2 per 1,000. The mean ± SD age was 68.1 ± 12.3 years, and 95% were male. The strongest positive associations with CPDD were hyperparathyroidism (OR 3.35 [95% confidence interval (95% CI) 2.96-3.79]), gout (OR 2.82 [95% CI 2.69-2.95]), osteoarthritis (OR 2.26 [95% CI 2.15-2.37]), rheumatoid arthritis (OR 1.88 [95% CI 1.74-2.03]), and hemochromatosis (OR 1.87 [95% CI 1.57-2.24]). Positive associations were also seen with higher odds for osteoporosis (OR 1.26 [95% CI 1.16-1.36]), hypomagnesemia (OR 1.23 [95% CI 1.16-1.30]), chronic kidney disease (OR 1.12 [95% CI 1.07-1.18]), and calcium supplementation (OR 1.15 [95% CI 1.06-1.24). Negative associations were seen with proton-pump inhibitors (OR 0.58 [95% CI 0.55-0.60]) and loop diuretics (OR 0.80 [95% CI 0.76-0.84]). CONCLUSION Using a large national data set, we confirmed known associations with CPDD, provided support for positive associations with rheumatoid arthritis, hypomagnesemia, and osteoporosis, and suggested potential novel negative associations with commonly used medications.
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Affiliation(s)
| | - Ann K Rosenthal
- Medical College of Wisconsin and the Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
| | - Daniel Lans
- Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
| | - Jasvinder A Singh
- University of Alabama at Birmingham and Birmingham VA Medical Center, Birmingham, Alabama
| | - Christie M Bartels
- University of Wisconsin and the William S. Middleton VA Medical Center, Madison, Wisconsin
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Tsuruta N, Imafuku S, Narisawa Y. Hyperuricemia is an independent risk factor for psoriatic arthritis in psoriatic patients. J Dermatol 2017; 44:1349-1352. [DOI: 10.1111/1346-8138.13968] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/09/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Noriko Tsuruta
- Department of Dermatology; Fukuoka University Faculty of Medicine; Fukuoka Japan
- Division of Dermatology; Department of Internal Medicine; Faculty of Medicine; Saga University; Saga Japan
| | - Shinichi Imafuku
- Department of Dermatology; Fukuoka University Faculty of Medicine; Fukuoka Japan
| | - Yutaka Narisawa
- Division of Dermatology; Department of Internal Medicine; Faculty of Medicine; Saga University; Saga Japan
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Detection of Calcium Crystals in Knee Osteoarthritis Synovial Fluid: A Comparison Between Polarized Light and Scanning Electron Microscopy. J Clin Rheumatol 2017; 22:369-71. [PMID: 27660935 DOI: 10.1097/rhu.0000000000000416] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The identification of calcium crystals in synovial fluid (SF) of patients with osteoarthritis (OA) represents an important step in understanding the role of these crystals in synovial inflammation and disease progression. OBJECTIVES This study aimed to investigate the presence of calcium pyrophosphate (CPP) and basic calcium phosphate (BCP) crystals in SF collected from patients with symptomatic knee OA by scanning electron microscopy (SEM) coupled to x-ray energy dispersive spectroscopy, compensated polarized light microscopy (CPLM), and alizarin red staining. METHODS Seventy-four patients with knee OA were included in the study. Synovial fluid samples were collected after arthrocentesis and examined under CPLM for the assessment of CPP crystals. Basic calcium phosphate crystals were evaluated by alizarin red staining. All the samples were examined by SEM. The concordance between the 2 techniques was evaluated by Cohen κ agreement coefficient. RESULTS Calcium pyrophosphate and BCP crystals were found, respectively, in 23 (31.1%) and 13 (17.5%) of 74 OA SFs by SEM analysis. Calcium pyrophosphate crystals were identified in 23 (31.1%) of 74 samples by CPLM, whereas BCP crystals were suspected in 27 (36.4%) of 74 samples. According to κ coefficient, the concordance between CPLM and SEM was 0.83 for CPP, and that between alizarin red and SEM was 0.68 for BCP. CONCLUSIONS The results of our study showed a high level of concordance between the 2 microscope techniques as regards CPP crystal identification and a lower agreement for BCP crystals. Although this finding highlights the difficulty in identifying BCP crystals by alizarin red staining, the use of SEM remains unsuitable to apply in the clinical setting. Because of the in vitro inflammatory effect of BCP crystals, further work on their analysis in SF could provide important information about the OA process.
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Torre-Alonso JC, Carmona L, Moreno M, Galíndez E, Babío J, Zarco P, Linares L, Collantes-Estevez E, Barrial MF, Hermosa JC, Coto P, Suárez C, Almodóvar R, Luelmo J, Castañeda S, Gratacós J. Identification and management of comorbidity in psoriatic arthritis: evidence- and expert-based recommendations from a multidisciplinary panel from Spain. Rheumatol Int 2017; 37:1239-1248. [DOI: 10.1007/s00296-017-3702-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 03/14/2017] [Indexed: 02/08/2023]
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Carlson AK, McCutchen CN, June RK. Mechanobiological implications of articular cartilage crystals. Curr Opin Rheumatol 2017; 29:157-162. [DOI: 10.1097/bor.0000000000000368] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
PURPOSE OF REVIEW Calcium pyrophosphate (CPP) crystal disease is a common rheumatologic disorder that has received limited attention from the scientific community. This review is aimed at summarizing current evidence for managing CPP disease (CPPD), focusing on recently reported advances. RECENT FINDINGS New data from case series indicate that interleukin-1β inhibitors can help patients with refractory forms of CPPD. Methotrexate, formerly a promising agent, failed to demonstrate benefits in a recent trial, but still merits consideration for some patients. No significant advances on crystal dissolution have been achieved to date. Proper characterization of the CPP crystal disease picture is needed, ruling out the possible coexistence of another persistent arthritis unrelated to the CPP deposition. SUMMARY Advances on CPP crystal dissolution and establishing definitions of the clinical spectrum of CPPD remain the main challenges for CPP crystal disease management.
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Synovial Fluid Findings and Demographic Analysis of Patients With Coexistent Intra-articular Monosodium Urate and Calcium Pyrophosphate Crystals. J Clin Rheumatol 2016; 22:68-70. [DOI: 10.1097/rhu.0000000000000321] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Rosenthal AK, Pascual E. Editorial: Decreasing Crystal-Induced Consternation: New Methods of Crystal Identification. Arthritis Rheumatol 2016; 68:1574-7. [PMID: 26882418 DOI: 10.1002/art.39640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 02/09/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Ann K Rosenthal
- Medical College of Wisconsin and Clement J. Zablocki VA Medical Center, Milwaukee
| | - Eliseo Pascual
- Universidad de Alicante and Hospital General Universitario de Alicante, Alicante, Spain
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Gamon E, Combe B, Barnetche T, Mouterde G. Diagnostic value of ultrasound in calcium pyrophosphate deposition disease: a systematic review and meta-analysis. RMD Open 2015; 1:e000118. [PMID: 26535143 PMCID: PMC4623362 DOI: 10.1136/rmdopen-2015-000118] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 06/14/2015] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE A systematic review and meta-analysis of data from cohort studies to analyse the diagnostic performances (ie, sensitivity and specificity) of ultrasound (US) for diagnosis of calcium pyrophosphate deposition (CPPD) disease with microscopic crystal detection used as a gold standard. METHODS We performed a systematic review of articles published up to December 2014 using EMBASE, MEDLINE and Cochrane databases and abstracts from the past two EULAR and ACR annual meetings. Only studies reporting the performance of US for diagnosis of CPPD disease were selected. A meta-analysis involved the inverse variance method to evaluate global sensitivity and specificity of US. Statistical heterogeneity was assessed by the Cochran Q-test and I(2) values. RESULTS The search resulted in 85 articles and 11 abstracts; 17 and 4, respectively, were selected for the systematic review. A total of 262 patients with CPPD disease and 335 controls from 4 original articles and 4 abstracts were included in the meta-analysis. The US diagnostic patterns most frequently recorded were thin hyperechoic bands in the hyaline cartilage (8 articles); hyperechoic spots in fibrous cartilage or in tendons (7 articles); and homogeneous hyperechoic nodules localised in bursa or articular recesses (4 articles). The meta-analysis revealed a heterogeneity of the data, with a sensitivity of 87.9% (95% CI 80.9% to 94.9%) and specificity of 91.5% (95% CI 85.5% to 97.5%) using a random model. CONCLUSIONS This meta-analysis confirmed that US has high sensitivity and specificity for the diagnosis of CPPD and may be a promising tool for the diagnosis and management of CPPD.
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Affiliation(s)
- Etienne Gamon
- Rheumatology Department, Lapeyronie Hospital and & EA 2415, Montpellier, France
| | - Bernard Combe
- Rheumatology Department, Lapeyronie Hospital and & EA 2415, Montpellier, France
| | | | - Gaël Mouterde
- Rheumatology Department, Lapeyronie Hospital and & EA 2415, Montpellier, France
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The prevalence of monosodium urate and calcium pyrophosphate crystals in synovial fluid from wrist and finger joints. Rheumatol Int 2015; 36:443-6. [DOI: 10.1007/s00296-015-3376-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 09/25/2015] [Indexed: 10/23/2022]
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Hospital burden of gout, pseudogout and other crystal arthropathies in France. Joint Bone Spine 2015; 82:326-9. [PMID: 25881756 DOI: 10.1016/j.jbspin.2015.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 01/22/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe the hospital burden of microcrystal arthropathies in France. METHODS Data were extracted from the 2009-2011 French hospital national databases. We selected all hospital stays for microcrystal arthropathies (gout, chondrocalcinosis, other) encoded as primary or secondary diagnoses in patients older than 18. A descriptive analysis focused on number of patients and hospital stays, age, gender, comorbidities related to metabolic syndrome, and hospital costs based on 2012 public-sector costs. RESULTS 132,275 hospitalizations involving 109,734 patients were related to microcrystal arthropathies encoded as primary or secondary diagnosis (61% related to gout, 34% to chondrocalcinosis, and 5% to other microcrystal arthropathies). 23,362 hospitalizations involving 25,105 patients were due to microcrystal diseases, encoded as primary diagnosis, (48% related to gout, 43% to chondrocalcinosis, and 9% to other microcrystal arthropathies). In this population, patients with chondrocalcinosis were older (mean 75.6±13.5 versus 71±16 years for other microcrystal arthropathies and 69.7±14.7 for gout). Men represented 70% of the patients with gout, 39% of those with chondrocalcinosis and 52% of the patients with other microcrystal arthropathies. Hypertension, diabetes, dyslipidemia, cardiac ischemia, and renal failure were more frequent in patients with gout than other patients. The hospital costs for microcrystal arthropathies encoded as primary diagnosis were 82.3 million Euros, 45% related to gout, 45% to chondrocalcinosis and 11% to other microcrystals. CONCLUSION In terms of hospital costs, gout and chondrocalcinosis represented the main part of the economic burden of crystal arthropathies and a high level of diseases belonging to the metabolic syndrome. Specific education programs favouring accurate microcrystal diagnosis and adherence to treatment could diminish this hospital economic burden.
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Erosive osteoarthritis, psoriatic arthritis and pseudogout; a casual association? Clin Rheumatol 2015; 35:1885-9. [PMID: 25833145 DOI: 10.1007/s10067-015-2927-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 03/22/2015] [Indexed: 10/23/2022]
Abstract
According to recent hypothesis, the inflammation has a pivotal role in the onset and progression of erosive hand osteoarthritis (EHOA), psoriatic arthritis (PsA) and chondrocalcinosis (CC)/pseudogout. Albeit, it has been recognised for years as an association between EHOA and radiographic evidence of CC, but there are few reports of coexistence of microcrystalline arthritis and PsA. This is the first report that described a clinical experience concerning two consecutive cases of patients presented with EHOA, PsA and pseudogout. Two Caucasian women of 71 and 85 years old with a history of OA and mild psoriasis are presented with tenderness and swelling of first interphalangeal (IP) and wrist joint, respectively. Arthrocentesis performed at the first IP and wrist joint, respectively, showed an inflammatory synovial fluid with presence of calcium pyrophosphate dehydrate crystals. X-rays of hands, feet and knees showed characteristic features of EHOA, PsA and CC. Furthermore, HLA typing evinces the presence of HLA C*06; DRB*01 07 and HLA C*07; DRB*01 *11 alleles, respectively, predisposing factors of these inflammatory diseases. The relationship between these aggressive rheumatic diseases along with their clinical, radiographic, laboratory and genetic features is discussed.
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36
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Why are rheumatologists still reluctant to perform joint-fluid analysis? Joint Bone Spine 2015; 82:139-40. [PMID: 25677411 DOI: 10.1016/j.jbspin.2015.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2011] [Indexed: 01/07/2023]
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Ficjan A, Husic R, Gretler J, Lackner A, Graninger WB, Gutierrez M, Duftner C, Hermann J, Dejaco C. Ultrasound composite scores for the assessment of inflammatory and structural pathologies in Psoriatic Arthritis (PsASon-Score). Arthritis Res Ther 2014; 16:476. [PMID: 25361855 PMCID: PMC4247751 DOI: 10.1186/s13075-014-0476-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 10/21/2014] [Indexed: 11/10/2022] Open
Abstract
Introduction This study was performed to develop ultrasound composite scores for the assessment of inflammatory and structural lesions in Psoriatic Arthritis (PsA). Methods We performed a prospective study on 83 PsA patients undergoing two study visits scheduled 6 months apart. B-mode and Power Doppler (PD) findings were semi-quantitatively scored at 68 joints (evaluating synovia, perisynovial tissue, tendons and bone) and 14 entheses. We constructed bilateral and unilateral (focusing the dominant site) ultrasound composite scores selecting relevant sites by a hierarchical approach. We tested convergent construct validity, reliability and feasibility of inflammatory and structural elements of the scores as well as sensitivity to change for inflammatory items. Results The bilateral score (termed PsASon22) included 22 joints (6 metacarpophalangeal joints (MCPs), 4 proximal interphalangeal joints (PIPs) of hands (H-PIPs), 2 metatarsophalangeal joints (MTPs), 4 distal interphalangeal joints (DIPs) of hands (H-DIPs), 2 DIPs of feet (F-DIPs), 4 large joints) and 4 entheses (bilateral assessment of lateral epicondyle and distal patellar tendon). The unilateral score (PsASon13) compromised 13 joints (2 MCPs, 3 H-PIPs, 1 PIP of feet (F-PIP), 2 MTPs, 1 H-DIP and 2 F-DIPs and 2 large joints) and 2 entheses (unilateral lateral epicondyle and distal patellar tendon). Both composite scores revealed a moderate to high sensitivity (bilateral composite score 43% to 100%, unilateral 36% to 100%) to detect inflammatory and structural lesions compared to the 68-joint/14-entheses score. The inflammatory and structural components of the composite scores correlated weakly with clinical markers of disease activity (corrcoeffs 0 to 0.40) and the health assessment questionnaire (HAQ, corrcoeffs 0 to 0.39), respectively. Patients with active disease achieving remission at follow-up yielded greater reductions of ultrasound inflammatory scores than those with stable clinical activity (Cohen’s d effect size ranging from 0 to 0.79). Inter-rater reliability of bi- and unilateral composite scores was moderate to good with ICCs ranging from 0.42 to 0.96 and from 0.36 to 0.71, respectively for inflammatory and structural sub-scores. The PsASon22 and PsASon13 required 16 to 26 and 9 to 13 minutes, respectively to be completed. Conclusion Both new PsA ultrasound composite scores (PsASon22 and PsASon13) revealed sufficient convergent construct validity, sensitivity to change, reliability and feasibility. Electronic supplementary material The online version of this article (doi:10.1186/s13075-014-0476-2) contains supplementary material, which is available to authorized users.
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Fibroblast-like synoviocytes induce calcium mineral formation and deposition. ARTHRITIS 2014; 2014:812678. [PMID: 24963403 PMCID: PMC4054973 DOI: 10.1155/2014/812678] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 04/14/2014] [Accepted: 04/19/2014] [Indexed: 12/17/2022]
Abstract
Calcium crystals are present in the synovial fluid of 65%–100% patients with osteoarthritis (OA) and 20%–39% patients with rheumatoid arthritis (RA). This study sought to investigate the role of fibroblast-like synoviocytes (FLSs) in calcium mineral formation. We found that numerous genes classified in the biomineral formation process, including bone gamma-carboxyglutamate (gla) protein/osteocalcin, runt-related transcription factor 2, ankylosis progressive homolog, and parathyroid hormone-like hormone, were differentially expressed in the OA and RA FLSs. Calcium deposits were detected in FLSs cultured in regular medium in the presence of ATP and FLSs cultured in chondrogenesis medium in the absence of ATP. More calcium minerals were deposited in the cultures of OA FLSs than in the cultures of RA FLSs. Examination of the micromass stained with nonaqueous alcoholic eosin indicated the presence of birefringent crystals. Phosphocitrate inhibited the OA FLSs-mediated calcium mineral deposition. These findings together suggest that OA FLSs are not passive bystanders but are active players in the pathological calcification process occurring in OA and that potential calcification stimuli for OA FLSs-mediated calcium deposition include ATP and certain unidentified differentiation-inducing factor(s). The OA FLSs-mediated pathological calcification process is a valid target for the development of disease-modifying drug for OA therapy.
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39
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Merola JF, Wu S, Han J, Choi HK, Qureshi AA. Psoriasis, psoriatic arthritis and risk of gout in US men and women. Ann Rheum Dis 2014; 74:1495-500. [PMID: 24651620 DOI: 10.1136/annrheumdis-2014-205212] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 03/06/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Individuals with psoriasis have increased blood levels of uric acid. However, there is no prospective data on the association between psoriasis and uric acid levels and subsequent development of gout. In this study, we examined the risk of gout among individuals with psoriasis and psoriatic arthritis (PsA) in two cohorts of men and women, the Health Professionals Follow-up Study (HPFS) (1986-2010) and Nurses' Health Study (NHS) (1998-2010). METHODS 27 751 men and 71 059 women were included in the analysis. Lifetime history of physician-diagnosed incident psoriasis and PsA was confirmed by validated supplementary questionnaires. Incident gout diagnoses were confirmed based on the American College of Rheumatology survey criteria. We used Cox proportional hazards models controlling for potential risk factors to calculate the HRs with 95% CIs of incident gout while simultaneously adjusting for several common risk factors. RESULTS We documented 2217 incident cases of gout during follow-up. Psoriasis was associated with an increased risk of subsequent gout with a multivariate HR of 1.71 (95% CI 1.36 to 2.15) in the pooled analysis. Risk of gout was substantially augmented among those with psoriasis and concomitant PsA (pooled multivariate HR: 4.95, 95% CI 2.72 to 9.01) when compared to participants without psoriasis. CONCLUSIONS In this prospective study of US women and men, psoriasis and PsA were associated with an increased risk of gout.
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Affiliation(s)
- Joseph F Merola
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA Division of Rheumatology, Allergy and Immunology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Shaowei Wu
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jiali Han
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA Department of Epidemiology, Fairbanks School of Public Health, Simon Cancer Center, Indiana University, Indianapolis, Indiana, USA Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Hyon K Choi
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA Section of Rheumatology and the Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Abrar A Qureshi
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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40
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Perez-Ruiz F, Castillo E, Chinchilla SP, Herrero-Beites AM. Clinical manifestations and diagnosis of gout. Rheum Dis Clin North Am 2014; 40:193-206. [PMID: 24703343 DOI: 10.1016/j.rdc.2014.01.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Gout has been academically considered to be a step-up disease consisting of different stages: acute gout, intercritical gout, and chronic gout. This simple approach may lead to misinterpretation and misdiagnosis. In clinical practice, we should consider gout as a single disease with either or both acute (most commonly, episodes of acute inflammation) and persistent clinical manifestations, but not restricted to chronic synovitis. In this article, an innovative, practical, and rational approach to the clinical manifestations and diagnosis of gout is presented, which may be supportive for clinicians involved in everyday care and management of patients with gout.
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Affiliation(s)
- Fernando Perez-Ruiz
- Division of Rheumatology, BioCruces Health Institute, Hospital Universitario Cruces, Pza Cruces sn, Baracaldo 48903, Spain.
| | - Edwin Castillo
- Division of Rheumatology, Hospital Universitario Cruces, Pza Cruces sn, Baracaldo 48903, Spain
| | - Sandra P Chinchilla
- Division of Rheumatology, Hospital Universitario Cruces, Pza Cruces sn, Baracaldo 48903, Spain
| | - Ana M Herrero-Beites
- Division of Physical Medicine, Hospital de Górliz, Astondo Ibiltoki, km. 2, Górliz 48630, Spain
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Oliviero F, Sfriso P, Scanu A, Fiocco U, Spinella P, Punzi L. Epigallocatechin-3-gallate reduces inflammation induced by calcium pyrophosphate crystals in vitro. Front Pharmacol 2013; 4:51. [PMID: 23616769 PMCID: PMC3627987 DOI: 10.3389/fphar.2013.00051] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 04/01/2013] [Indexed: 12/19/2022] Open
Abstract
Although osteoarthritis (OA) is defined as a cartilage disease, synovitis involving mononuclear cell infiltration and overexpression of proinflammatory mediators is common in early and late OA. Calcium crystals deposition is thought to be a factor that likely contributes to synovial inflammation. In recent years, significant interest has emerged in the beneficial health effects attributed to the green tea polyphenols and in particular to epigallocatechin-3-gallate (EGCG). It has been demonstrated that some of the actions of EGCG are linked to its ability to interfere with cell membranes. The objective of this study was to evaluate the influence of EGCG in some inflammatory aspects of OA and whether EGCG is able to interfere with membrane organization. We assessed the effect of EGCG on the production of proinflammatory cytokines and chemokines released by human fibroblast-like synoviocytes (FLS) and THP-1 cells stimulated with calcium pyrophosphate (CPP) crystals in presence of methyl-β-cyclodextrin (MβCD), a cholesterol-removing agent that disturbs lipid raft structures. The chemotactic effect of culture supernatants was also evaluated. EGCG inhibited interleukin (IL)-1β, transforming growth factor beta, IL-8, and chemokine (C–C motif) ligand 2 (CCL2) release by stimulated FLS and/or THP-1 cells in a dose-dependent manner. Supernatants of CPP-stimulated cells induced the migration of neutrophils and mononuclear cells which decreased in a dose-dependent manner in the presence of EGCG. EGCG increased cell viability when added to THP-1 cells treated with MβCD. Furthermore, MβCD enhanced the inflammatory response to CPP crystals increasing IL-8 and CCL2 secretion which was inhibited by EGCG in a dose-dependent manner. This study showed that EGCG is able to reduce the inflammatory response induced by CPP crystals in vitro. The identification of EGCG as dietary supplement capable of affording protection or modulating the inflammatory response to CPP crystals may have important implications in the prevention and treatment of OA and crystal-related arthropathies.
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Affiliation(s)
- Francesca Oliviero
- Rheumatology Unit, Department of Medicine, University of Padova Padova, Italy
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