#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Calcium PyroPhosphate Deposition disease


Authors: T. Zitko
Authors‘ workplace: Canadian medical, Praha ;  Centrum pohybové medicíny Pavla Koláře, Praha ;  Artmedi UPD s. r. o., Hostivice
Published in: Čes. Revmatol., 29, 2021, No. 3, p. 150-160.
Category: Review Article

Overview

Precipitation of crystals of calcium pyrophosphate dihydrate (CPP crystals) can be asymptomatic or associated with degenerative and/or inflammatory changes. The spectrum of CPPD disease (Calcium PyroPhosphate Deposition disease) consists of acute CPP crystal arthritis (closely resembling gout), chronic CPP crystal inflammatory arthritis (similar to rheumatoid arthritis), osteoarthritis with CPPD (similar to osteoarthritis), and other less frequent manifestations; more than one clinical phenotype is present in many patients. It is one of the most common forms of inflammatory arthritis, yet one of the least studied. Preferably, the diagnosis is based on the combination of clinical picture and detection of CPP crystals in the synovial fluid from affected joint. However, since accurate synovial fluid analysis is not always feasible in daily practice, X-ray imaging (or USG/CT) with a demonstration of chondrocalcinosis or soft-tissue calcification in the affected joint represents an alternative. If this does not enable establishing the diagnosis, X-rays of hands/wrists, pelvis, and knees can be added. The vast majority of patients suffer from an idiopathic form of CPPD disease, but the condition can develop on the background of an injury (trauma, surgery – meniscectomy, etc.), underlying genetic impairment, hyperparathyroidism, hemochromatosis, or hypomagnesaemia, and this should be considered in a younger individual (< 60 years of age). The therapeutic options consist of usual non-pharmacologic measures (rest, splinting, icing), joint aspiration and/or intra-articular steroid injection, analgesics, and, in particular, anti-inflammatory therapies. Unfortunately, the evidence base for individual treatment modalities is of a low quality, or absent. The widely recommended first-line options are NSAIDs, colchicine, and steroids, but none of them has been evaluated in a randomized controlled trial. The second-line options are hydroxychloroquine, methotrexate, magnesium carbonate, ACTH analogs, anakinra, tocilizumab, and radiation synovectomy. There is no modality that can eliminate the causative CPP crystals from the body.

Keywords:

calcium-pyrophosphate-dihydrate crystals – chondrocalcinosis – CPPD


Sources
  1. Doherty M, Abhishek A. Calcium pyrophosphate crystal– associated arthropathy. In: Hochberg M, Silman A, Smolen J, Weinblatt M, Weisman M. (eds.) Rheumatology. 5th ed. Philadelphia: Elsevier 2011; 1875–1887.
  2. McCarty DJ. Calcium pyrophosphate dihydrate crystal deposition disease – 1975. Arthritis Rheum 1976; 3(Suppl): 275–285.
  3. Zhang W, Doherty M, Bardin T, Barskova V, Guerne PA, Jansen TL, et al. European League Against Rheumatism recommendations for calcium Pyrophosphate Deposition, Part I: Terminology and Diagnosis. Ann Rheum Dis 2011; 4: 563–570.
  4. Zhang W, Doherty M, Pascual E, Barskova V, Guerne PA, Jansen TL, et al. European League Against Rheumatism recommendati[1]ons for calcium Pyrophosphate Deposition, Part II: Management. Ann Rheum Dis 2011; 4: 571–575.
  5. Abhishek A, Neogi T, Choi H, Doherty M, Rosenthal AK, Terkeltaub R. Review: Unmet Needs and the Path Forward in Joint Disease Associated With Calcium Pyrophosphate Crystal Deposition. Arthritis Rheum 2018; 8: 1182–1191.
  6. Rosenthal A. Clinical manifestations and diagnosis of calcium pyrophosphate crystal deposition (CPPD) disease. In: Post TW. (ed.) UpToDate (Internet). Waltham, MA, USA: UpToDate Inc 2021. Available from: www.uptodate.com
  7. Rosenthal A. Pathogenesis and etiology of calcium pyro[1]phosphate crystal deposition (CPPD) disease. In: Post TW. (ed.) UpToDate (Internet). Waltham, MA, USA: UpToDate Inc; 2021. Available from: www.uptodate.com
  8. Abhishek A, Doherty M. Update on calcium pyrophosphate deposition. Clin Exp Rheumatol 2016; 34(Suppl 98): S00–S00.
  9. Terkeltaub R. Calcium Crystal Disease: Calcium Pyrophosphate Dihydrate and Basic Calcium Phosphate. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O’Dell J. (eds.) Kelley and Firestein‘s  Textbook of Rheumatology. 10th ed. Philadelphia: Elsevier 2016; 1645–1665.
  10. Campillo-Gimenez L, Renaudin F, Jalabert M, Gras P, Gosset M, Rey C, et al. Inflammatory Potential of Four Different Phases of Calcium Pyrophosphate Relies on NF-κB Activation and MAPK Pathways. Front Immunol 2018; 9: 48.
  11. Rosenthal A, Ryan L. Calcium Pyrophosphate Deposition Disease. N Eng J Med 2016; 374: 2575–2584.
  12. Abhishek A. Calcium pyrophosphate deposition disease: a review of epidemiologic findings. Curr Opin Rheumatol 2016; 2: 133–139.
  13. Doherty M, Watt I, Dieppe PA. Localised chondrocalcinosis in post–meniscectomy knees. Lancet 1982; 1: 1207–1210.
  14. Oliviero F, Scanu A, Galozzi P, Gava A, Frallonardo P, Ramonda R, et al. Prevalence of calcium pyrophosphate and monosodium urate crystals in synovial fluid of patients with previously diagnosed joint diseases. Joint Bone Spine 2013; 3: 287–290.
  15. Filippou G, Adinolfi A, Iagnocco A, Filippucci E, Cimmino MA, Bertoldi I, et al. Ultrasound in the diagnosis of calcium pyrophosphate dihydrate deposition disease. A  systematic literature review and a meta-analysis. Osteoarthritis Cartilage 2016; 6: 973–981.
  16. Filippou G, Scirè CA, Damjanov N, Adinolfi A, Carrara G, Picerno V, et al. Definition and Reliability Assessment of Elementary Ultrasonographic Findings in Calcium Pyrophosphate Deposition Disease: A  Study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound Subtask Force. J Rheumatol 2017; 11: 1744–1749.
  17. Filippou G, Scirè CA, Adinolfi A, Damjanov NS, Carrara G, Bruyn GAW, et al. Identification of calcium pyrophosphate deposition disease (CPPD) by ultrasound: reliability of the OMERACT definitions in an extended set of joints-an international multiobserver study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound Subtask Force. Ann Rheum Dis 2018; 8: 1194–1199.
  18. Parperis K, Papachristodoulou E, Kakoullis L, Rosenthal AK. Management of calcium pyrophosphate crystal deposition disease: A  systematic review. Semin Arthritis Rheum 2021; 1: 84–94.
  19. Rosenthal A. Treatment of calcium pyrophosphate crystal deposition (CPPD) disease. In: Post TW. (ed.) UpToDate (Internet). Waltham, MA, USA: UpToDate Inc 2021. Available from: www.uptodate.com
  20. Rosenthal A. Calcium pyrophosphate deposition disease (pseudogout). In: Hochberg M, Gravallese E, Silman A, Smolen J, Weinblatt M, Weisman M. (eds.) Rheumatology. 7th ed. Philadelphia: Elsevier 2018; 1621–1631.
  21. Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castañeda-Sanabria J, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 2017; 76: 29–42.
  22. Alvarellos A, Spilberg I. Colchicine prophylaxis in pseudo[1]gout. J Rheumatol 1986; 13: 804.
  23. Rothschild B, Yakubov LE. Prospective 6-month, double blind trial of hydroxychloroquine treatment of CPPD. Compr Ther 1997; 23: 327–331.
  24. Finckh A, Mc Carthy GM, Madigan A, Van Linthoudt D, Weber M, Neto D, et al. Methotrexate in chronic–recurrent calcium pyrophosphate deposition disease: no significant effect in a randomized crossover trial. Arthritis Res Ther 2014; 5: 458.
  25. Doherty M, Dieppe PA. Double blind, placebo controlled trial of magnesium carbonate in chronic pyrophosphate arthropathy. Ann Rheum Dis 1983; 42(Suppl): 106–107.
  26. Andrés M, Sivera F, Pascual E. Therapy for CPPD: Options and Evidence. Curr Rheumatol Rep 2018; 6: 31.
  27. Latourte A, Ea HK, Frazier A, Blanchard A, Lioté F, Marotte H, et al. Tocilizumab in symptomatic calcium pyrophosphate deposition disease: a pilot study. Ann Rheum Dis 2020; 79: 1126–1128.
  28. Doherty M, Dieppe PA. Effect of intra-articular yttrium-90 on chronic pyrophosphate arthropathy of the knee. Lancet 1981; 2: 1243–1246.
Labels
Dermatology & STDs Paediatric rheumatology Rheumatology
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#