Calcium Pyrophosphate Crystal Deposition Disease Research Articles

Diastolic Dysfunction of the Left and Right Ventricles in Patients with Calcium Pyrophosphate Crystal Storage Disease and Osteoarthritis.

The frequency and risk factors for the development of diastolic dysfunction (DD) in patients with CPPD and OA have not been studied. The objective of this study was to determine the frequency and identify risk factors (RF) for the development of DD of the left and right ventricles (LV and RV) in patients with calcium pyrophosphate crystal deposition disease (CPPD) and osteoarthritis (OA). The study included 26 patients with CPPD and with knee OA 18-65 years old, matched in age and gender, without cardiovascular disease (CVD), type 2 diabetes mellitus (DM2), and rheumatic diseases. Conventional risk factors (TRF) of CVD were assessed, and echocardiography was performed. The frequency of DD in patients with CPPD and OA was quite high and almost did not differ in both groups: it was detected in 19 patients, of which 11 (42%) had CPPD and 8 (31%) had OA (p = 0.39). Type 1 LV DD was detected in 10 (39%) patients with CPPD and in 8 (31%) with OA (p = 0.11); type 1RV DD was detected in 8 (31%) patients with CPPD and in 7 (27%) patients with OA (p = 0.17); and type 1 LV DD and RV DD was detected in 7 (27%) patients with both CPPD and with OA. DD types 2 and 3 were not detected in both groups. There were no differences in both groups in CV risk factors, except for the level of CRP (it was higher in CPPD) (p = 0.03). In the CPPD group, mean values of LV E/E' (p = 0.02), LVDT (p = 0.03), LVMI (p = 0.04) were significantly higher than in patients with OA. On the contrary, in patients with OA, indices EDV (p = 0.004) and TVC (p = 0.02) were higher. There were direct correlations between diastolic function indices and the following factors in CPPD: LVL, PWLV and PTH level (r = 0.7, p <0.005), LV E' and PTH level (r = 0.7, p < 0.005). Inverse correlations were found between the level of PTH and IS (r = -0.5, p < 0.005), LVMI (r = -0.5, p < 0.005), and the level of vitamin D and VDDT (r = -0.6, p < 0.005). Direct correlations in OA were found between the level of CRP and PVAdiast (r = 0.6, p < 0.005), and the level of sUA (r = 0.7, p < 0.005), and the level of vitamin D and E/E'LV (r = 0.6, p < 0.005). A high prevalence of LV and RV DD was found in patients with CPPD and OA. The presence of DD in CPPD was associated with lower vitamin D levels, and in OA with a higher level of sUA and a lower level of PTH.

Calcium pyrophosphate crystal arthritis associated with immune checkpoint inhibitor successfully treated with intra-articular glucocorticoid: A case report.

Immune checkpoint inhibitors (ICIs) sometimes induce immune-related adverse events (irAEs), and arthritis is one of the irAE symptoms. Recently, crystal-induced arthritis, such as calcium pyrophosphate (CPP) crystal deposition disease and gout, has been reported to occur after ICI administration. However, the distinction between ICI-associated crystal arthritis and ICI-induced non-crystal arthritis is difficult because their symptoms are similar. Besides, optimal treatment for ICI-associated crystal arthritis has not been established. Here, we report a patient who developed CPP crystal arthritis twice after pembrolizumab (ICI) administration and was successfully treated with intra-articular glucocorticoid injection. He suffered arthritis and acute interstitial nephritis simultaneously after ICI administration. Musculoskeletal ultrasound of his affected joint suggests that his arthritis was crystal-induced arthritis, and arthrocentesis detected CPP crystal in synovial fluid. Thus, we diagnosed his arthritis as ICI-associated cystal arthritis. Therefore, our case encourages the use of musculoskeletal ultrasound in patients with arthritis after treatment with ICI because it may distinguish between ICI-associated crystal arthritis and ICI-induced non-crystal arthritis. Besides, ICI-associated crystal arthritis could be treatable by intra-articular glucocorticoid injection.

Diagnosis of calcium pyrophosphate crystal deposition disease by ultrasonography: how many and which sites should be scanned?

To develop the optimal US scanning protocol for the diagnosis of calcium pyrophosphate crystal deposition (CPPD) disease. In this cross-sectional study, consecutive patients with a crystal-proven diagnosis of CPPD disease, and age-, sex-matched disease controls with a negative synovial fluid analysis were prospectively enrolled in two Italian Institutions. Four rheumatologists, blinded to patients' clinical details, performed US examinations using a standardized scanning protocol including 20 joints (shoulders, elbows, wrists, metacarpophalangeal joints from second to fifth fingers, hips, knees, ankles). CPPD was identified as presence/absence, according to the OMERACT definitions. Reduced US scanning protocols were developed by selecting the most informative joints to be imaged by US using the LASSO technique. Patients were randomly divided into training and validation sets. Their diagnostic accuracy was tested comparing the area under the receiver operating characteristic curves. The number of participants enrolled was 204: 102 with CPPD disease and 102 disease controls [age, mean (s.d.): 71.3 (12.0) vs 71.1 (13.5) years; female: 62.8% vs 57.8%]. The median number of joints with US evidence of CPPD was 5 [interquartile range (IQR): 4-7] and 0 (IQR: 0-1) in patients with CPPD disease and controls, respectively (P < 0.01). The detection of CPPD in ≥2 joints using a reduced scanning protocol (bilateral assessment of knees, wrists and hips) showed a sensitivity of 96.7% (95% CI: 82.8, 99.9) and a specificity of 100 (95% CI: 88.8, 100.0) for the diagnosis of CPPD disease and had good feasibility [mean (s.d.): 12.5 (5.3) min]. Bilateral US assessment of knees, wrists and hips had excellent accuracy and good feasibility for the diagnosis of CPPD disease.

Diastolic dysfunction of ventricles in patients with calcium pyrophosphate crystal deposition disease while receiving anti-inflammatory therapy

Calcium pyrophosphate crystal deposition disease (CPPD) may be associated with developing of diastolic dysfunction (DD). To determine the variability of echocardiographic parameters in patients with CPPD receiving anti-inflammatory therapy. Twenty six patients with CPPD and osteoarthritis (OA) from 18 to 65 years old were included in the case-control study. All patients underwent echocardiography, laboratory parameters at baseline and after 6 months. Patients with CPPD received methotrexate 15 mg per week or hydroxychloroquine 200 mg once a day, or colchicine 1 mg per day. Diastolic function according to echocardiography was assessed. Diastolic dysfunction was detected in 19 patients: in 11 (42%) patients with CPPD and 8 (31%) patients with OA (p=0.39). The baseline serum CRP level was higher in the CPPD group (p=0.03), no differences were found for other indicators. Twenty-two patients with CPPD and 19 patients with OA completed the study. In patients with OA, there were no significant changes in indicators reflecting the diastolic function of ventricles. CPPD therapy with colchicine, hydroxychloroquine and methotrexate has a positive effect on indicators of diastolic ventricular function.

Editorial introductions.

Current Opinion in Rheumatology was launched in 1989. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of Rheumatology is divided into 15 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS W. Joseph McCuneW. Joseph McCuneDr W. Joseph McCune, MD, is Michael and Marcia Klein Professor of Rheumatic Diseases and Director of the Lupus Program at the University of Michigan. Following an Internal Medicine residency at the University of Michigan and a fellowship in Immunology and Rheumatology at Harvard Medical School and the Brigham and Woman's Hospital, Dr McCune has been a member of the faculty at the University of Michigan where he specializes in the epidemiology, diagnosis, and treatment of lupus and systemic vasculitis. Sara K. TedeschiSara K. TedeschiDr. Sara K. Tedeschi, MD, MPH, received her medical degree from Vanderbilt University, USA and her MPH degree from the Harvard School of Public Health, USA. She joined the rheumatology faculty at Brigham and Women's Hospital, USA, after completing her internal medicine residency and rheumatology fellowship there. Her clinical research on calcium pyrophosphate crystal deposition disease is supported by the National Institutes of Health. David FoxDavid FoxDr. Fox is a graduate of the Massachusetts Institute of Technology and Harvard Medical School. Following internal medicine residency and rheumatology fellowship at the Brigham and Women's Hospital, he joined the faculty of the University of Michigan School of Medicine in 1985. Dr. Fox is Professor of Internal Medicine and, from 1990 to 2018, was Chief of the Division of Rheumatology. In 2013, Dr. Fox became the Frederick G. L. Huetwell and William D. Robinson, M.D. Professor of Rheumatology. He is currently a Deputy Director of the Immune Tolerance Network. Dr. Fox's research focuses on defining and characterizing pathways of human T cell activation, determining the role of these pathways in the pathogenesis of autoimmune disease, investigating T cell interactions with synovial fibroblasts, and exploring novel approaches to the treatment of rheumatoid arthritis and scleroderma. He is author of more than 260 scientific papers and book chapters. Dr. Fox is also active in the clinical care of patients with rheumatic diseases and in teaching students and fellows in both clinical and research settings. From 2007–2008, Dr. Fox served as the seventy-first President of the American College of Rheumatology and the sixth ACR President from the University of Michigan

Diastolic dysfunction of the left and right ventricles in patients with calcium pyrophosphate crystal deposition disease and osteoarthritis

The frequency and risk factors for the development of diastolic function in patients with calcium pyrophosphate crystal deposition disease (CPPD) and osteoarthritis (OA) have not been studied.The aim – to determine the frequency and to identify risk factors (RF) for the development of diastolic dysfunction (DD) of the left (LV) and right (RV) ventricles in patients with calcium pyrophosphate crystal deposition disease and osteoarthritis.Material and methods. 26 patients (18–65 years) each were included with CPРD and with knee OA, matched in age and gender, without cardiovascular disease (CVD), type 2 diabetes mellitus, rheumatic diseases. Traditional risk factors of CVD were assessed, echocardiography was performed.Results. The frequency of DD in patients with CPРD and OA was quite high and almost did not differ in both groups: it was detected in 19 patients, of which 11 (42%) with CPРD and 8 (31%) with OA (p=0.39). Type 1 LV DD was detected in 10 (39%) patients with CPРD and in 8 (31%) with OA (p=0.11); type 1 RV DD – in 8 (31%) patients with CPРD and in 7 (27%) patients with OA (p=0.17); type 1 LV DD and RV DD – in 7 (27%) patients with both CPРD and with OA. DD types 2 and 3 were not detected in both groups. There were no differences in both groups in CV risk factors, except for the level of C-reactive protein (CRP) – it was higher in CPРD (p=0.03). In the CPРD group, mean values of LV E/E′ (p=0.02), LV DT (p=0.03), LV MI (p=0.04) were significantly higher than in patients with OA. On the contrary, in patients with OA, the following indicators: EDV (p=0.004), TVC (p=0.02) were higher.There were direct correlations between diastolic function indices and the following factors in CPРD: LVL, PWLV and PTH level (r=0.7; p&lt;0.005), LV E′ and PTH level (r=0.7; p&lt;0.005); inverse correlations – the level of PTH and IS (r=–0.5; p&lt;0.005), LV MI (r=–0.5; p&lt;0.005), the level of vitamin D and VD DT (r=–0.6; p&lt;0.005). Direct correlations in OA: the level of CRP and PVAdiast (r=0.6; p&lt;0.005), and the level of sUA (r=0.7; p&lt;0.005), the level of vitamin D and E/E′ LV (r=0.6; p&lt;0.005).Conclusion. A high prevalence of LV and RV DD was found in patients with CPРD and OA. The presence of DD in CPРD was associated with lower vitamin D levels, and in OA with a higher level of sUA and a lower level of PTH.

Pseudogout, Neutropenia, and Splenomegaly: A Case of Felty Syndrome

Felty syndrome is a rare entity of rheumatoid arthritis, neutropenia, and splenomegaly. Patients typically develop the syndrome years after a diagnosis of rheumatoid arthritis. Here, we present a case of a 76-year-old man with history of chronic calcium pyrophosphate crystal deposition disease, or pseudogout, who presented with neutropenic fever. Given his progressive arthralgias and symmetric synovitis on physical examination, serologies were sent and identified a new diagnosis of rheumatoid arthritis. This, together with exclusion of other causes of neutropenia and discovered splenomegaly, led to diagnosis of Felty syndrome.

The use of Anakinra in treatment of calcium pyrophosphate crystal deposition disease: Analysis of own experience and a literature review

Calcium pyrophosphate crystal deposition disease (CPPD) is a disease caused by the deposition of calcium pyrophosphate crystals, mainly in the articular cartilage, and often manifests as severe acute or chronic arthritis. Therapy given in such cases with non-steroidal anti-inflammatory drugs, colchicine, methotrexate and glucocorticoids is often effective. In these cases, the possibility of prescribing biological drugs, primarily interleukin 1 (IL-1) inhibitors, is being considered. The article analyzes the experience of using Anakinra, an IL-1 receptor antagonist, registered in the Russian Federation in 2021, in 5 patients with persistent arthritis in CPPD. The article also presents an analysis of data from key studies on the use of the drug in patients with CPPD.

Use of anakinra in treatment of combination of calcium pyrophosphate deposition desease and gout (clinical observation)

Gout and calcium pyrophosphate crystal deposition disease (CPPD) are the most common inflammatory rheumatic diseases. It is known that the clinical manifestations of both diseases can simulate each other, in addition, cases of a combination of gout and CPPD are not uncommon, which complicates the diagnosis and selection of therapy. We present a case report of the successful use of the interleukin-1 beta (IL-1β) receptor antagonist Anakinra in a patient with a combination of gout and CPPD with chronic arthritis resistant to previous therapy with colchicine, non-steroidal anti-inflammatory drugs and glucocorticoids.

Usefulness of ultrasound in the diagnosis of crystal deposition diseases.

Gout and calcium pyrophosphate crystal deposition disease (CPPD) are common forms of inflammatory arthritis whose prevalence has increased in recent years. Although the identification of monosodium urate crystals (MSU) and calcium pyrophosphate crystals (CPP) in synovial fluid (SF) by polarized light microscopy are the gold standard for diagnosing these diseases, SF analysis is not always available. An early diagnosis and specific treatment, especially in gout, allows avoiding irreversible structural damage, comorbidities, and a severe impact on the quality of life of patients. Musculoskeletal ultrasound (US) is a noninvasive tool that allows detecting aggregates of microcrystals at multiple anatomical sites and helps to establish a specific diagnosis. The objective of this review is to evaluate the applications of US in the diagnosis and clinical management of the main microcrystalline arthropathies. The US has helped improve our understanding of the natural history of the disease, due to its ability to visualize not only soft tissue inflammation and structural damage, but also the characteristics of MSU and CPP crystal deposition. The anatomical sites of crystal deposition are also a key factor for differential diagnosis in different microcrystalline diseases. The US allows establishing an early diagnosis, especially in asymptomatic hyperuricemia, to discriminate with other inflammatory diseases, to assess the extent of microcrystalline deposition and their sensitivity to change after treatment. Given its increasing availability in clinical practice and strong evidence, US is a bedside imaging technique helping clinicians to improve diagnosis and therapy monitoring in their daily practice.

Editorial introductions

Current Opinion in Rheumatology was launched in 1989. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of Rheumatology is divided into 15 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Kenneth G. SaagKenneth G. SaagKenneth G. Saag, MD, MSc, is Jane Knight Lowe Professor of Medicine, Division of Clinical Immunology and Rheumatology, at the University of Alabama at Birmingham (UAB) in Birmingham, Alabama, USA and Professor of Epidemiology, at the UAB School of Public Health. Dr Saag is a native of Chicago, and following studies in engineering at the University of Michigan, USA, he returned to Chicago for medical school and Internal Medicine Residency at Northwestern University, USA. He then traveled to the University of Iowa, USA, for his rheumatology and epidemiology training and remained on the faculty there until moving to UAB in 1998. Dr Saag is the founding Director of the Agency for Health Care Research and Quality Deep South Center for Education and Research on Therapeutics, the UAB Center of Research Translation in Gout and Hyperuricemia, and the UAB Outcomes Research Center. He also serves as a Vice Chair for the UAB Department of Medicine. He has published over 300 peer reviewed manuscripts; has also authored more than 100 reviews, editorials, and book chapters. Recently he published the first edition of the clinical handbook Diagnosis and Management of Osteoporosis. Dr Saag is the Secretary of the American College of Rheumatology (ACR) and Past President of the Board of Trustees of the National Osteoporosis Foundation. Sara K. TedeschiSara K. TedeschiDr Tedeschi is a Rheumatologist at Brigham and Women's Hospital and an Assistant Professor of Medicine at Harvard Medical School, both in Boston, Massachusetts, USA. She completed medical school at Vanderbilt University School of Medicine in Nashville, Tennessee, USA. Dr Tedeschi then completed both her internal medicine residency and rheumatology fellowship training at Brigham and Women's Hospital and received her MPH from the Harvard T.H. Chan School of Public Health. Her clinical research focuses on risk factors for and outcomes in rheumatic diseases. Dr Tedeschi's current work which focuses on calcium pyrophosphate crystal deposition disease is funded by the National Institutes of Health. She is Co-Chair of the OMERACT CPPD Working Group and serves on the leadership team of the ACR/EULAR CPPD Classification Criteria working group. George C. TsokosGeorge C. TsokosDr George C. Tsokos, MD is Professor of Medicine at Harvard Medical School and Chief, Rheumatology Division, Beth Israel Deaconess Medical Center in Boston, USA. He trained in Rheumatology at the National Institutes of Health, USA. He has served various leadership positions including President of the Clinical Immunology Society, Chair of the Council of the University of Athens and Member or Chair of multiple federal study sections and Editor or Member of editorial boards of scientific journals. Dr Tsokos holds a MERIT Award from the National Institutes of Health and has received several prestigious awards including the Kirkland, Howley, Evelyn Hess awards and the Distinguished Basic Investigator Award from the American College of Rheumatology, the Lupus Insight Award, the Carol Nachman International Prize in Rheumatology and the Marian Ropes Physician Achievement Award. Dr Tsokos’ laboratory has opened and led the field of molecular abnormalities on immune cells in patients with SLE and identified previously unknown pathways which have served as the basis for novel treatments which are currently in various phases of development.

The effect of therapy on subclinical atherosclerosis of the carotid arteries in patients with calcium pyrophosphate crystal deposition disease and osteoarthritis (pilot study)

Endothelial dysfunction associated with chronic microcrystalline inflammation plays a role in the progression of atherosclerosis in calcium pyrophosphate crystal deposition diseases (CPPD).The aim of the study was to assess the dynamics of the development of atherosclerosis based on changes in the thickness of the intima-media complex (ICIM) of the carotid arteries (CA) in patients with CPPD receiving long-term anti-inflammatory therapy (colchicine, methotrexate, hydroxychloroquine).Materials and methods. 26 patients with CPPD and 26 patients with osteoarthritis aged over 18 years old were included. Exclusion criteria: age &gt;65 years; presence of cardiovascular diseases. The blood lipid spectrum, hs-CRP level, anthropometric parameters were determined for all, and Doppler ultrasound ultrasonography of the carotid arteries (CA) was performed. Patients were followed up for not &lt;6 months, assessed ICIM CA at 1 visit, then patients with CPPD, at the discretion of the attending physician, were prescribed methotrexate at a dose of 15 mg per week, hydroxychloroquine 200 mg 1 time per day or colchicine 0.5 mg 2 times a day. Patients could take NSAIDs if they were in pain. The SCORE index has been calculated for everyone.Results. Initially, ICIM values did not differ in patients with CPPD and OA. Initially, ICIM&gt;0.9 mm were detected in 11 of 22 (50%) patients with CPPD and in OA in 8 of 19 (42%) (p=0.39). In dynamics, patients with CPPD revealed a decrease in the number of patients with ICIM&gt;0.9 mm from 42 to 18%. At the same time, in 8 patients with CPPD, ICIM&gt;0.9 mm was combined with a CRP level &gt;0.2 mg/l. Out of 22 patients with CPPD, 14 (64%) patients showed a decrease in the mean values of ICIM, in 2 (9%) patients - an increase, in 5 patients the mean values of ICIM did not change. After 6 months of therapy, out of 11 patients with CPPD with ICIM &gt;0.9 mm, after 6 months of therapy, in 7 cases there was a decrease in the indicator less than the specified value, in 5 of them a decrease in serum CRP level &lt;2 mg/l was recorded. In patients with CPPD, the serum CRP level significantly decreased; in patients with OA, it did not change. Out of 19 patients with OA, 9 (47%) patients showed an increase in the mean ICIM over time, while the rest did not change. In those treated with hydroxychloroquine, a decrease in the mean ICIM parameters was observed in 5 out of 6 (83%) patients, colchicine - in 6 out of 9 (67%) patients, methotrexate - in 4 out of 7 (57%) patients.With CPPD, the result of therapy with colchicine, methotrexate and hydroxychloroquine in relation to the development of the initial signs of atherosclerosis according to Doppler ultrasound ultrasonography of CA can be realized based on the presence of chronic inflammation.

Effect of colchicine, methotrexate, and hydroxychloroquine therapy on cardiovascular outcomes in patients with calcium pyrophosphate crystal deposition disease

Anti-inflammatory therapy, such as colchicine (COL), has been suggested to affect the incidence of cardiovascular events in patients with calcium pyrophosphate crystal deposition disease (CPPD).Objective: to study the effect of anti-inflammatory therapy with COL, hydroxychloroquine (HC), and methotrexate (MT) on cardiovascular outcomes in patients with CPPD.Patients and methods. The study included 305 patients with CPPD, the majority (62.30%) were women. The average follow-up period was 3.9±2.7 years. Among factors influencing cardiovascular outcome were considered: gender; age; smoking; alcohol intake &gt;20 conventional doses per week; arterial hypertension; a history of cardiovascular diseases (CVD), in particular ischemic heart disease, acute myocardial infarction, acute cerebrovascular accident, chronic heart failure &gt;III stage according to NYHA, as well as type 2 diabetes mellitus (DM); body mass index &gt;25 kg/m2 and &gt;30 kg/m2; cholesterol level (CHOL) &gt;5.1 mmol/l; glomerular filtration rate (GFR) &lt; 60 ml/min/1.73 m2; serum uric acid level &gt;360 μmol/l; hypercalcemia (serum calcium level &gt;2.62 mmol/L); CRP level &gt;2 mg/l; the presence of hyperparathyroidism (parathyroid hormone level &gt;65 pg/ml); CPPD phenotypes (asymptomatic, osteoarthritis with calcium pyrophosphate crystals, chronic arthritis, acute arthritis); intake of COL, HC, MT, glucocorticoids and non-steroidal anti-inflammatory drugs (NSAIDs).Results and discussion. 264 patients were under dynamic observation. Any of the studied cardiovascular events were registered in 79 (29.9%) patients. During the observation period, 46 (17.4%) patients died, in 76.1% of cases the cause of death was CVD. Death from other causes was diagnosed in 11 (23.9%) patients. Non-fatal cardiovascular events were reported in 44 (16.7%) cases. The risk of cardiovascular events was higher in patients over 65 years of age (odds ratio, OR 5.97; 95% confidence interval, CI 3.33–10.71), with serum cholesterol levels ≥5.1 mmol/L (OR 1,95; 95% CI 1.04–3.65), GFR &lt;60 ml/min/1.73 m2 (OR 2.78; 95% CI 1.32–5.56), history of CVD (OR 2,32; 95% CI 1.22–4.44). COL therapy reduced the risk of cardiovascular events (OR 0.20; 95% CI 0.11–0.39).Conclusion. Poor CVD outcomes in CPPD are associated with age, hypercholesterolemia, chronic kidney disease, and a history of CVD. The use of COL, in contrast to MT and HC, was accompanied by a decrease in cardiovascular risk.

The prevalence of subclinical atherosclerosis of carotid arteries in patients with calcium pyrophosphate crystal deposition disease and osteoarthritis (pilot study)

To this date there have been no studies of subclinical atherosclerosis in the patients with calcium pyrophosphate crystal deposition disease (CPPD); in osteoarthritis (OA) such works are rare.Objective: to assess the prevalence of subclinical atherosclerosis of carotid arteries (CA) in patients with CPPD and OA.Patients and methods. The case-control study included 26 patients with CPPD and OA. The diagnosis of CPPD was based on the criteria of D.J. McCarty, diagnosis of OA was based on national clinical practice guidelines. We recorded data on smoking, blood pressure level. Assessed blood lipid spectrum, serum levels of glucose, creatinine, uric acid, CRP. Obesity was diagnosed in accordance with the WHO recommendations. All patients underwent CA Doppler ultrasonography (DUS). An increase in intima-media thickness (IMT) &gt;0.9 mm was considered a manifestation of subclinical atherosclerosis. The SCORE index was calculated for all patients.Results and discussion. The median serum CRP level was comparable in CPPD and OA. The CRP level &gt;5 mg/L was detected in 8 patients with CPPD and in 3 patients with OA (p=0.09). Initial signs of atherosclerosis were present in 11 (42%) patients with CPPD and in 8 (31%) patients with OA (p=0.39). In CPPD, an increase in IMT was associated with a CRP level of ≥5 mg/L in 19% of cases, and in OA – in 12.5% (p=0.08). An increase in IMT &gt;1.3 mm was not found in patients of both groups.Conclusion. In patients with CPPD and OA, subclinical atherosclerosis is often present according to the CA ultrasound. Early detection of uncomplicated subclinical atherosclerosis in CPPD and OA is necessary for timely initiation of treatment aimed to prevent the progression of atherosclerosis and the development of cardiovascular diseases.

Cervical vertebrae affection in calcium pyrophosphate crystal deposition disease (description of a clinical case)

Calcium pyrophosphate deposition disease (CPPD) is characterized by polymorphism of clinical manifestations: from asymptomatic course to severe chronic arthropathy with destruction of bone structures. It is believed that calcium pyrophosphate crystals are more often found in the knee and so-called root joints (hip and shoulder), as well as in the triangular fibro-cartilaginous complex. However, CPPD can also affect the axial skeleton. A pathological process localized in the spine is more common in older people and is rare at a young age. The article presents a case of chondrocalcinosis of the cervical spine in a 62-year-old female patient who did not have risk factors.

Calcification of coronary arteries in patients with calcium pyrophosphate crystal deposition disease and knee osteoarthritis

The frequency of vascular calcification in patients with osteoarthritis (OA) and calcium pyrophosphate crystal deposition disease (CPPD) has not yet been studied, and the role of calcium crystals (basic and pyrophosphates) in the development of calcification is also unknown.Objective. Determine the presence and degree of calcification of the coronary vessels in patients with calcium pyrophosphate crystal deposition disease and osteoarthritis of the knee joints with no clinical signs of cardiovascular diseases.Materials and methods. One-stage, single-center study, performed by the “case – control” method. The main group – 20 patients with CPPD, the comparison group – 20 patients with OA of the knee joints. Inclusion criteria: age from 18 to 65 years; absence of clinical signs of cardiovascular disease at the time of examination and indications of a history of cardiovascular accidents. Exclusion criteria: unsigned informed consent; pregnancy; breastfeeding; other rheumatic disease; cancer; high and very high cardiovascular risk on the SCORE scale. The survey included an assessment of anthropometric data, blood pressure (BP), lipid profile, serum levels of glucose, creatinine, uric acid, C-reactive protein, vitamin D, osteoprotegerin, parathyroid hormone, and the levels of magnesium, phosphorus, and total calcium were studied. All patients underwent multispiral computed tomography with determination of calcium count and the number of affected arteries. To calculate the coronary score, the A.S. Agatston et al.Results and discussion. Most of the parameters in the compared groups did not differ. When assessing the calcification of the coronary arteries according to the A.S. Agatston et al. 9 (45%) patients with CPPD and 8 (40%) patients with OA had a coronary calcium score &gt;1. Quantitative indicators of calcium score can correspond to coronary artery stenosis ≥20% in 8 (40%) patients with CPPD and in 5 (25%) patients with OA according to J.A. Rumberger et al. The serum level of osteoprotegerin was significantly higher in patients with a calcium score ≥27 according to J.A. Rumberger et al. (p=0.04). Calcification was detected in 9 (56%) of 16 patients with serum vitamin D levels &lt;30 ng/ml and in 8 (33%) of 24 patients with serum vitamin D levels &gt;30 ng/ml.Conclusions. In patients with an initially low cardiovascular risk, the probability of a combination of chondrocalcinosis and cardiovascular calcification is 45%, in OA it is 40%. The risk factors for coronary calcification in patients with CPPD and OA should be studied further.

Features and Outcomes of Microcrystalline Arthritis Treated by Biologics: A Retrospective Study.

ObjectivesThe usual treatments for crystal-associated arthritis are sometimes contraindicated; thus, new therapies against interleukin-1beta (IL-1) have been developed. We evaluated the characteristics of patients who received biological treatment for crystal-associated arthritis.Patients and MethodsWe conducted a multicentric retrospective observational study in six rheumatology units in western France. Patients receiving a biological treatment for crystal-associated arthritis between 1 January 2010 and 31 December 2018 were included. Improvement was defined as at least a 50% decrease in the count of synovitis and C-reactive protein level.ResultsForty-six patients were included: 31 (67.4%) were treated for gouty arthritis, and 15 (32.6%) for calcium pyrophosphate crystal deposition disease (CCPD). The first biotherapy used was anakinra for 14 patients (93.3%) with CCPD and 31 patients (100.0%) with gout. The first biotherapy course was more efficient in treating gout than in treating CCPD, with success in 28 patients (90.3%) and 5 patients (35.7%), respectively (p = 0.001). Six patients (42.9%) with CCPD stopped their first biotherapy course because of side effects. Among the patients with gout, urate-lowering therapy was more frequently used after (100%) than before the first biotherapy course (67.7%) (p = 0.002).ConclusionAnakinra was prescribed for cases of refractory crystal-associated arthritis or cases with contraindications for usual treatments. The efficacy of anakinra in treating CCPD was not obvious. Patients with CCPD had more side effects. The biotherapy was introduced with a long-term objective, while anti-IL-1 therapies are approved for acute crises only.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40744-021-00335-7.

Towards development of core domain sets for short term and long term studies of calcium pyrophosphate crystal deposition (CPPD) disease: A framework paper by the OMERACT CPPD working group

IntroductionAlthough calcium pyrophosphate deposition (CPPD) is common, there are no published outcome domains or validated measurement instruments for CPPD studies. In this paper, we describe the framework for development of the Outcome Measures in Rheumatology (OMERACT) CPPD Core Domain Sets. MethodsThe OMERACT CPPD working group performed a scoping literature review and qualitative interview study. Generated outcomes were presented at the 2020 OMERACT CPPD virtual Special Interest Group (SIG) meeting with discussion focused on whether different core domain sets should be developed for different calcium pyrophosphate deposition (CPPD) clinical presentations and how the future CPPD Core Domain Set may overlap with already established osteoarthritis (OA) domains. These discussions informed development of a future work plan for development of the OMERACT CPPD Core Domain Sets. FindingsDomains identified from a scoping review of 112 studies and a qualitative interview study of 36 people (28 patients with CPPD, 7 health care professionals, one stakeholder) were mapped to core areas of OMERACT Filter 2.1. The majority of SIG participants agreed there was need to develop separate core domain sets for “short term” and “long term” studies of CPPD. Although CPPD + OA is common and core domain sets for OA have been established, participants agreed that existing OA core domain sets should not influence the development of OMERACT core domain sets for CPPD. Prioritization exercises (using Delphi methodology) will consider 40 potential domains for short term studies of CPPD and 47 potential domains for long term studies of CPPD. ConclusionSeparate OMERACT CPPD Core Domain Sets will be developed for “short term” studies for an individual flare of acute CPP crystal arthritis and for “long term” studies that may include participants with any clinical presentation of CPPD (acute CPP crystal arthritis, chronic CPP crystal inflammatory arthritis, and/or CPPD + OA).

Assessment of cardiovascular risk in patients with crystal-induced arthritides and rheumatoid arthritis by the ATP III and Reynolds Risk Score

Cardiovascular risk (CVR) in patients with calcium pyrophosphate crystal deposition disease (CPPD) has not been studied, and the optimal method for assessing it has not been established yet.Objective: Evaluation of CVR and comparison of results using Adult Treatment Panel III (ATP III) and Reynolds Risk Score (RRS) scales in patients with CPPD, gout, rheumatoid arthritis (RA) and in the control group.Materials and methods: Cross-sectional, single-center study performed by case-control method. There are 42 patients with CPPD in main group, 42 patients with gout and RA in the comparison groups are, 42 healthy volunteers in the control group. The survey included measurements of anthropometric measures, blood pressure (BP), serum glucose, creatinine, cholesterol (TC), high density lipoproteins (HDL), low density lipoproteins (LDL), C-reactive protein (CRP). CVR was assessed on ATP III and RRS scales, comparison of its evaluation results was carried out between groups and between scales within groups.Results and discussion: Most of the parameters in the compared groups did not differ. However, HDL CS levels were significantly higher in patients with CPPD and in the control group than in RA and gout (p&lt;0.05). In addition, in patients with gout and RA, systolic BP was higher than in CPPD and in control (p&lt;0.05).CRP in CPPD was lower than in gout and RA and was not significantly different from this indicator in the control group. Its median was 3.8 [1.0; 12.4], 8.5 [4.1; 12.9] (р&lt;0.05), 8.6 [4.1; 20.6] (р&lt;0.05), 1.5 [0.8; 2.6] mg/l (p&gt;0.05). The CRP &gt; 5 mg/L in CPPD and in the control group was greater than in RA (p&lt;0.05) and gout (p&lt;0.05), but CRP≥5 mg/L was determined in 18 patients (43%) with CPPD and only in 3 (7%) people in the control group (p&lt;0.05). A high and very high risk of cardiovascular disease (CVD) on the ATP III scale in CPPD was noted in 5 (12%) in gout – in 7 (17%), in RA – in 9 (21%) and in the control group – in 8 (19%) cases. Its frequency in all groups was comparable.A high and very high risk of CVD for RRS was identified in 9 (21%), 14 (33%), 12 (29%) and 7 (17%) cases, respectively.Conclusions: CVR under CPPD, RA and gout is comparable and quite high. The RRS scale may be a more objective method of assessing CVD risk in patients with CPPD, gout and RA.

Editorial introductions

Current Opinion in Rheumatology was launched in 1989. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of Rheumatology is divided into 15 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Kenneth SaagKenneth SaagKenneth Saag, MD, MSc, is Jane Knight Lowe Professor of Medicine, Division of Clinical Immunology and Rheumatology, at the University of Alabama at Birmingham (UAB) in Birmingham, Alabama, USA and Professor of Epidemiology, at the UAB School of Public Health. Dr Saag is a native of Chicago, and following studies in engineering at the University of Michigan, USA, he returned to Chicago for medical school and Internal Medicine Residency at Northwestern University, USA. He then traveled to the University of Iowa, USA, for his rheumatology and epidemiology training and remained on the faculty there until moving to UAB in 1998. Dr Saag is the founding Director of the Agency for Health Care Research and Quality Deep South Center for Education and Research on Therapeutics, the UAB Center of Research Translation in Gout and Hyperuricemia, and the UAB Outcomes Research Center. He also serves as a Vice Chair for the UAB Department of Medicine. He has published over 300 peer reviewed manuscripts; has also authored more than 100 reviews, editorials, and book chapters. Recently he published the first edition of the clinical handbook Diagnosis and Management of Osteoporosis. Dr Saag is the Secretary of the American College of Rheumatology (ACR) and Past President of the Board of Trustees of the National Osteoporosis Foundation. Sara K. TedeschiSara K. TedeschiDr Tedeschi is a Rheumatologist at Brigham and Women's Hospital and an Assistant Professor of Medicine at Harvard Medical School, both in Boston, Massachusetts, USA. She completed medical school at Vanderbilt University School of Medicine in Nashville, Tennessee, USA. Dr Tedeschi then completed both her internal medicine residency and rheumatology fellowship training at Brigham and Women's Hospital and received her MPH from the Harvard T.H. Chan School of Public Health. Her clinical research focuses on risk factors for and outcomes in rheumatic diseases. Dr Tedeschi's current work which focuses on calcium pyrophosphate crystal deposition disease is funded by the National Institutes of Health. She has received several prestigious awards including the Distinguished Fellow Award from the American College of Rheumatology and election to Alpha Omega Alpha. George C. TsokosGeorge C. TsokosDr George C. Tsokos, MD, is Professor of Medicine at Harvard Medical School and Chief, Rheumatology Division, Beth Israel Deaconess Medical Center in Boston, USA. He trained in Rheumatology at the National Institutes of Health, USA. He has served various leadership positions including President of the Clinical Immunology Society, Chair of the Council of the University of Athens and Member or Chair of multiple federal study sections and Editor or Member of editorial boards of scientific journals. Dr Tsokos holds a MERIT Award from the National Institutes of Health and has received several prestigious awards including the Kirkland, Howley, Evelyn Hess awards and the Distinguished Basic Investigator Award from the American College of Rheumatology, the Lupus Insight Award, the Carol Nachman International Prize in Rheumatology and the Marian Ropes Physician Achievement Award. Dr Tsokos’ laboratory has opened and led the field of molecular abnormalities on immune cells in patients with SLE and identified previously unknown pathways which have served as the basis for novel treatments which are currently in various phases of development.