287 results on '"Crystal arthropathy"'
Search Results
2. Calcium Pyrophosphate and Basic Calcium Phosphate Deposition Diseases: The Year in Review 2022.
- Author
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McCarthy, Geraldine Mary
- Subjects
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CALCIUM phosphate , *CALCIUM , *CRYSTALS , *GOUT - Abstract
Calcium-containing crystal deposition diseases are a common cause of pain and disability but remain relatively under-investigated. No drug has been identified that can prevent deposition or effect dissolution of either calcium pyrophosphate (CPP) or basic calcium phosphate (BCP) crystals. In comparison to the field of gout and urate biology, published research in relation to calcium crystal deposition diseases in 2022 was relatively modest in quantity. In CPP deposition (CPPD) disease, progress was made mainly in epidemiology, imaging, surgical management and Gitelman's syndrome. In relation to BCP crystals, the effect on tenocytes in vitro was explored and results indicate that BCP crystals likely reduce tendon matrix integrity via their interaction with tenocytes. The involvement of calcification in the progression of osteoarthritis (OA) was elegantly demonstrated contributing to further discovery of the process of OA progression. There was a paucity of mechanistic and genetic studies in calcium crystal deposition diseases published in 2022, nor any breakthrough in therapy, showing that there is abundant scope for investigation under these themes in the future. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
3. Calcium pyrophosphate crystal size and characteristics
- Author
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Zell, Monica, Aung, Thanda, Kaldas, Marian, Rosenthal, Ann K, Bai, Bijie, Liu, Tairan, Ozcan, Aydogan, and FitzGerald, John D
- Subjects
CPPD ,Calcium pyrophosphate ,Crystal arthropathy ,Light microscopy - Abstract
To describe the characteristics of calcium pyrophosphate (CPP) crystal size and morphology under compensated polarized light microscopy (CPLM). Secondarily, to describe CPP crystals seen only with digital enhancement of CPLM images, confirmed with advanced imaging techniques. Clinical lab-identified CPP-positive synovial fluid samples were collected from 16 joint aspirates. Four raters used a standardized protocol to describe crystal shape, birefringence strength and color. A crystal expert confirmed CPLM-visualized crystal identification. For crystal measurement, a high-pass linear light filter was used to enhance resolution and line discrimination of digital images. This process identified additional enhanced crystals not seen by raters under CPLM. Single-shot computational polarized light microscopy (SCPLM) provided further confirmation of the enhanced crystals' presence. Of 932 suspected crystals identified by CPLM, 569 met our inclusion criteria, and 293 (51%) were confirmed as CPP crystals. Of 175 unique confirmed crystals, 118 (67%) were rods (median area 3.6 μm2 [range, 1.0-22.9 μm2]), and 57 (33%) were rhomboids (median area 4.8 μm2 [range, 0.9-16.7 μm2]). Crystals visualized only after digital image enhancement were smaller and less birefringent than CPLM-identified crystals. CPP crystals that are smaller and weakly birefringent are more difficult to identify. There is likely a population of smaller, less birefringent CPP crystals that routinely goes undetected by CPLM. Describing the characteristics of poorly visible crystals may be of use for future development of novel crystal identification methods.
- Published
- 2021
4. Diagnosis and Treatment of Calcium Pyrophosphate Deposition (CPPD) Disease: A Review
- Author
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Cowley S and McCarthy G
- Subjects
crystal arthropathy ,calcium pyrophosphate dihydrate ,cppd ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Sharon Cowley, Geraldine McCarthy Department of Rheumatology, Mater Misericordiae University Hospital, Dublin, IrelandCorrespondence: Sharon Cowley, Mater Misericordiae University Hospital, Dublin, Ireland, Email sharoncowley111@gmail.comAbstract: Calcium Pyrophosphate Dihydrate (CPPD) crystal-related arthropathies are a common cause of acute and chronic arthritis caused by the deposition of calcium pyrophosphate crystals in joints and soft tissues, resulting in inflammation and joint damage. They present with a wide spectrum of clinical manifestations and often present challenges to diagnosis and management as they commonly affect older co-morbid patients. The challenges are compounded by a lack of a well-defined description of CPPD. However, an international expert-driven process is underway to develop CPPD classification criteria. Treatment is also problematic as unlike gout, there are no agents available that decrease the crystal burden. Treatment options have often been extrapolated from gout treatment pathways without having extensive trials or a solid evidence base. It is hoped the new CPPD classification guidelines will contribute to large multicentre studies, with well-defined patient cohorts, which will facilitate the production of high-quality evidence to guide the management of this condition. Here, we discuss the barriers and facilitators in diagnosing and treating CPPD-related arthropathy.Keywords: crystal arthropathy, calcium pyrophosphate dihydrate, CPPD
- Published
- 2023
5. Monosodium urate crystals alter the circadian clock in macrophages leading to loss of NLRP3 inflammasome repression: Implications for timing of the gout flare.
- Author
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Popov, Dmitry, Jain, Lekha, Alhilali, Mariam, Dalbeth, Nicola, and Poulsen, Raewyn C.
- Abstract
Gout is caused by monosodium urate (MSU) crystal deposition within joints. This leads to acute episodes of inflammation ("gout flares") driven by NLRP3 inflammasome activation in macrophages. Gout flares are frequently present during late night/early morning. The reason for this timing is unclear. Recent evidence suggests the NLRP3 inflammasome is under circadian control. The purpose of this study was to determine whether MSU crystals cause changes in the circadian clock in macrophages leading to time‐of‐day differences in NLRP3 inflammasome activation. Levels of circadian clock components were measured in undifferentiated "monocytic" and PMA‐differentiated "macrophagic" THP‐1 cells cultured with/without MSU crystals. Caspase‐1 activity was measured to assess NLRP3 inflammasome activity. MSU crystal exposure resulted in minimal effects on clock genes in THP‐1 monocytes but BMAL1, CRY1, PER2, and REV‐ERBα showed altered expression with reduced protein levels of BMAL1 and REV‐ERBα in THP‐1 macrophages. REV‐ERBα activation or BMAL1 over‐expression resulted in reduced MSU crystal‐induced caspase‐1 activity. BMAL1 knockdown resulted in a further increase in MSU crystal‐induced caspase‐1 activity, but only at times of day when BMAL1 levels were naturally high. MSU crystal‐induced NLRP3 inflammasome activation was greatest at the time of day when BMAL1 levels were naturally low. MSU crystals alter the expression of circadian clock components in THP‐1 macrophages leading to loss of BMAL1 and REV‐ERBα‐mediated repression of NLRP3 inflammasome activity and time‐of‐day differences in susceptibility to inflammasome activation. Our findings suggest that the nocturnal risk of gout flare is at least partially a consequence of altered circadian control of immune cell function. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
6. Elbow Joint, Intra-articular Injections
- Author
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Tran, Bryant W., Buxhoeveden, Michael R., Wills, Timothy T., Souza, Dmitri, editor, and Kohan, Lynn R, editor
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- 2022
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7. Management of temporomandibular joint diseases: a rare case report of coexisting calcium pyrophosphate crystal deposition and synovial chondromatosis
- Author
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Makoto Murahashi, Edward Hosea Ntege, Masaru Higa, Nobuyuki Maruyama, Toshihiro Kawano, Yusuke Shimizu, and Hiroyuki Nakamura
- Subjects
Synovial chondromatosis ,Calcium pyrophosphate ,Pseudogout ,Temporomandibular joint ,Crystal arthropathy ,Inorganic pyrophosphate ,Dentistry ,RK1-715 - Abstract
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.
- Published
- 2022
- Full Text
- View/download PDF
8. Management of temporomandibular joint diseases: a rare case report of coexisting calcium pyrophosphate crystal deposition and synovial chondromatosis.
- Author
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Murahashi, Makoto, Ntege, Edward Hosea, Higa, Masaru, Maruyama, Nobuyuki, Kawano, Toshihiro, Shimizu, Yusuke, and Nakamura, Hiroyuki
- Subjects
TEMPOROMANDIBULAR joint radiography ,PREOPERATIVE care ,SYNOVECTOMY ,PATIENT aftercare ,BIOPSY ,SYNOVIAL chondromatosis ,FACIAL pain ,MAGNETIC resonance imaging ,CHONDROCALCINOSIS ,TRISMUS ,TEMPOROMANDIBULAR disorders ,COMPUTED tomography ,RARE diseases ,COMORBIDITY - 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. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
9. Gout and Pseudogout
- Author
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Kaplan, Elizabeth, Jackson, Molly Blackley, editor, Huang, Ronald, editor, Kaplan, Elizabeth, editor, and Mookherjee, Somnath, editor
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- 2020
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10. Gout and 'Podagra' in medieval Cambridge, England.
- Author
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Dittmar, Jenna M., Mitchell, Piers D., Jones, Peter M., Mulder, Bram, Inskip, Sarah A., Cessford, Craig, and Robb, John E.
- Abstract
To estimate the prevalence rate of gout and to explore the social factors that contributed to its development in the various sub-populations in medieval Cambridge. 177 adult individuals from four medieval cemeteries located in and around Cambridge, UK. Lesions were assessed macroscopically and radiographically. Elements with lytic lesions were described and imaged using micro-computed tomography (μCT) to determine their morphology. Gout was identified in 3 % of the population. Individuals buried in the friary had highest prevalence (14 %), with low prevalence rates in the Hospital (3 %) and town parish cemetery (2 %), with no cases in the rural parish cemetery. Gout was more prevalent during the 14th–15th centuries than the 10th–13th centuries. The high prevalence rate of gout in the friary is at least partly explained by the consumption of alcohol and purine-rich diets by the friars and the wealthy townsfolk. Medieval medical texts from Cambridge show that gout (known as podagra) was sometimes treated with medications made from the root of the autumn crocus. This root contains colchicine, which is a medicine that is still used to treat gout today. This is one of the first studies to assess the epidemiology of gout in medieval England and suggests that gout varied with social status. Our sample size precludes statistical analysis. Additional studies that assess the epidemiology of gout in medieval Europe is needed in order to be able to fully contextualize these findings. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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11. The diagnostic value of conventional radiography and musculoskeletal ultrasonography in calcium pyrophosphate deposition disease: a systematic literature review and meta-analysis.
- Author
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Cipolletta, E., Filippou, G., Scirè, C.A., Di Matteo, A., Di Battista, J., Salaffi, F., Grassi, W., and Filippucci, E.
- Abstract
Objective: To examine and compare the accuracy of conventional radiography (CR) and musculoskeletal ultrasonography (US) in the diagnosis of calcium pyrophosphate (CPP) crystals deposition disease (CPPD).Design: A systematic search of electronic databases (PubMed, Embase, and Cochrane), conference abstracts and reference lists was undertaken. Studies which evaluated the accuracy of CR and/or US in the diagnosis of CPPD, using synovial fluid analysis (SFA), histology or classification criteria as reference tests were included. Subgroup analyses by anatomic site and by reference test were performed.Results: Twenty-six studies were included. Using SFA/histology as reference test, CR and US showed an excellent (CR AUC = 0.889, 95%CI = 0.811-0.967) and an outstanding (US AUC = 0.954, 95%CI = 0.907-1.0) diagnostic accuracy (p < 0.01), respectively. Furthermore, US showed a higher sensitivity (0.85, 95%CI = 0.79-0.90 vs 0.47, 95%CI = 0.40-0.55) and only a little lower specificity (0.87, 95%CI = 0.83-0.91 vs 0.95, 95%CI = 0.92-0.97) than CR. A considerable heterogeneity between the studies was found, with adopted reference test being the main source of heterogeneity. In fact, subgroup analysis showed a significant change in the diagnostic accuracy of CR, but not of US, using Ryan and McCarty criteria or SFA/histology as reference test (CR: AUC = 0.956, 95%CI = 0.925-1.0 vs AUC = 0.889, 95%CI = 0.828-0.950, respectively, p < 0.01) (US: AUC = 0.922, 95%CI = 0.842-1.0 vs AUC = 0.957, 95%CI = 0.865-1.0, respectively, p = 0.08) CONCLUSIONS: Although US is more sensitive and a little less specific than CR for identifying CPP crystals, both these two techniques showed a great diagnostic accuracy and should be regarded as complementary to each other in the diagnostic work-up of patients with CPPD. [ABSTRACT FROM AUTHOR]- Published
- 2021
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12. Calcium pyrophosphate crystal size and characteristics
- Author
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Monica Zell, MD, Thanda Aung, MD, MS, Marian Kaldas, MD, Ann K. Rosenthal, MD, Bijie Bai, Tairan Liu, Aydogan Ozcan, PhD, and John D. FitzGerald, MD, PhD
- Subjects
Calcium pyrophosphate ,CPPD ,Crystal arthropathy ,Light microscopy ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Objective: To describe the characteristics of calcium pyrophosphate (CPP) crystal size and morphology under compensated polarized light microscopy (CPLM). Secondarily, to describe CPP crystals seen only with digital enhancement of CPLM images, confirmed with advanced imaging techniques. Methods: Clinical lab-identified CPP-positive synovial fluid samples were collected from 16 joint aspirates. Four raters used a standardized protocol to describe crystal shape, birefringence strength and color. A crystal expert confirmed CPLM-visualized crystal identification. For crystal measurement, a high-pass linear light filter was used to enhance resolution and line discrimination of digital images. This process identified additional enhanced crystals not seen by raters under CPLM. Single-shot computational polarized light microscopy (SCPLM) provided further confirmation of the enhanced crystals’ presence. Results: Of 932 suspected crystals identified by CPLM, 569 met our inclusion criteria, and 293 (51%) were confirmed as CPP crystals. Of 175 unique confirmed crystals, 118 (67%) were rods (median area 3.6 μm2 [range, 1.0–22.9 μm2]), and 57 (33%) were rhomboids (median area 4.8 μm2 [range, 0.9–16.7 μm2]). Crystals visualized only after digital image enhancement were smaller and less birefringent than CPLM-identified crystals. Conclusions: CPP crystals that are smaller and weakly birefringent are more difficult to identify. There is likely a population of smaller, less birefringent CPP crystals that routinely goes undetected by CPLM. Describing the characteristics of poorly visible crystals may be of use for future development of novel crystal identification methods.
- Published
- 2021
- Full Text
- View/download PDF
13. An Interesting Image of Gout Crystals with Surrounding Tophi
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- 2023
- Full Text
- View/download PDF
14. Acute Calcium Pyrophosphate Crystal Arthritis Flare Rate and Risk Factors for Recurrence.
- Author
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Yates, Katherine A., Kazuki Yoshida, Chang Xu, Houchen Lyu, Vibeke Norvang, Solomon, Daniel H., Tedeschi, Sara K., Yoshida, Kazuki, Xu, Chang, Lyu, Houchen, and Norvang, Vibeke
- Subjects
CHONDROCALCINOSIS ,DISEASE relapse ,DISEASE incidence ,SYNOVITIS ,COHORT analysis - Abstract
Objective: Little is known about acute calcium pyrophosphate (CPP) crystal arthritis flare rates and risk factors for recurrence. We characterized flares and determined the rate and predictors of acute CPP crystal arthritis flares in an academic medical center cohort.Methods: We performed a retrospective cohort study among a random sample of patients with acute CPP crystal arthritis identified in the Partners HealthCare electronic medical record, 1991-2017. Flare was defined as self-limited, acute-onset synovitis with synovial fluid CPP crystals and/or chondrocalcinosis, not better explained by another cause. We calculated incidence rates (IR) for acute CPP crystal arthritis flare among all subjects and by sex. We estimated HR for recurrent flare using univariate Cox models that accounted for within-person correlated data.Results: We identified 70 patients with acute CPP crystal arthritis with a total of 111 flares. Recurrent flares occurred in 24% of patients; half of flares occurred in a previously unaffected joint. The acute CPP crystal arthritis flare rate was 11.4 per 100 person-years overall (95% CI 8.2-15.4), 14.2 in women (95% CI 9.6-0.1), and 7.1 in men (95% CI 3.4-13.0). Cancer (HR 2.98, 95% CI 1.33-6.68) and chronic kidney disease (HR 2.92, 95% CI 1.10-7.76) were associated with a higher rate for recurrent flare.Conclusion: Recurrent flares occurred in about one-fourth of patients with acute CPP crystal arthritis and often occurred in previously unaffected joints. The acute CPP crystal arthritis flare rate was twice as high in women as in men. [ABSTRACT FROM AUTHOR]- Published
- 2020
- Full Text
- View/download PDF
15. Gout mimicking spondyloarthritis: case report and literature review
- Author
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Chen W, Wang Y, Li Y, Zhao Z, Feng L, Zhu J, Zhang J, and Huang F
- Subjects
gout ,crystal arthropathy ,sacroiliac joint ,radiography ,Medicine (General) ,R5-920 - Abstract
Wenji Chen,1 Yanyan Wang,2 Yan Li,2 Zheng Zhao,2 Lixia Feng,2 Jian Zhu,2 Jianglin Zhang,2 Feng Huang2 1Department of Rheumatology, Hainan Branch of Chinese People’s Liberation Army General Hospital, Sanya, 2Department of Rheumatology, Chinese People’s Liberation Army General Hospital, Beijing, People’s Republic of China Abstract: Gout is clinically characterized by episodes of monoarthritis, which not only typically affects the peripheral joints but also occasionally affect the axial joint, such as the sacroiliac joint (SIJ), and often mimics spondyloarthritis (SpA). Two cases of gout mimicking SpA are presented in the current paper. One patient was a 32-year-old man with a history of asymmetrical oligoarthritis of ankle and metatarsophalangeal joints (MTPJ). He had left gluteal pain for 2 weeks. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed the bone erosion of the left SIJ. T1-weighted MRI showed hypointense T1 and hyperintense T2 signals of the left SIJ. The other patient was a 24-year-old man with left back pain and hip pain for 4 months and intermittent fever for 3 months. He had a history of gout for 3 years. Both patients underwent CT-guided sacroiliac biopsy, and monosodium urate (MSU) crystals were shown by polarized microscopy. Gout can often mimic SpA and seldomly affects the SIJ. Thus, its correct diagnosis and adequate therapy can halt the development of such damaging complications. Keywords: gout, crystal arthropathy, sacroiliac joint, radiography
- Published
- 2017
16. Secular trends in the incidence and prevalence of gout in Denmark from 1995 to 2015: a nationwide register-based study.
- Author
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Zobbe, Kristian, Prieto-Alhambra, Daniel, Cordtz, René, Højgaard, Pil, Hindrup, Jens Skøt, Kristensen, Lars Erik, and Dreyer, Lene
- Subjects
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AGE distribution , *REPORTING of diseases , *GOUT , *SEX distribution , *TIME , *DESCRIPTIVE statistics - Abstract
Objective To investigate temporal trends in the incidence and prevalence of gout in the adult Danish population. Methods Using the nationwide Danish National Patient Registry, we calculated the number of incident gout patients (per 100 000 person-years) within each 1 year period from 1995 to 2015 and the prevalence of gout in 2000 and 2015. Further, we calculated age- and gender-specific incidence rates of gout from 1995 to 2015. Results We identified a total of 45 685 incident gout patients (72.9% males) with a mean age of 65 years (s.d. 16) at diagnosis. In both genders, an increase in age-standardized incidence rates was observed from 32.3/100 000 (95% CI 30.7, 33.9) in 1995 to 57.5/100 000 (95% CI 55.6, 59.5) in 2015 (P < 0.001). Similar trends were observed for 8950 cases diagnosed in rheumatology departments. We likewise observed an increase in the prevalence of gout from 0.29% (95% CI 0.29, 0.30) in 2000 to 0.68% (95% CI 0.68, 0.69) in 2015. Conclusions The annual incidence rate of gout increased by almost 80% in Denmark between 1995 and 2015. The prevalence increased by nearly 130% between 2000 and 2015. Reasons for this are unknown but may include an increase in risk factors (e.g. obesity, diabetes mellitus), longer life expectancy and increased awareness of the disease among patients and/or health professionals. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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- View/download PDF
17. Altered expression of the core circadian clock component PERIOD2 contributes to osteoarthritis-like changes in chondrocyte activity.
- Author
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Rong, Jing, Zhu, Mark, Munro, Jacob, Cornish, Jillian, McCarthy, Geraldine M, Dalbeth, Nicola, and Poulsen, Raewyn C
- Subjects
- *
OSTEOARTHRITIS , *CARTILAGE cells , *SOX2 protein , *MATRIX metalloproteinases , *THROMBOSPONDINS - Abstract
In osteoarthritis, chondrocytes undergo a phenotype shift characterised by reduced expression of SOX9 (sry-box 9) and increased production of cartilage-degrading enzymes, e.g. MMP13 (matrix metalloproteinase 13) and ADAMTS5 (a disintegrin and metalloproteinase with thrombospondin motifs 5). The chondrocyte clock is also altered. Specifically, the peak level of PER2 is elevated, but peak level of BMAL1 reduced in osteoarthritic chondrocytes. The purpose of this study was to determine whether increased PER2 expression causes disease-associated changes in chondrocyte activity and to identify whether known risk factors for osteoarthritis induce changes in PER2 and BMAL1 expression. Primary human chondrocytes isolated from macroscopically normal cartilage were serum-starved overnight then re-fed with serum-replete media with/without interleukin 1β (IL-1β) (10 ng/mL), hydrogen peroxide (100 µM) or basic calcium phosphate (BCP) crystals (50 µg/mL). Peak level of BMAL1 was lower, whereas PER2 levels remained elevated for longer, in chondrocytes treated with IL-1β, hydrogen peroxide or BCP crystals compared to untreated cells. Levels of SOX9 were lower, whereas levels of ADAMTS5 and MMP13 were higher, in chondrocytes exposed to any of the three treatments compared to untreated cells. Knockdown of PER2 using siRNA partially abrogated the effects of each treatment on chondrocyte phenotype marker expression. Similarly, in chondrocytes isolated from osteoarthritic cartilage PER2 knockdown was associated with increased SOX9, reduced ADAMTS5 and reduced RNA and protein levels of MMP13 indicating partial mitigation of the osteoarthritic phenotype. Conversely, further ablation of BMAL1 expression in osteoarthritic chondrocytes resulted in a further reduction in SOX9 and increase in MMP13 expression. Overexpression of PER2 in the H5 chondrocyte cell line led to increased ADAMTS5 and MMP13 and decreased SOX9 expression. Localised inflammation, oxidative stress and BCP crystal deposition in osteoarthritic joints may contribute to disease pathology by inducing changes in the chondrocyte circadian clock. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
18. Basic Calcium Phosphate Crystals Induce Osteoarthritis-Associated Changes in Phenotype Markers in Primary Human Chondrocytes by a Calcium/Calmodulin Kinase 2-Dependent Mechanism.
- Author
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Rong, Jing, Pool, Bregina, Zhu, Mark, Munro, Jacob, Cornish, Jillian, McCarthy, Geraldine M., Dalbeth, Nicola, and Poulsen, Raewyn
- Subjects
- *
CALMODULIN , *CALCIUM phosphate , *CARTILAGE cells , *CRYSTALS - Abstract
Chondrocytes in osteoarthritis undergo a phenotype shift leading to increased production of cartilage-degrading enzymes. There are similarities between the phenotype of osteoarthritic chondrocytes and those of growth plate chondrocytes. Hydroxyapatite can promote chondrocyte differentiation in the growth plate. Basic calcium phosphate (BCP) crystals (which consist of hydroxyapatite, octacalcium apatite and tricalcium phosphate) are frequently found in osteoarthritic joints. The objective of this study was to determine whether BCP crystals induce disease-associated changes in phenotypic marker expression in chondrocytes. Primary human chondrocytes isolated from macroscopically normal cartilage were treated with BCP for up to 48 h. Expression of indian hedgehog (IHH), matrix metalloproteinase 13 (MMP13), interleukin-6 (IL-6) and type X collagen (COLX) were higher, and expression of sry-box 9 (SOX9) lower, in BCP-treated chondrocytes (50 µg/mL) compared to untreated controls. COLX protein was also present in BCP-treated chondrocytes. Intracellular calcium and levels of phosphorylated and total calcium/calmodulin kinase 2 (CaMK2) were elevated following BCP treatment due to BCP-induced release of calcium from intracellular stores. CaMK2 inhibition or knockdown ameliorated the BCP-induced changes in SOX9, IHH, COLX, IL-6 and MMP13 expression. BCP crystals induce osteoarthritis-associated changes in phenotypic marker expression in chondrocytes by calcium-mediated activation of CaMK2. The presence of BCP crystals in osteoarthritic joints may contribute to disease progression. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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19. Can drugs trigger CPPD acute attacks?
- Author
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Huang, Yun-Ju and Kuo, Chang-Fu
- Subjects
- *
CHONDROCALCINOSIS , *GRANULOCYTE-colony stimulating factor , *PHOSPHATE metabolism , *AGE distribution , *COMPARATIVE studies , *DIPHOSPHONATES , *RESEARCH methodology , *MEDICAL cooperation , *MEMBRANE proteins , *PATIENT safety , *RESEARCH , *RISK assessment , *EVALUATION research , *ACUTE diseases - Published
- 2019
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20. Identification and characterization of peripheral vascular color-coded DECT lesions in gout and non-gout patients: The VASCURATE study
- Author
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Hyon K. Choi, Jean-François Budzik, Fabio Becce, Paul Carpentier, V. Ducoulombier, Julie Legrand, Eric Houvenagel, Sébastien Verclytte, Tristan Pascart, Laurène Norberciak, and Hélène Luraschi
- Subjects
medicine.medical_specialty ,Gout ,Arterial calcifications ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Monosodium urate ,medicine ,Crystal arthropathy ,Humans ,030212 general & internal medicine ,030203 arthritis & rheumatology ,Arthritis, Gouty ,business.industry ,Soft tissue ,medicine.disease ,INCEPTION COHORT ,Uric Acid ,Peripheral ,Anesthesiology and Pain Medicine ,Concomitant ,Radiology ,Tomography, X-Ray Computed ,business ,Follow-Up Studies - Abstract
To characterize peripheral vascular plaques color-coded as monosodium urate (MSU) deposition by dual-energy computed tomography (DECT) and assess their association with the overall soft-tissue MSU crystal burden.Patients with suspected crystal arthropathies were prospectively included in the CRYSTALILLE inception cohort to undergo baseline knees and ankles/feet DECT scans; treatment-naive gout patients initiating treat-to-target urate-lowering therapy (ULT) underwent repeated DECT scans with concomitant serum urate level measurements at 6 and 12 months. We determined the prevalence of DECT-based vascular MSU-coded plaques in knee arteries, and assessed their association with the overall DECT volumes of soft-tissue MSU crystal deposition and coexistence of arterial calcifications. DECT attenuation parameters of vascular MSU-coded plaques were compared with dense calcified plaques, control vessels, control soft tissues, and tophi.We investigated 126 gout patients and 26 controls; 17 ULT-naive gout patients were included in the follow-up study. The prevalence of DECT-based vascular MSU-coded plaques was comparable in gout patients (24.6%) and controls (23.1%; p=0.87). Vascular MSU-coded plaques were strongly associated with coexisting arterial calcifications (p0.001), but not with soft-tissue MSU deposition. Characterization of vascular MSU-coded plaques revealed specific differences in DECT parameters compared with control vessels, control soft tissues, and tophi. During follow-up, vascular MSU-coded plaques remained stable despite effective ULT (p=0.64), which decreased both serum urate levels and soft-tissue MSU volumes (p0.001).Our findings suggest that DECT-based MSU-coded plaques in peripheral arteries are strongly associated with calcifications and may not reflect genuine MSU crystal deposition. Such findings should therefore not be a primary target when managing gout patients.
- Published
- 2021
21. Advanced Imaging in the Diagnosis of Gout and Other Crystal Arthropathies.
- Author
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Teh, James, McQueen, Fiona, Eshed, Iris, Plagou, Athena, and Klauser, Andrea
- Subjects
- *
GOUT diagnosis , *JOINT disease diagnosis , *MAGNETIC resonance imaging , *DUAL energy CT (Tomography) , *ULTRASONIC imaging - Abstract
In recent years significant advances have been made in imaging techniques. Dual-energy computed tomography has revolutionized the ability to detect and quantify gout. The key ultrasound features of gout have been defined. Magnetic resonance imaging is an excellent modality for demonstrating the extent and severity of crystal arthropathies, but the findings may be nonspecific. This article summarizes the use of advanced imaging techniques in the diagnosis and assessment of gout and other crystal arthropathies. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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22. The diagnostic value of conventional radiography and musculoskeletal ultrasonography in calcium pyrophosphate deposition disease: a systematic literature review and meta-analysis
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J.A. Di Battista, Carlo Alberto Scirè, Walter Grassi, Georgios Filippou, Emilio Filippucci, Fausto Salaffi, A. Di Matteo, Edoardo Cipolletta, Cipolletta, E, Filippou, G, Scire, C, Di Matteo, A, Di Battista, J, Salaffi, F, Grassi, W, and Filippucci, E
- Subjects
Biomedical Engineering ,Chondrocalcinosis ,Diagnostic accuracy ,Disease ,Calcium Pyrophosphate ,Sensitivity and Specificity ,Crystal arthropathy ,Tendons ,chemistry.chemical_compound ,Rheumatology ,Musculoskeletal ultrasonography ,Synovial Fluid ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Fascia ,Muscle, Skeletal ,Conventional radiography ,Ultrasonography ,business.industry ,Calcium pyrophosphate ,Calcium pyrophosphate deposition disease ,Radiography ,Systematic review ,chemistry ,Meta-analysis ,Ligaments, Articular ,Joints ,Nuclear medicine ,business - Abstract
Objective: To examine and compare the accuracy of conventional radiography (CR) and musculoskeletal ultrasonography (US) in the diagnosis of calcium pyrophosphate (CPP) crystals deposition disease (CPPD). DESIGN: A systematic search of electronic databases (PubMed, Embase, and Cochrane), conference abstracts and reference lists was undertaken. Studies which evaluated the accuracy of CR and/or US in the diagnosis of CPPD, using synovial fluid analysis (SFA), histology or classification criteria as reference tests were included. Subgroup analyses by anatomic site and by reference test were performed. Results: Twenty-six studies were included. Using SFA/histology as reference test, CR and US showed an excellent (CR AUC = 0.889, 95%CI = 0.811–0.967) and an outstanding (US AUC = 0.954, 95%CI = 0.907–1.0) diagnostic accuracy (p < 0.01), respectively. Furthermore, US showed a higher sensitivity (0.85, 95%CI = 0.79–0.90 vs 0.47, 95%CI = 0.40–0.55) and only a little lower specificity (0.87, 95%CI = 0.83–0.91 vs 0.95, 95%CI = 0.92–0.97) than CR. A considerable heterogeneity between the studies was found, with adopted reference test being the main source of heterogeneity. In fact, subgroup analysis showed a significant change in the diagnostic accuracy of CR, but not of US, using Ryan and McCarty criteria or SFA/histology as reference test (CR: AUC = 0.956, 95%CI = 0.925–1.0 vs AUC = 0.889, 95%CI = 0.828–0.950, respectively, p < 0.01) (US: AUC = 0.922, 95%CI = 0.842–1.0 vs AUC = 0.957, 95%CI = 0.865–1.0, respectively, p = 0.08) Conclusions: Although US is more sensitive and a little less specific than CR for identifying CPP crystals, both these two techniques showed a great diagnostic accuracy and should be regarded as complementary to each other in the diagnostic work-up of patients with CPPD.
- Published
- 2021
23. 20 Years of Radiographic Imaging: Crystalline Deposits Causing Severe Arthropathy and Erosions
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Crystal Breighner, Sanket Meghpara, Sean Babb, Elianna Goldstein, Jefferson Roberts, and Victoria Mank
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musculoskeletal diseases ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Arthropathy ,Crystal arthropathy ,medicine ,030212 general & internal medicine ,education ,030203 arthritis & rheumatology ,education.field_of_study ,business.industry ,Public Health, Environmental and Occupational Health ,Arthrocentesis ,Calcium pyrophosphate ,General Medicine ,medicine.disease ,Dermatology ,Gout ,chemistry ,Joint pain ,medicine.symptom ,business ,Chondrocalcinosis - Abstract
Urate crystal gout arthritis and calcium pyrophosphate deposition disease (CPPD) are crystalline arthropathies seen in middle age to elderly patients, but are also seen in the active duty military population. Flares of either can be identified by acute joint pain, associated swelling, tenderness, and warmth. Definitive diagnosis involves synovial analysis from arthrocentesis. Gout and CPPD are common inflammatory joint diseases. Both arthropathies presenting themselves in the same joint are rather rare. An elderly female with a history of gout presented to the hospital with severe hip pain. She was on urate-lowering therapy at the time, and uric acid levels on admission were not significantly elevated. Radiographic imaging of her hip demonstrated periarticular cartilage calcifications. A review of radiographic imaging over the last 20 years found significant erosive arthropathy in multiple joints and radiographic evidence of chondrocalcinosis, suggesting CPPD. Synovial analysis was not obtained during this admission as the patient declined procedures due to her elderly age. Her condition improved with oral steroids. Few literatures have demonstrated that gout and CPPD are common crystal arthropathies that can occur concomitantly in the same joint. A 20-year review of imaging in an elderly female with known gout arthropathy found that she had radiographic evidence of concomitant CPPD-associated damage to many of her joints. Clinicians should be aware of the different erosive arthropathies, their corresponding imaging findings, evaluation for underlying metabolic disorders if appropriate, and the possibility that they may occur in the same joint. Early prevention can reduce joint destruction later in life.
- Published
- 2021
24. Wichtige Differenzialdiagnosen von Mon- und Oligoarthritiden
- Author
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Anna Kernder and Philipp Sewerin
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Anamnesis ,medicine.medical_specialty ,Oligoarthritis ,medicine.diagnostic_test ,business.industry ,Physical examination ,General Medicine ,medicine.disease ,Crystal arthropathy ,Medicine ,Synovial fluid ,Reactive arthritis ,Septic arthritis ,Radiology ,Differential diagnosis ,business - Abstract
Reasons of mon- and oligoarthritis are heterogeneous. The diagnostic approach includes a detailed medical anamnesis, physical examination and imaging (conventional X-ray, sonography, MRI and, CT). Analysis of the synovial fluid is required in suspected septic arthritis and frequently helps in diagnosis and differential diagnosis of crystal arthropathies. Dual-energy-CT (DECT) detects sodium urate crystals and can replace joint puncture in some cases. In addition to crystal arthropathies and septic arthritis, differential diagnosis of mon-/oligoarthritis includes reactive arthritis, arthrosis and monarthritic courses of SpA/PsA. A rheumatologist should be consulted particularly in the case of persistent monarthritides, in order to initiate a specific therapy to prevent secondary damage.
- Published
- 2021
25. Imaging of crystal disorders: calcium pyrophosphate dihydrate crystal deposition disease, calcium hydroxyapatite crystal deposition disease and gout pathophysiology, imaging, and diagnosis
- Author
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Reijnierse, M., Schwabl, C., and Klauser, A.
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Calcium pyrophosphate ,Gout ,CPPD ,Crystal arthropathy ,Hydroxyapatite ,Barbotage - Abstract
Crystal arthropathies are a group of joint disorders due to deposition of crystals in and around joints, which lead to joint destruction and soft tissue masses. Clinical presentation is variable and diagnosis might be challenging. Therefore, first-line imaging of ultrasound in accessible joints is recommended to assess crystal arthropathies; however, DECT is a useful adjunct to differentiate gout from CPPD.
- Published
- 2022
26. Differenzialdiagnose Rückenschmerzen mit Entzündungsparametern: Fallvorstellung: Manifestation einer CPPD als Crowned Dens Syndrom mit Befall peripherer Gelenke
- Author
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Frank W. Roemer, Georg Schett, Arnd Kleyer, and Bernhard Manger
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030203 arthritis & rheumatology ,Gynecology ,medicine.medical_specialty ,business.industry ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Crystal arthropathy ,medicine ,Pseudogout ,business ,030217 neurology & neurosurgery ,Chondrocalcinosis - Abstract
ZusammenfassungDer aktuelle Fall beschreibt den Fall eines 84 jährigen Patienten mit zunächst unklaren Rückenschmerzen und hohen Entzündungsparameter. Nach Ausschluss infektiöser Ursache konnte im Verlauf eine CPPD (Calcium pyrophosphat deposition disease) Erkrankung mit Wirbelsäulenbefall diagnostiziert werden. Neue radiologische Segmentierungsverfahren erlaubten zudem die Detektion von CPPD Kristallen in peripheren Gelenken. Nach Gabe von Prednisolon und Kineret konnte die Beschwerdesymptomatik erfolgreich behandelt werden.
- Published
- 2021
27. Gout and Other Crystal Arthritides
- Author
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Joan McTigue
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,Crystal arthropathy ,General Medicine ,medicine.disease ,business ,Dermatology ,Gout - Published
- 2021
28. Langsam progrediente Gelenkzerstörung bei einem älteren Mann als Ausdruck einer Hydroxylapatiterkrankung. Fallbericht und Literaturübersicht
- Author
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Zipfel, N., Dießel, L., Delank, K.-S., Keyßer, G., and Schäfer, C.
- Published
- 2020
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29. Arthroscopic diagnosis and medical management of calcium pyrophosphate deposition disease in the temporomandibular joint
- Author
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Carla M. Davis, Drew Smith, Daniel D. Choi, and Joseph P. McCain
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musculoskeletal diseases ,medicine.medical_specialty ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Internal medicine ,medicine ,Crystal arthropathy ,business.industry ,Calcium pyrophosphate ,030206 dentistry ,medicine.disease ,Rheumatology ,Temporomandibular joint ,Surgery ,medicine.anatomical_structure ,Otorhinolaryngology ,chemistry ,030220 oncology & carcinogenesis ,Joint pain ,Orthopedic surgery ,Oral Surgery ,Pseudogout ,medicine.symptom ,business ,Chondrocalcinosis - Abstract
Calcium pyrophosphate deposition disease (CPPD) is a crystal arthropathy that can involve the temporomandibular joint. It is known to accelerate the osteoarthritic process, often initially presenting with advanced level of disease. The management of CPPD in the rheumatology and orthopedic literature is one of early diagnosis and medical management of acute attacks. The cases of three patients who presented with initial complaints of joint pain and limited mouth opening are presented. Preoperative imaging identified calcifications in two of these patients. Definitive diagnosis was achieved through arthroscopic-assisted biopsy. Rheumatology referrals revealed chondrocalcinosis of the knee in one patient. All patients had improved mouth opening and pain.
- Published
- 2020
30. Calcium pyrophosphate deposition disease: The role of imaging in their detection and in differential diagnosis of crystal arthropathies
- Author
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Antonio Corvino, Pietro Venetucci, Antonio Catelli, Filippo Rosati Tarulli, Anna Castaldo, Mariapaola Carpiniello, Mariateresa De Angelis, and Giovanni Loiudice
- Subjects
lcsh:Medical physics. Medical radiology. Nuclear medicine ,musculoskeletal diseases ,Pathology ,medicine.medical_specialty ,Pseudogout ,endocrine system diseases ,lcsh:R895-920 ,Chondrocalcinosis ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,medicine ,Crystal arthropathy ,Radiology, Nuclear Medicine and imaging ,CPPD ,Hemochromatosis ,Hyperparathyroidism ,US ,business.industry ,Calcium pyrophosphate ,medicine.disease ,CT ,Imaging arthropathy ,chemistry ,Musculoskeletal ,Differential diagnosis ,business ,030217 neurology & neurosurgery ,Hypophosphatemia - Abstract
Calcium pyrophosphate deposition disease is characterized by the deposition of pyrophosphate crystals in various joint structures. Calcium pyrophosphate deposition disease can be linked to underlying metabolic disorders such as hemochromatosis, hyperparathyroidism, hypophosphatemia, hypomagnesaemia, and hypothyroidism, all of which increase the risk of calcium pyrophosphate deposition. We present the case of a 55-year-old male who underwent diagnostic examination for the onset of recurrent joint pain in the right knee.
- Published
- 2020
31. Gout mimicking spondyloarthritis: case report and literature review.
- Author
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Wenji Chen, Yanyan Wang, Yan Li, Zheng Zhao, Lixia Feng, Jian Zhu, Jianglin Zhang, and Feng Huang
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ARTHRITIS diagnosis ,METATARSOPHALANGEAL joint ,COMPUTED tomography ,MAGNETIC resonance imaging - Abstract
Gout is clinically characterized by episodes of monoarthritis, which not only typically affects the peripheral joints but also occasionally affect the axial joint, such as the sacroiliac joint (SIJ), and often mimics spondyloarthritis (SpA). Two cases of gout mimicking SpA are presented in the current paper. One patient was a 32-year-old man with a history of asymmetrical oligoarthritis of ankle and metatarsophalangeal joints (MTPJ). He had left gluteal pain for 2 weeks. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed the bone erosion of the left SIJ. T1-weighted MRI showed hypointense T1 and hyperintense T2 signals of the left SIJ. The other patient was a 24-year-old man with left back pain and hip pain for 4 months and intermittent fever for 3 months. He had a history of gout for 3 years. Both patients underwent CT-guided sacroiliac biopsy, and monosodium urate (MSU) crystals were shown by polarized microscopy. Gout can often mimic SpA and seldomly affects the SIJ. Thus, its correct diagnosis and adequate therapy can halt the development of such damaging complications. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
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32. Acute Inflammatory Arthropathy and Hypercalcemia Leading to a Diagnosis of Primary Hyperparathyroidism in a Patient With Known Sarcoidosis.
- Author
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Larsen K, Guma J, Mehannek R, and Guma M
- 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., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Larsen et al.)
- Published
- 2023
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33. Single source dual-energy computed tomography in the diagnosis of gout: Diagnostic reliability in comparison to digital radiography and conventional computed tomography of the feet.
- Author
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Kiefer, Tobias, Diekhoff, Torsten, Hermann, Sandra, Stroux, Andrea, Mews, Jürgen, Blobel, Jörg, Hamm, Bernd, Hermann, Kay-Geert A., and Hermann, Kay-Geert
- Subjects
- *
GOUT diagnosis , *DUAL energy CT (Tomography) , *FOOT radiography , *MEDICAL digital radiography , *URATES , *RHEUMATOLOGY , *COMPARATIVE studies , *COMPUTED tomography , *DIAGNOSTIC imaging , *FOOT , *GOUT , *RESEARCH methodology , *MEDICAL cooperation , *RADIOGRAPHY , *RESEARCH , *EVALUATION research , *RETROSPECTIVE studies ,RESEARCH evaluation - Abstract
Objectives: To investigate the diagnostic value of single-source dual-energy computed tomography (SDECT) in gouty arthritis and to compare its capability to detect urate depositions with digital radiography (DR) and conventional computed tomography (CT).Methods: Forty-four patients who underwent SDECT volume scans of the feet for suspected gouty arthritis were retrospectively analyzed. SDECT, CT (both n=44) and DR (n=36) were scored by three blinded readers for presence of osteoarthritis, erosions, and tophi. A diagnosis was made for each imaging modality. Results were compared to the clinical diagnosis using the American College of Rheumatology (ACR) classification criteria.Results: The patient population was divided into a gout (n=21) and control (n=23) group based on final clinical diagnosis. Osteoarthritis was evident in 15 joints using CT and 30 joints using DR (p=0.165). There were 134 erosions detected by CT compared to 38 erosions detected by DR (p<0.001). In total 119 tophi were detected by SDECT, compared to 85 tophi by CT (p=0.182) and 25 tophi by DR (p<0.001). SDECT had best diagnostic value for diagnosis of gout compared to DR and conventional CT (sensitivity and specificity for SDECT: 71.4% and 95.7%, CT: 71.4% and 91.3% and DR: 44.4% and 83.3%, respectively). For all three readers, Cohen's kappa for DR and conventional CT were substantial for all scoring items and ranged from 0.75 to 0.77 and 0.72-0.76, respectively. For SDECT Cohen's kappa was good to almost perfect with 0.77-0.84.Conclusions: SDECT is capable to detect uric acid depositions with good sensitivity and high specificity in feet, therefore diagnostic confidence is improved. Using SDECT, inter-reader variance can be markedly reduced for the detection of gouty tophi. [ABSTRACT FROM AUTHOR]- Published
- 2016
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34. Pseudo-abcès musculaire d'origine microcristalline : une localisation exceptionnelle de chondrocalcinose.
- Author
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Oliosi, E., Pointeau, O., Dacheux, C., Souchon, L., Dhôte, R., Mourad, J.-J., and Le Jeune, S.
- Abstract
Résumé Introduction La chondrocalcinose est un rhumatisme microcristallin provoqué par la présence de cristaux de pyrophosphate de calcium dans l'articulation. Nous rapportons une observation exceptionnelle de pseudo-abcès musculaire microcristallin mimant une infection ostéo-musculaire de hanche. Observation Un homme de 92 ans était hospitalisé pour l'exploration de douleurs inguinales gauches subaiguës. À l'examen clinique, le patient présentait une douleur inguinale et un psoïtis. Le bilan biologique montrait un syndrome inflammatoire. L'imagerie mettait en évidence plusieurs collections au sein des muscles iliopsoas et petit glutéal associées à une arthrite de hanche gauche. La ponction des collections rapportait un liquide inflammatoire stérile. L'analyse anatomopathologique révélait des cristaux de pyrophosphate de calcium, confirmant le diagnostic de pseudo-abcès aseptique lié à une chondrocalcinose, probablement conséquence d'une bursite de hanche. Le traitement médical associé au drainage radioguidé était partiellement efficace, le patient récidivant sous la forme de bursites multiples. Conclusion L'atteinte de chondrocalcinose de hanche est rare, et son association à une atteinte musculaire est exceptionnelle, avec à notre connaissance seule 4 autres cas publiés dans la littérature. Le mécanisme le plus probable est une infiltration par contiguïté avec formation d'un pseudo-abcès aseptique musculaire. Un mécanisme primitif par néoformation musculaire de microcristaux est également discuté. Une revue des cas publiés dans la littérature montre une évolution favorable mais parfois au prix d'un drainage chirurgical. Cette atteinte doit être connue et distinguée des abcès musculaires d'origine infectieuse. Abstract Introduction Chondrocalcinosis results from calcium pyrophosphate crystals deposition in the joints. We report an exceptional case of aseptic psoas abscess with a deposition of calcium pyrophosphate crystals. Case report A 92-year-old man presented to our department for an acute onset of inflammatory pain in the left hip. Computed tomography detected a coxofemoral arthritis and multiple intramuscular collections located in the iliopsoas muscle and the gluteus minimus. A sample of the fluid was obtained with a guided aspiration, and its analysis revealed an inflammatory liquid with no bacteria but numerous calcium pyrophosphate crystals. The final diagnosis was thus a muscular calcium pyrophosphate deposition pseudo-abscess, associated with a hip arthritis. Conclusion Hip chondrocalcinosis is unusual, and the association with intramuscular deposition of calcium pyrophosphate crystals seems extremely rare as we found only four other published cases. A microcrystalline arthritis could have spread from the coxofemoral joint through the iliopsoas bursa and into the muscle. However, the imaging aspect with an abscess and a predominant muscular injury might suggest a mechanism of crystal formation originating directly within the muscle. The outcome was always favourable even if some patients required surgery. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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35. Nonoperative Treatment of a Periprosthetic Gout Flare in the Setting of a Positive Alpha-Defensin Result
- Author
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Matthew Kelly, Kalain K. Workman, and David S. Phillips
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,Prosthetic joint infection ,Gout ,Total knee arthroplasty ,Periprosthetic ,Case Report ,Alpha defensin ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Crystal arthropathy ,Synovial fluid ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Orthopedic surgery ,030222 orthopedics ,business.industry ,fungi ,medicine.disease ,Surgery ,Alpha-defensin assay ,Knee pain ,Concomitant ,medicine.symptom ,business ,RD701-811 - Abstract
Gout is a rare cause of pain after total knee arthroplasty, and its presentation can be difficult to distinguish from a prosthetic joint infection. We describe a patient with left knee pain that had a history of gout and left total knee arthroplasty. Synovial fluid demonstrated monosodium urate crystals and positive alpha-defensin assay. Surgery was not pursued given a low clinical suspicion for infection and negative cultures. Her symptoms improved and ultimately resolved. There are limited case reports of periprosthetic aseptic gout flare, and only one case of concomitant positive alpha-defensin assay and monosodium urate crystals in a patient treated surgically. This case raises the possibility that patients with periprosthetic crystal arthropathy and a positive alpha-defensin test can be managed nonoperatively in the appropriate setting.
- Published
- 2021
36. Histopathologische Differenzialdiagnostik von Kristall-Arthritiden
- Author
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W. Waldstein, M. Liebisch, V. Krenn, N. Badiian, and Veit Krenn
- Subjects
Chemistry ,Kalziumkarbonat ,Crystal arthropathy ,General Medicine ,Calcium Pyrophosphate Dihydrate Deposition ,Crystal induced arthritis ,Calcium pyrophosphate dihydrate ,Molecular biology - Abstract
Wenngleich Kristall-induzierte Gelenkerkrankungen mehrheitlich auf klinischen, serologischen und bildgebenden Diagnosekriterien beruhen, kann die histopathologische Diagnostik einen wesentlichen Beitrag leisten. Ein umfassendes Spektrum dieser histopathologischen Differenzialdiagnostik ist im Gelenk-Pathologie- und im Gelenk-Partikel-Algorithmus dargelegt. Dies ist dahingehend von Bedeutung, da oft erst durch diese histopathologische Diagnostik Erkrankungen erkannt werden konnen, welche in der initialen klinischen Diagnostik nicht berucksichtigt worden sind. Die wichtigsten Kristall-induzierten Gelenkerkrankungen und deren Differenzialdiagnosen umfassen folgende Depositionen: Urat-Kristalle, Kalziumpyrophosphat-Kristalle, kalkartige Depositionen (basisches Kalziumphosphat, Kalziumkarbonat), Knochen-Trabekelfragmente, Blutungsresiduen (Hamosiderin-Granula, Hamatoidin-Konkremente, Gandy-Gamna-Korper, Formalin-Pigment), Lipideinschlusse und Amyloid-Depositionen. Wesentlich fur die Qualitat der Diagnostik ist die Ubersendung des Gewebes in unterschiedlichen und somit getrennten Fraktionen, da diese krankhaften Veranderungen multifokal im Gelenk vorliegen konnen. Die Gewebeubersendung erfolgt ublicherweise in 5 % gepuffertem Formalin. Bei der Fragestellung nach Urat-Kristall-Arthritis bzw. Urat-Arthropathien empfiehlt sich die Ubersendung eines Teil der Gewebeproben in Alkohol und einer anschliesenden wasserfreien bzw. wasserreduzierten Entwasserung, da Urat-Kristalle wasserloslich sind und bei Wasserkontakt insbesondere aus kleinen Geweben herausgelost werden konnen. Diese Modalitat stellt aber keine Notwendigkeit dar, da Kristallablagerungen im Allgemeinen auch indirekt, uber das Gewebe-Reaktionsmuster (z. B. Urat-Tophus) und uber die oft erhaltenen Kristallmatrix mittels der Histopathologie nachweisbar sind. The contribution of histopathology in the diagnosis of crystal induced arthritis and crystal induced arthropathies is manifold since the histopathologic differential diagnosis includes the complete spectrum of synovial diseases. This heterogenous pathogenetic spectrum is described in the joint pathology algorithm and the particle algorithm which includes inflammatory and non-inflammatory diseases, endogenous- and non-endogenous particles and particle like artefacts. Gout is the most common crystal arthropathy, followed by calcium pyrophosphate dihydrate deposition diseases, basic calciumcarbonat and calcium-phosphate arthropathies (tumor like calcinosis) and in very rare cases calcium oxalate crystal arthropathy. Crystal- and crystal-like deposits are heterogenous by its morphology and etiology and include: gout-crystals, calcium pyrophosphate dihydrate crystals, basic calcium carbonate and calcium-phosphate-deposits, haemosiderin and haematoidin-depositis, Gandy-Gamna bodies, small bone fragments, lipid droplets and amyloid-deposits. These crystals and deposits are responsible for different inflammatory and non-inflammatory arthropathies. Identification of crystals and crystal-like deposits should be carried out with the application of the joint particle algorithm which addresses the identification of endogenous- and non endogenous particle deposits in the synovial tissues. Tissue samples should be fixed in formalin but also in an alcohol since the later allows a direct identification of gout crystals by histopathology.
- Published
- 2020
37. Detection of Subclinical Crystal Arthropathy in Primary Knee Osteoarthritis Patients
- Author
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Mohamed Elwan Said, Mohamed Moneer Rayan, and Mohamed Hesham Mohamed Shehata
- Subjects
musculoskeletal diseases ,030203 arthritis & rheumatology ,medicine.medical_specialty ,WOMAC ,medicine.diagnostic_test ,business.industry ,Physical examination ,Osteoarthritis ,medicine.disease ,Rheumatology ,03 medical and health sciences ,0302 clinical medicine ,030502 gerontology ,Synovitis ,Internal medicine ,medicine ,Crystal arthropathy ,Synovial fluid ,Radiology ,0305 other medical science ,business ,Chondrocalcinosis - Abstract
Background: Crystal deposition is one of the most common arthropathies among the elderly. Similarly, osteoarthritis (OA) considers the most common joint pathology amongst the elderly; it is usually associated with significant pain, disability, and even synovitis. Objective: The aim of the work was to detect Crystals in Non-symptomatized crystal arthropathy in cases of primary knee Osteoarthritis. Patients and Methods: 50 patients with primary knee osteoarthritis who diagnosed according to the American College of Rheumatology classification criteria for osteoarthritis. Patients underwent to history taking, clinical examination, laboratory examination, knee US, plain radiography and synovial fluid analysis. Results: Fifty patients (35 females, 15 males) were enrolled. Mean values were 65.4 years ± 13.5 SD for age and 50.7 months ± 35.5 SD for disease duration. Plain radiography revealed chondrocalcinosis in 4 patients (8%). Crystals were detected by US in 36 knees (72%), 24 patients had calcification characteristic of CPPD and 12 patients had calcifications characteristic of MSU crystals deposition. synovial fluid examination revealed crystal deposition in 38 knees (76%), it was MSU in 12 patients and CPPD in 26 patients. The sensitivity of US for the detection of calcification was (83.3%) while that of plain X-ray was (22.2%), and the specificity was (93.8%) and (90.2%) respectively. There is statistically significant difference between patients with crystal deposition and patients without crystal deposition as regard WOMAC stiffness score. Conclusion: Subclinical crystals were detected in a significant number of Primary Knee Osteoarthritis Patients. US showed high specificity and acceptable sensitivity for the diagnosis of Crystal Arthropathy.
- Published
- 2020
38. Giht, suvremeni pogled na drevnu bolest
- Author
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Nadica Laktašić Žerjavić, Nadia Hoteit, and Dragica Soldo Jureša
- Subjects
medicine.medical_specialty ,business.industry ,Crystal arthropathy ,Medicine ,General Medicine ,business ,medicine.disease ,Dermatology ,Gout - Abstract
Giht je kronična metabolička, no istovremeno i upalna reumatska bolest koja nastaje kao posljedica hiperuricemije i taloženja kristala mononatrijeva urata. Glavni uzrok hiperuricemije je smanjeno bubrežno izlučivanje urata. U patogenezi upalnog odgovora na kristale urata važna je fagocitoza kristala od strane makrofaga koja dovodi do aktivacije inflamasoma NLRP3 i posljedičnog oslobađanja glavnog proupalnog citokina u gihtu interleukina 1β. Neadekvatno liječenje hiperuricemije dovodi do razvoja kroničnog gihta s tofima, značajnih strukturnih oštećenja zglobova s umanjenom funkcionalnom sposobnosti i kvalitetom života. Stoga je važno dugotrajno liječenje usmjereno k cilju održavanja koncentracije urata < 350 umol/L, a u težem obliku bolesti s tofima < 300 umol/L. Akutni artritis u gihtu i akutizaciju kroničnog gihta treba liječiti protuupalnim lijekovima: nesteroidnim antireumaticima, kolhicinom ili glukokortikoidima, uglavnom po monoterapijskom principu. Pacijente s gihtom treba pažljivo pratiti radi udruženih bolesti, posebice bubrežne bolesti, hipertenzije, metaboličkog sindroma i povišenog kardiovaskularnog rizika.
- Published
- 2020
39. Auricular Multiple Tophi Presenting as Painful Bilateral Nodules: A Case Report and Literature Review
- Author
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Jeong Hwan Choi
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,Crystal arthropathy ,General Medicine ,medicine.disease ,business ,Dermatology ,Ear Auricle ,Gout - Published
- 2020
40. Two cases of calcium pyrophosphate deposition disease (CPPD) presented with spondylodiscitis
- Author
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Tugba Izci Duran and Metin Ozgen
- Subjects
030203 arthritis & rheumatology ,musculoskeletal diseases ,lcsh:Immunologic diseases. Allergy ,medicine.medical_specialty ,Case-based Review ,business.industry ,Inflammatory arthritis ,Calcium pyrophosphate ,Arthritis ,Osteoarthritis ,medicine.disease ,Dermatology ,03 medical and health sciences ,Myelopathy ,chemistry.chemical_compound ,0302 clinical medicine ,chemistry ,medicine ,Back pain ,Crystal arthropathy ,Pseudogout ,medicine.symptom ,business ,lcsh:RC581-607 ,030217 neurology & neurosurgery - Abstract
Calcium pyrophosphate deposition disease (CPPD) is a crystal arthropathy, and may present with various clinical manifestations such as asymptomatic CPPD, osteoarthritis with CPPD, acute CPPD crystal arthritis (formerly pseudogout), and chronic CPPD crystal inflammatory arthritis. It is known that aging, trauma and osteoarthritis are major risk factors for CPPD. Acute CPP arthritis may occur as monoarticular or oligoarticular and usually involves large peripheral joints such as the knees, wrists and ankles. CPPD is characterized by sudden onset of severe pain, swelling and periarticular erythema, and systemic symptoms such as fever, chills, and weakness may occur. On the other hand, axial CPPD has been reported rarely and most cases appear with symptoms related to a mass effect such as foramen magnum syndrome, spinal stenosis, radiculopathy, myelopathy, synovial cyst or cauda equina syndrome. In addition, there are fewer reported cases of spinal CPPD that cause neck and back pain. This clinical condition should be considered in the differential diagnosis of acute neck and back pain.
- Published
- 2020
41. Patients Presenting with a Hot, Swollen Joint: A Single-Centre Retrospective Analysis
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Fidel Peat, Khaled M Yaghmour, Wasim S. Khan, and Emanuele Chisari
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Male ,medicine.medical_specialty ,Gout ,Elbow ,Chondrocalcinosis ,Knee Joint ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Internal medicine ,Monoarthritis ,Crystal arthropathy ,Humans ,Medicine ,Synovial fluid ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,030203 arthritis & rheumatology ,business.industry ,Middle Aged ,medicine.disease ,United Kingdom ,medicine.anatomical_structure ,Female ,Pseudogout ,Emergency Service, Hospital ,business - Abstract
Background: A hot, swollen joint is a common clinical condition encountered in the ED and elective orthopaedic and rheumatology clinics. These patients can be difficult to manage and properly treat. Aims and Objectives: The aim of this study was to report a single centre retrospective analysis of patients presenting to our institution for a hot, swollen joint over a three-month period. Methods: The study included patients presenting with a hot, swollen joint to ED or electively to clinics. The synovial fluid was aspirated and sent for microbiological and cytological investigation. P value was set to < 0.001. 36 patients (22 M, 14 F) with a mean age of 72.8 ± 17.4 years met our criteria. 20 cases (55.6 %) involved the knee joint, the wrist in 10 cases (27.8%), the elbow in 3 cases (8.3%) and the shoulder in 3 cases (8.3%). Results: Of the 36 synovial fluid samples collected, only 7 (19.4%) reported evidence of infection. On cytological examination of the synovial fluid, 21 (58.3%) reported presence of calcium pyrophosphates crystals (Pseudogout), 4 (11.1 %) reported presence of uric acid crystals (Gout) and 11 (30.5%) reported absence of crystals. We found a significant correlation between age and the diagnosis of pseudogout and between previous antibiotic treatment and ED presentation. Our study sheds light on the high incidence of crystal-related pathologies. Conclusion: In order to improve our management of this common condition and enhance our understanding of the clinical diagnosis in certain patient population, further high-profile clinical studies are needed.
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- 2020
42. Dual-energy CT in the differentiation of crystal depositions of the wrist: does it have added value?
- Author
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Torsten Diekhoff, Kay-Geert A. Hermann, Katharina Ziegeler, Bernd Hamm, and Sandra Hermann
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Male ,Wrist Joint ,Crystal Arthropathies ,Wrist ,Sensitivity and Specificity ,030218 nuclear medicine & medical imaging ,Diagnosis, Differential ,Radiography, Dual-Energy Scanned Projection ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Medical imaging ,medicine ,Crystal arthropathy ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,Retrospective Studies ,030203 arthritis & rheumatology ,business.industry ,Reproducibility of Results ,Calcium pyrophosphate ,Digital Enhanced Cordless Telecommunications ,Dual-Energy Computed Tomography ,medicine.disease ,medicine.anatomical_structure ,chemistry ,Case-Control Studies ,Female ,Dual energy ct ,Tomography, X-Ray Computed ,Nuclear medicine ,business ,Chondrocalcinosis - Abstract
To evaluate the ability of dual-energy computed tomography (DECT) to improve diagnostic discrimination between gout and other crystal arthropathies such as calcium pyrophosphate deposition disease (CPPD) of the wrist in a clinical patient population. This retrospective case-control study included 29 patients with either gout (case group; n = 9) or CPPD (control group; n = 20) who underwent DECT of the wrist for clinically suspected crystal arthropathy. Color-coded urate and enhanced calcium as well as virtual 120 kVe blended images were reconstructed from the DECT datasets. Two independent and blinded readers evaluated each reconstructed dataset for the presence of depositions in 17 predefined regions. Additionally, a global diagnosis was made first for 120 kVe images only, based solely on morphologic criteria, and subsequently for all reconstructed images. Sensitivity for the global diagnosis of gout was 1.0 (95% CI 0.63–1) for both DECT and 120 kVe images with specificities of 0.70 (95% CI 0.46–0.87) for DECT and 0.80 (95% CI 0.56–0.93) for 120 kVe images. Color-coded DECT images did not detect more depositions than monochrome standard CT images. Discrimination of crystal arthropathies of the wrist is limited using DECT and primarily relying on color-coded images. Evaluation of morphologic criteria on standard CT images is essential for accurate diagnosis.
- Published
- 2019
43. The diagnostic value of conventional radiography and musculoskeletal ultrasonography in calcium pyrophosphate deposition disease: a systematic literature review and meta-analysis
- Abstract
Objective: To examine and compare the accuracy of conventional radiography (CR) and musculoskeletal ultrasonography (US) in the diagnosis of calcium pyrophosphate (CPP) crystals deposition disease (CPPD). DESIGN: A systematic search of electronic databases (PubMed, Embase, and Cochrane), conference abstracts and reference lists was undertaken. Studies which evaluated the accuracy of CR and/or US in the diagnosis of CPPD, using synovial fluid analysis (SFA), histology or classification criteria as reference tests were included. Subgroup analyses by anatomic site and by reference test were performed. Results: Twenty-six studies were included. Using SFA/histology as reference test, CR and US showed an excellent (CR AUC = 0.889, 95%CI = 0.811–0.967) and an outstanding (US AUC = 0.954, 95%CI = 0.907–1.0) diagnostic accuracy (p < 0.01), respectively. Furthermore, US showed a higher sensitivity (0.85, 95%CI = 0.79–0.90 vs 0.47, 95%CI = 0.40–0.55) and only a little lower specificity (0.87, 95%CI = 0.83–0.91 vs 0.95, 95%CI = 0.92–0.97) than CR. A considerable heterogeneity between the studies was found, with adopted reference test being the main source of heterogeneity. In fact, subgroup analysis showed a significant change in the diagnostic accuracy of CR, but not of US, using Ryan and McCarty criteria or SFA/histology as reference test (CR: AUC = 0.956, 95%CI = 0.925–1.0 vs AUC = 0.889, 95%CI = 0.828–0.950, respectively, p < 0.01) (US: AUC = 0.922, 95%CI = 0.842–1.0 vs AUC = 0.957, 95%CI = 0.865–1.0, respectively, p = 0.08) Conclusions: Although US is more sensitive and a little less specific than CR for identifying CPP crystals, both these two techniques showed a great diagnostic accuracy and should be regarded as complementary to each other in the diagnostic work-up of patients with CPPD.
- Published
- 2021
44. Crystalline-Induced Arthropathy Following Total Knee Replacement
- Author
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Adam M Green, Anthony Gemayel, and Eric Silberg
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,Inflammatory arthritis ,medicine.medical_treatment ,painful total knee ,Total knee replacement ,knee ,Physical examination ,gout ,Rheumatology ,Arthropathy ,medicine ,Crystal arthropathy ,total knee replacement (tkr) ,crystal arthropathy ,medicine.diagnostic_test ,business.industry ,General Engineering ,medicine.disease ,Arthroplasty ,Gout ,Surgery ,Orthopedics ,Erythrocyte sedimentation rate ,arthroplasty ,business - Abstract
Gout rarely occurs in the setting of prior total joint replacement. It can present as an acute or chronic painful joint that may mimic prosthetic joint infection with further similarities found on physical examination and initial workup. Elevated leukocyte count, erythrocyte sedimentation rate, and C-reactive protein are common to both conditions. The confirmatory test to distinguish infection versus inflammatory arthropathy is joint aspiration with crystal or micro-organism identification microscopically. Establishing proper diagnosis is important in guiding appropriate treatment, which may prevent the unnecessary removal of implants. The current study includes a review of the literature and presents a case of bilateral gouty arthropathy after total knee arthroplasty.
- Published
- 2021
45. The DIGICOD cohort: A hospital-based observational prospective cohort of patients with hand osteoarthritis - methodology and baseline characteristics of the population
- Author
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Bruno Fautrel, Anne Miquel, Francis Berenbaum, Amel Touati, Emmanuel Maheu, Michel D. Crema, Tabassome Simon, Bernard Combe, Maxime Dougados, Jean-Denis Laredo, Damien Loeuille, Xavier Chevalier, Sophie Tuffet, Alexandra Rousseau, Pascal Richette, Alice Courties, François Rannou, Margreet Kloppenburg, Jérémie Sellam, Service de rhumatologie [CHU Saint-Antoine], CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Radiologie [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Service de pharmacologie - Dosage de médicaments [CHU Saint-Antoine], Service de rhumatologie [CHU Henri Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor, Département de Rhumatologie[Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, Service de rhumatologie [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de rhumatologie [CHU Pitié Salpêtrière] (GRC-08 EEMOIS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Leiden University Medical Center (LUMC), Service de Rhumatologie [CHU Lariboisière], Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Rhumatologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de rééducation et de réadaptation de l'appareil locomoteur et des pathologies du rachis [CHU Cochin], Service de Neuroradiologie [CHU Lariboisière], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP]
- Subjects
Male ,medicine.medical_specialty ,Hand Joints ,Visual analogue scale ,Population ,Osteoarthritis ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Interquartile range ,Internal medicine ,medicine ,Crystal arthropathy ,Humans ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,education ,Aged ,030203 arthritis & rheumatology ,education.field_of_study ,business.industry ,Cohort ,Middle Aged ,medicine.disease ,Hand ,Hospitals ,3. Good health ,Erosive hand osteoarthritis ,[SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system ,Female ,business ,Cohort study - Abstract
Objective: Despite its prevalence, there are few worldwide hand osteoarthritis (HOA) cohorts. The main objective of DIGItal COhort Design (DIGICOD) cohort is to investigate prognostic clinical, biological, genetic and imaging factors of clinical worsening after 6 years follow-up.Methods: DIGICOD is a hospital-based prospective cohort including patients > 35 years-old with symptomatic HOA fulfilling: (i) ACR criteria for HOA with > 2 symptomatic joints among proximal/distal interphalangeal joints or 1st interphalangeal joint with Kellgren-Lawrence (KL) > 2; or (ii) symptomatic thumb base OA with KL > 2. Main exclusion criteria were inflammatory arthritis and crystal arthropathies. Annual clinical evaluations were scheduled with imaging (X-rays of the hands and of other OA symptomatic joints) and biological sampling every 3 years. Hand radiographs are scored using KL and anatomical Verbruggen-Veys scores. Follow-up visits are ongoing. Cohort methodology and baseline characteristics are presented.Results: Between April 2013 and June 2017, from the 436 HOA included patients, 426 have been analysed of whom 357 (84%) are women. Mean age +/- standard deviation was 66.7 +/- 7.3 years and mean disease duration was 12.6 +/- 9.6 years. Metabolic syndrome affected 151 (36.5%) patients. Mean Visual Analog Scale (VAS) hand pain (0-100 mm) was 44.4 +/- 26.7 mm at activity. Mean FIHOA (0-100) was 19.9 + 18.6. Elevated serum CRP level (>= 5 mg/L) involved 10% patients. Mean KL score (0-128) was 46.7 +/- 18 and the mean number ofjoint with KL >= 2 was 15.1 +/- 6.3. Erosive HOA (defined as >= 1 Erosive or Remodeling phase joint according to Verbruggen-Veys score) involved 195/426 (45.8%) patients and the median number (interquartile range) of erosive joints in erosive patients was 3.0 (1.0-5.0).Conclusion: DIGICOD is a unique prospective HOA cohort with a long-term 6 years standardized assessment and has included severe radiologically HOA patients with a high prevalence of erosive disease. 2021 Societe francaise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.
- Published
- 2021
46. Confusion With Presentations of Calcium Pyrophosphate Dihydrate Disease: A Report of Two Cases Mistaken for Cellulitis.
- Author
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Rana MS, Raza M, Arif M, Akinpelu T, and Waheed A
- Abstract
Both pseudogout and cellulitis are diseases that may mimic one another in clinical practice. We discuss two cases of acute calcium pyrophosphate dihydrate (CPPD) arthritis mistaken for cellulitis in the emergency department. Both patients experienced significant improvement after management was changed to treat CPPD. These cases highlight how it is essential for physicians to consider CPPD as a differential diagnosis for a patient that is presenting with signs of inflammation in any joint., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Rana et al.)
- Published
- 2023
- Full Text
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47. Synovium to Myocardium: A Case of Calcium Pyrophosphate Dihydrate Crystal Arthritis Associated With Myocardial Infarction.
- Author
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Raza M, Rana MS, Arif M, Akinpelu T, and Waheed A
- Abstract
Both gout and pseudogout are crystal-induced arthropathies. Here, we report a case of acute calcium pyrophosphate dihydrate (CPPD) arthritis associated with type 1 myocardial infarction (MI). An 83-year-old female presented to our emergency department with generalized weakness and bilateral lower extremity edema. Her left foot was noted to be more inflamed compared to the right, with cardinal signs of pain, swelling, erythema, and warmth. A presumptive diagnosis of cellulitis was made, and antibiotics were initiated. Further investigations revealed elevated troponins with new-onset bundle branch block, ST, and T-wave changes on electrocardiogram, indicating a type 1 MI. After a review of the patient's history, imaging of the extremity, elevated inflammatory markers, and the typical distribution and pattern of inflammation, the diagnosis was changed to pseudogout. Steroids and colchicine were initiated, providing instant relief. This case highlights a possible association between cardiovascular disease and pseudogout, emphasizing the need for further studies regarding this relationship. Despite being rare, physicians should be made aware of this relationship, especially in patients with a history of CPPD arthritis presenting with type 1 MI., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Raza et al.)
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- 2023
- Full Text
- View/download PDF
48. Gout and 'Podagra' in medieval Cambridge, England
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Dittmar, Jenna M, Mitchell, Piers D, Jones, Peter M, Mulder, Bram, Inskip, Sarah A, Cessford, Craig, Robb, John E, Dittmar, Jenna [0000-0003-3514-1869], Mitchell, Piers [0000-0002-1009-697X], Cessford, Craig [0000-0001-7291-7828], Robb, John [0000-0002-7987-4549], and Apollo - University of Cambridge Repository
- Subjects
musculoskeletal diseases ,Hallux valgus ,Adult ,congenital, hereditary, and neonatal diseases and abnormalities ,Gout ,nutritional and metabolic diseases ,X-Ray Microtomography ,Micro-computed tomography (μCT) ,Crystal arthropathy ,Diet ,Social status ,England ,Inflammatory arthritis ,Humans ,Cemeteries ,Bone Diseases - Abstract
OBJECTIVE: To estimate the prevalence rate of gout and to explore the social factors that contributed to its development in the various sub-populations in medieval Cambridge. MATERIALS: 177 adult individuals from four medieval cemeteries located in and around Cambridge, UK. METHODS: Lesions were assessed macroscopically and radiographically. Elements with lytic lesions were described and imaged using micro-computed tomography (μCT) to determine their morphology. RESULTS: Gout was identified in 3 % of the population. Individuals buried in the friary had highest prevalence (14 %), with low prevalence rates in the Hospital (3 %) and town parish cemetery (2 %), with no cases in the rural parish cemetery. Gout was more prevalent during the 14th-15th centuries than the 10th-13th centuries. CONCLUSION: The high prevalence rate of gout in the friary is at least partly explained by the consumption of alcohol and purine-rich diets by the friars and the wealthy townsfolk. Medieval medical texts from Cambridge show that gout (known as podagra) was sometimes treated with medications made from the root of the autumn crocus. This root contains colchicine, which is a medicine that is still used to treat gout today. SIGNIFICANCE: This is one of the first studies to assess the epidemiology of gout in medieval England and suggests that gout varied with social status. LIMITATIONS: Our sample size precludes statistical analysis. SUGGESTIONS FOR FURTHER RESEARCH: Additional studies that assess the epidemiology of gout in medieval Europe is needed in order to be able to fully contextualize these findings.
- Published
- 2021
49. Images in Primary Care Medicine: Point-of-Care Ultrasound in Gout
- Author
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Dennis Espejo, Elizabeth Dearing, Keith S. Boniface, Kathleen Ogle, and Maria Portela
- Subjects
musculoskeletal diseases ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Early signs ,Primary care ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Double contour sign ,Internal Medicine ,Crystal arthropathy ,medicine ,ultrasound-guided ,crystal arthropathy ,business.industry ,Point of care ultrasound ,Ultrasound ,General Engineering ,nutritional and metabolic diseases ,medicine.disease ,Ultrasound guided ,primary care medicine ,Gout ,point-of-care-ultrasound ,gout crystals ,Radiology ,business ,Family/General Practice ,030217 neurology & neurosurgery - Abstract
Gout is the most common crystal arthropathy and is frequently diagnosed and managed by primary care physicians. Point-of-care ultrasound (POCUS) is a valuable tool to aid in the diagnosis of gout via the identification of the double contour sign, aggregates of crystals, tophi, and erosions. In addition, POCUS can aid in the management of gout by recognizing early signs of gout, monitoring the effectiveness of urate-lowering therapy, and guiding aspiration and corticosteroid injection.
- Published
- 2021
50. 12-month results from the real-life observational treat-to-target and tight-control therapy NOR-Gout study: achievements of the urate target levels and predictors of obtaining this target
- Author
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Tore K Kvien, Lars Fridtjof Karoliussen, Hilde Berner Hammer, Tove Borgen, Till Uhlig, Espen A Haavardsholm, and Joseph O. Sexton
- Subjects
Male ,medicine.medical_specialty ,Crystal Arthropathies ,Gout ,medicine.medical_treatment ,Immunology ,Physical examination ,rehabilitation ,Gout Suppressants ,Treatment targets ,Rheumatology ,Internal medicine ,Crystal arthropathy ,Humans ,Immunology and Allergy ,Medicine ,Rehabilitation ,medicine.diagnostic_test ,business.industry ,Treat to target ,Middle Aged ,Symptom Flare Up ,medicine.disease ,health services research ,Uric Acid ,Treatment Outcome ,patient reported outcome measures ,Female ,Observational study ,business ,Alcohol consumption - Abstract
ObjectivesGout is often not adequately treated, and we aimed to apply urate lowering treatment (ULT) combined with individual information to achieve target serum urate (sUA) in clinical practice, and to identify predictors of achievement of this sUA target.MethodsPatients with a recent gout flare and sUA >360 µmol/L (>6 mg/dL) were consecutively included in a single-centre study and managed with a treat-to-target approach combining nurse-led information about gout with ULT. All patients were assessed with tight controls at baseline, 1, 2, 3, 6, 9 and 12 months including clinical examination, information on demographics, lifestyle, self-efficacy and beliefs about medicines. The treatment target was sUA ResultsOf 211 patients (mean age 56.4 years, disease duration 7.8 years, 95% males), 186 completed the 12-month study. Mean sUA levels decreased from baseline mean 500 to 311 µmol/L at 12 months with 85.5% achieving the treatment target. Alcohol consumption at least weekly versus less frequently (OR 0.14; 95% CI 0.04 to 0.55) as well as beliefs in overuse of medicines (OR per unit 0.77; 95 CI 0.62 to 0.94) decreased the chance of reaching the treatment target, while higher self-efficacy for arthritis symptoms (OR 1.49 per 10 units; 95% CI 1.09 to 2.05) increased the likelihood.ConclusionsThis study shows that target sUA can be achieved with ULT in most patients. Less self-reported alcohol consumption, low beliefs in overuse of medicines and higher self-efficacy are associated with treatment success.
- Published
- 2021
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