Acute Attacks Of Pseudogout Research Articles

SAT213 Post-parathyroidectomy Acute Pseudogout Flare-up; A Case Report

Abstract Disclosure: S. Rabiei: None. V. Kantorovich: None. Introduction: Acute post-parathyroidectomy pseudogout has been reported in the early post-operative. Although the exact mechanism is unknown, accepted theories include decreased solubility of calcium pyrophosphate and unbalanced equilibrium between production and hydrolysis of inorganic phosphate. We present a patient who developed an acute pseudogout attack after parathyroidectomy. The Case: Patient is a 45-year-old male with a history of nephrolithiasis who presented to outpatient clinic with a right-sided neck mass that has been present for several years with recent increase in size. He reported unintentional weight loss (25 pounds) and night sweats. On physical examination, a right lateral neck mass measuring 6 x 4 cm was noted. CT scan of the neck demonstrated a complex mass with calcification. Serum calcium (Ca), phosphorus (P), potassium (K), and alkaline phosphatase levels were 17.2 mg/dL, 1.8 mg/dL, 2.6 mmol/L, and 1,782 U/L, respectively. Serum intact parathyroid hormone (iPTH) was 3,341 pg/mL. The patient was then admitted. He received intravenous fluid, zolindronic acid, and started on vitamin D supplementation in preparation for surgery. Pre-operative CT scan of the chest, abdomen, and pelvis was concerning for metastatic disease (retroperitoneal lymphadenopathy, multiple bilateral lung solid nodules, liver, kidney and bone lesions). The patient underwent complete resection of the tumor. Intra-operative frozen section confirmed parathyroid tumor with atypia. Twenty-minute post-excision iPTH was 476 pg/mL. In the early post-operative period, serum Ca level was reduced to 7.5-8.5 mg/dL and oral Ca and calcitriol supplementation were administered. However, serum PTH reached levels as high as 900 pg/mL. Post-operative MRI demonstrated benign liver and kidney lesion with non-visualization of the previously reported retroperitoneal lymph nodes and pulmonary nodules on the CT.A few days later, the patient complained of bilateral knee pain. Serum Ca, P, and PTH levels were 7.9 mg/dL, 3.0 mg/dL, and 861 pg/mL, respectively. The skeletal survey revealed diffuse osseous metabolic process with scattered lucent osseous lesions compatible with osteitis fibrosa cystica/brown tumors as well as chondrocalcinosis of knees and hand joints. Prednisone was started for treatment of presumed acute CPPD attack with subsequent significant resolution of patient’s joint pain. Discussion: This case demonstrated the importance of thorough evaluation of musculoskeletal complaints in patients with hyperparathyroidism. Bone and joint pain in patients with hyperparathyroidism is common and is most often the result of high bone turnover. However, other etiologies including acute pseudogout should be contemplated in order to provide the appropriate treatment. Post-parathyroidectomy acute pseudogout attack should generally be treated in the same way as in the general population. Presentation: Saturday, June 17, 2023

A Case of Pseudogout Following Zoledronic Acid Administration

Calcium pyrophosphate dihydrate (CPPD) deposition in the joints, often referred to as pseudogout, can lead to debilitating arthritis. Rare cases of pseudogout associated with bisphosphonate therapy have been reported in the literature, although the mechanism for this remains unclear. We report a case of a 53-year-old female who developed an acute pseudogout attack following administration of zoledronic acid for treatment of osteoporosis.

An Acute Attack of Pseudogout Treated with Bofutsushosan and Orengedokuto —A Case Report

偽痛風は高齢者によく発症する結晶性関節炎である。今回，偽痛風の急性発作に対して防風通聖散と黄連解毒湯の併用が有効であったので報告する。症例は87歳男性であり，左手関節痛があり経過をみていたが疼痛が続くため発症2日目に当院を受診した。理学所見では左手関節の圧痛を認めた。左手関節単純レントゲンで軽度の石灰化を認め，血液検査で炎症所見があり，手関節の偽痛風による急性発作と診断した。防風通聖散と黄連解毒湯を併用して投与したところ徐々に症状が軽快していった。初診3日後には左手関節痛が消失し，初診9日後には炎症所見も正常化した。防風通聖散と黄連解毒湯の併用は偽痛風の急性発作に対して有効であると考えられた。

Pseudogout: A Rare Cause of Acute Arthritis Following Arthroscopic Anterior Cruciate Ligament Reconstruction.

We report a case of an acute pseudogout attack following single-bundle anterior cruciate ligament (ACL) reconstruction in a 35-year-old man. At the initial reconstruction surgery, he was found to have early degenerative changes mainly in the lateral compartment. He presented with acute onset pain and swelling following reconstruction of the ACL. Arthroscopic irrigation was performed and the synovial fluid was positive for calcium pyrophosphate crystals. A pseudogout attack must be considered in the differential diagnosis in cases of acute onset pain and swelling after arthroscopic surgery, especially with the background of degenerative knee changes, and this may signify a poorer long-term outcome.

Chondrocalcinosis. Clinical impact of intra-articular calcium phosphate crystals

Calcium pyrophosphate dihydrate (CPPD) crystals are known to cause acute attacks of pseudogout in joints but crystal deposition has also been reported to be associated with osteoarthritis (OA). Aside from CPPD crystals, basic calcium phosphates (BCPs), consisting of carbonate-substituted hydroxyapatite (HA), tricalcium phosphate and octacalcium phosphate, have been found in synovial fluid, synovium and cartilage of patients with OA. Although CPPD crystals have been found to be associated with OA and are an important factor in joint disease, this has also recently been associated with a genetic defect. However, according to the most recent findings, the association of BCP crystals, such as apatite with OA is much stronger, as their presence significantly correlates with the severity of cartilage degeneration. Identification of BCP crystals in OA joints remains problematic due to a lack of simple and reliable methods of detection. The clinical and pathological relevance of cartilage mineralization in patients with OA is not completely understood. It is well established that mineralization of articular cartilage is often found close to hypertrophic chondrocytes. A significant correlation between the expression of type X collagen, a marker for chondrocyte hypertrophy and cartilage mineralization was observed. In the process of endochondral ossification, the link between hypertrophy and matrix mineralization is particularly well described. Hypertrophic chondrocytes in OA cartilage and at the growth line share certain features, not only hypertrophy but also a capability to mineralize the matrix. Recent data indicate that chondrocyte hypertrophy is a key factor in articular cartilage mineralization strongly linked to OA and does not characterize a specific subset of OA patients, which has important consequences for therapeutic strategies for OA.

AB1068 Efficacy of anakinra in pseudogout: Report of 3 cases

BackgroundAnakinra has shown modest efficacy in rheumatoid arthritis and there is proof of principle for its efficacy in gout. Several case reports have suggested it is effective in pseudogout [1-2].MethodsWe...

Pseudogout Mimicking Infection Following Total Knee Arthroplasty: A Report of Two Cases.

One of the most serious postoperative complications following total knee arthroplasty is periprosthetic infection, with a reported rate of 1% to 2%1. Early diagnosis of the infection is critical for successful treatment, but diagnosis can be difficult. An acute pseudogout attack, for instance, should be included in the differential diagnosis of septic arthritis because the two conditions can have similar presentations, including joint pain, swelling, fever, and elevations in serum inflammatory marker levels. Several pseudogout cases mimicking infection after total knee arthroplasty have been reported, but most of these developed years after the surgery2-5. We report two cases of pseudogout mimicking infection that arose within two weeks after total knee arthroplasty. The patients were informed that data concerning their cases would be submitted for publication, and they provided consent. Case 1. A sixty-four-year-old woman with a history of hypertension underwent a primary right total knee arthroplasty for osteoarthritis (OA). Two days after the surgery, she began rehabilitation therapy; thirteen days after the surgery, she developed a fever of 38.4°C. The right knee was swollen and warm to the touch, but the surgical wound was free of drainage and was healing well. She had no pain in the right knee and was not taking nonsteroidal anti-inflammatory drugs (NSAIDs). Both the C-reactive protein (CRP) level (22.5 mg/L; normal: <3 mg/L) and the erythrocyte sedimentation rate (ESR) (29 mm/h; normal: <10 mm/h) were elevated. The total white blood-cell count and neutrophil count were 6.4 × 108/L and 4.9 × 108/L, respectively. She walked with a cane and had a knee range of motion …

Anakinra is a possible alternative in the treatment and prevention of acute attacks of pseudogout in end-stage renal failure

We describe the case of a 71-year-old man with recurrent pseudogout attacks affecting multiple joints. He had end-stage renal failure that contra-indicated the use of non-steroidal anti-inflammatory drugs and was resistant to therapy with glucocorticoids. Based on the recent findings that interleukin (IL)-1β is involved in crystal-induced inflammation, the patient received anakinra, a specific IL-1 inhibitor, in order to treat an acute attack of pseudogout. In addition, anakinra was administered as preventive therapy 3 days per week after each hemodialysis session. Under this treatment, he did not present any severe episode of arthritis after a follow-up of 8 months. This observation suggests that anakinra is efficacious and safe for the prevention of crystal-induced arthritis in patients with severe renal failure.

Improvement of Acute Pseudogout Attacks after Parathyroidectomy in Patients with Pseudogout and Primary Hyperparathyroidism-Two Cases Report and Review of Literature

Pseudogout is a clinical entity characterized by acute arthritis in one or more joints associated with the presence of calcium pyrophosphate dihydrate (CPPD) crystals in the synovial fluid of the affect joints. It is also known as a biochemical entity associated with primary hyperparathyroidism and it may offer a useful clue to screen the disease. Patients with long standing hypercalcemia related to hyperparathyroidism have a high incidence of CPPD crystal deposition in the articular cartilage which is so called chondrocalcinosis. In patients of CPPD deposition disease with primary hyperparathyroidism, relative hypocalcemia after parathyroidectomy could provide stimulus for crystal shedding into synovial fluid, which may precipitate acute attacks of pseudogout. Thus, trying calcium supplement after parathyroid surgery may be a good and reasonable consideration to prevent the postoperative complication. Here, we illustrate two female patients of pseudogout related arthritis with primary hyperparathyroidism, and, both of them have single-gland disease who go on parathyroidectomy experienced much improvement in pseudogout attacks after surgical interventions.

副甲状腺摘出後に発症した偽痛風例

We reported a patient with pseudogout associated with parathyroidectomy. A 68-year-old woman, diagnosed with primary hyperparathyroidism, presented with serum concentrations of ionized calcium. Patients with hypercalcemia have a high incidence of calcium pyrophosphate dihydrate crystal deposition into joints. Rapid drops in serum calcium levels can cause shedding of these crystals into synovial fluid which may precipitate acute attacks of pseudogout. Furthermore, the patient has diabetes mellitus. Diabetes mellitus inhibits insorption of magnesium which may cause high incidence of calcium pyrophosphate dihydrate crystal deposition into joints, too. It has been well established that acute attacks of pseudogout may be precipitated by parathyroidectomy and/or diabetes mellitus.

Molecular Dynamics Simulation of Crystal-Induced Membranolysis

Calcium pyrophosphate dihydrate (CPPD) crystals occur frequently in noninflammatory osteoarthritic joints; however, they can be phlogistic and membranolytic, causing acute pseudogout attack. So far, the molecular mechanism of crystal-induced membranolysis is still unclear. In this study, using the method of Chemistry at Harvard Macromolecular Mechanics (CHARMM) molecular dynamics, we show that the interactions between the surface of CPPD crystal and the extracellular layer of the hydrated dimyristoyl phosphatidylcholine (DMPC) phospholipid bilayer may lead to decoupling of the external layer from the intracellular side of the membrane. As a result, a local thinning of the layer on the intracellular side of the membrane occurs, which favors water penetration, leading to membranolysis.

Molecular modeling of inhibition of crystals of calcium pyrophosphate dihydrate by phosphocitrate

Crystalline calcium pyrophosphate dihydrate crystals occur frequently in degenerative joints diseases, causing acute attacks of pseudogout. These crystals appear in cartilage and can engender enzymatic damage to cartilage matrix. Currently no reliable method exists to prevent calcium pyrophosphate dihydrate deposition. In this study we investigate the role that phosphocitrate, a naturally occurring compound, may play in preventing calcium phosphate precipitation in cells or cellular compartments. Based on the experimental evidence that phosphocitrate blocks ATP-induced CPPD crystal growth in both articular cartilage vesicles and cartilage explants, we use molecular modeling to analyze how the inhibitory activity of phosphocitrate results from the stereospecific interaction between phosphocitrate and the specific faces of calcium pyrophosphate dihydrate crystal. Our molecular modeling binding studies indicate that phosphocitrate ion is able to bind to (010), (011), (100), (001), (01−1), and (1−10) faces of CPPD crystal with the strongest binding energies obtained for the high calcium density planes (010) and (011). We propose that the binding of phosphocitrate to specific faces of CPPD induces morphological changes that may lead to diminished crystal growth or its total cessation.

Two Cases of Acute Pseudogout Attack following Parathyroidectomy.

Two cases of acute attack of pseudogout associated with primary hyperparathyroidism are reported. Case 1 suffered from acute pain and swelling of the right ankle and dorsal of the right foot. Case 2 suffered from unknown fever and pain of the bilateral jaw, shoulder, elbow, wrist and knee joints. Postoperative radiological studies revealed the association of chondrocalcinosis in both cases. Synovial fluid in case 2 was aspirated and analyzed for calcium pyrophosphate dihydrate crystal by microscopic examination.

Crystal shedding and acute pseudogout. An hypothesis based on a therapeutic failure

Four patients with chondrocalcinosis of the knees volunteered for joint lavage. Preliminary experiments indicated that disodium EDTA and magnesium ions were potent solubilizers of CPPD crystals. The procedure was a therapeutic failure in that insignificant amounts of CPPD were removed and all 4 subjects developed postlavage attacks of pseudogout. It is hypothesized that the acute attack of pseudogout is a result of crystal shedding and may be triggered by any factor that enhances CPPD solubility.