Calcium Pyrophosphate Crystal Arthritis Research Articles

FRI0400 Efficacy of anakinra in calcium pyrophosphate crystal arthritis

BackgroundCalcium pyrophosphate (CPP) associated arthritis is common in elderly patients. Non-steroidal anti-inflammatory drugs (NSAID), colchicine, oral or local steroids are recommended (1), but in some patients these therapies are non-effective...

Bilateral Acute Calcium Pyrophosphate Crystal Arthritis After Bilateral Total Knee Arthroplasty: A Case Report.

Calcium pyrophosphate dihydrate (CPPD) deposition disease is a well-described condition of synovial joints that frequently causes major pain and disability1,2. Acute calcium pyrophosphate (CPP) crystal arthritis, commonly called “pseudogout,” refers to the acute attacks of synovitis clinically resembling acute gouty arthropathy and was initially described nearly fifty years ago1,3. The body’s inflammatory response to the crystalline arthropathy causes painful synovitis, and it may bear all of the clinical hallmarks of septic arthritis. The incidence of the disease increases with age, and CPP crystals are commonly found in the synovial fluid aspirates of osteoarthritic knees before total joint arthroplasty4. Cases of CPPD disease, however, have rarely been reported after total joint arthroplasty5-9. To our knowledge, bilateral attacks of pseudogout after bilateral total knee arthroplasty have never been reported in the English-language literature. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. A fifty-two-year-old woman with a history of insulin-dependent diabetes mellitus and hypertension presented to the emergency department (ED) with a three-day history of acute bilateral knee pain of atraumatic onset. She had undergone bilateral total knee arthroplasty for premature osteoarthritis seven years earlier (Figs. 1-A, 1-B, and 1-C), and she had been free of knee pain since the surgery. She had no history of crystalline arthropathy in any joint. On presentation, she reported pain with weight-bearing as well as decreased knee motion bilaterally. Seven days prior to presentation, she had undergone a dental procedure, which included standard antibiotic prophylaxis with amoxicillin. That evening, she had had an initial sensation of tightness in …

Prevalence of calcium pyrophosphate and monosodium urate crystals in synovial fluid of patients with previously diagnosed joint diseases

ObjectiveThe main aim of this study was to investigate the frequency of monosodium urate (MSU) and calcium pyrophosphate (CPP) crystals in synovial fluid (SF) obtained from patients with previously diagnosed joint diseases. MethodsWe reviewed the results of SF analysis of 5020 samples identifying those collected from patients with a previously definite diagnosis (2370 samples). SF analysis results, age, sex, diagnosis and disease duration were recorded from computerized records of patients’ archives. ResultsThe prevalence of CPP crystals in SF was 22.28% in osteoarthritis (OA), 8.28% in rheumatoid arthritis (RA), 3.82% in psoriatic arthritis (PsA), 2.79% in other spondyloarthropathies (SpA), 10% in septic arthritis (SeA), 0.66% in gout and 9.18% in the miscellanea of joint diseases, respectively. The prevalence of MSU crystals in SF was 0.30% in RA, 3.34% in PsA, 0.70% in other SpA, 0.80% in acute CPP crystal arthritis (CPP-CA), 0% in OA, reactive arthritis (ReA), SeA, juvenile idiopathic arthritis (JIA) and miscellanea.In OA group, we observed that age and SF inflammatory indices were higher in SF positive to CPP crystals with respect to those without crystals (P<0.0001). In RA, we found that the group of patients with CPP crystals was significantly older (P=0.001) and had a SF less inflammatory (P=0.022) with respect to that without crystals but with a higher disease duration than those without crystals. ConclusionCrystals can be detected more frequently than expected in SF from joint diseases with a previous established diagnosis. This highlights the importance of SF analysis for the diagnosis of possible comorbidities linked to the presence of crystals.

Chronic calcium pyrophosphate crystal inflammatory arthritis induced by extreme hypomagnesemia in short bowel syndrome

BackgroundShort bowel syndrome (SBS) may induce a plethora of clinical symptoms ranging from underweight to nutrient-, vitamin- and electrolyte deficiencies. The objective of this case report is to illustrate how demanding the management of a 60 year old patient with SBS and recurrent joint attacks was for different medical disciplines.Case presentationThe patient with SBS presented with a body mass index of 16.5 kg/m2 after partial jejunoileal resection of the small intestine with a six year long history of recurrent pain attacks in multiple peripheral joints, chronic diarrhoea and food intolerances. Pain attacks occurred 4–5 times a week with a median consumption of 15 mg prednisone per day. The interdisciplinary workup after several gastroenterologic, rheumatologic, radiologic, psychiatric and orthopedic consultations is shown including successful treatment steps.Clinical diagnosis revealed no systemic inflammatory disease, but confirmed extreme hypomagnesemia (0.2 mmol/l) after reproducible pathological magnesium resorption tests as causative for chronic calcium pyrophosphate crystal inflammatory arthritis (pseudogout, chondrocalcinosis).Multidisciplinary treatment included application of colchicines, parenteral nutrition and magnesium substitution, antiperistaltic agents and avoidance of intolerant foods. Normalization of magnesium levels and a marked remission of joint attacks were achieved after six months with significant reduction of prednisone to 1.5 mg/day.ConclusionDespite the rarity of this condition, it is important to know that hypomagnesaemia may be associated with calcium pyrophosphate crystal inflammatory arthritis (chondrocalcinosis) and that SBS patients may be prone to develop extreme hypomagnesaemia causing recurrent joint attacks without systemic inflammation.

Interleukin 1β Blockade Improves Signs and Symptoms of Chronic Calcium Pyrophosphate Crystal Arthritis Resistant to Treatment

A 54-year-old woman with recurrent episodes of bilateral knee arthritis was admitted several times to the Department of Rheumatology. She was diagnosed to have chronic calcium pyrophosphate crystal arthritis. Interleukin 1β (IL-1β) plays a central role in the pathogenesis of inflammation induced by calcium pyrophosphate crystals, and IL-1β blockade may be an effective treatment in patients with severe chronic calcium pyrophosphate crystal arthritis. Because of the short effect of treatment with corticosteroids and the frequent attacks of arthritis, the patient was treated with the IL-1 receptor antagonist anakinra. She responded well after 1 week with normalization of inflammation. Eight months after the initiation of treatment, the patient has had no relapses, although we were unable to withdraw the anakinra.

Efficacy of anakinra for refractory acute calcium pyrophosphate crystal arthritis

Acute synovitis induced by deposition of calcium pyrophosphate (CPP) and monosodium urate crystals involves interleukin-1β production and activation. The efficacy of blocking interleukin-1β activity (with an interleukin-1 receptor antagonist [anakinra] or interleukin-1β antibody) is well documented for gout attacks but has only been reported in two single-case reports of CPP crystal-induced acute arthritis. Here we report on five cases (four males, mean age 71±27) of CPP crystal-induced inflammatory arthritis refractory and/or intolerant to usual drug therapy and efficiently treated with anakinra. Diagnosis of CPP crystal-induced arthritis was confirmed by identification of crystals in synovial fluid. CPP crystal-induced oligo-arthritis (n=4) and polyarthritis (n=1) were refractory to conventional treatments, including non-steroidal anti-inflammatory drugs, colchicine and steroids (systemic administration or intra-articular injection). After latent infection was ruled out, anakinra, 100mg/day, was administered subcutaneously for 3 days. Four patients showed rapid clinical and biological responses at a mean of 3 days after treatment. Anakinra provided good joint pain relief (baseline 0–100mm visual analog scale score 60±17mm, outcome 10±10mm) and decreased serum C-reactive protein level (58±43 to 5±2mg/L). Anakinra was well tolerated. One injection-site skin reaction was observed but no infection. Anakinra was effective and safe in this small series of patients with refractory arthritis due to acute CPP crystal deposition.