Calcium Pyrophosphate Dihydrate Deposition Research Articles

Systematic literature review to inform the EULAR recommendations for the use of imaging in crystal-induced arthropathies in clinical practice

ObjectiveTo summarise current data regarding the use of imaging in crystal-induced arthropathies (CiAs) informing a European Alliance of Associations for Rheumatology task force.MethodsWe performed four systematic searches in Embase, Medline...

CALCIUM PYROPHOSPHATE DIHYDRATE DEPOSITION DISEASE OF ELBOW WITH ULNAR NERVE NEUROPATHY: A CASE REPORT

Crystal deposition disorders are one of the causes of inflammatory arthropathy. A rare variety of this disorder is Calcium Pyrophosphate Dihydrate deposition disease. It is usually seen in the elderly and progresses as calcifications in and around the joint i.e. Chondrocalcinosis with repeated synovitis leading to degenerative changes of large and unusual or non-weight-bearing joints. It is a case report of 43 years housewife with a gradually enlarging mass at posteromedial aspect of the left elbow with ulnar nerve weakness for 1 year. Radiographs revealed degenerative joint with periarticular calcifications. The electrodiagnostic test showed ulnar nerve demyelination and axonal neuropathy. Surgical excision with decompression of ulnar nerve was done. Histopathology revealed features consistent with Pseudogout. Subsequent follow-up resulted in improvement of nerve function with no clinicoradiological evidence of recurrence. So, degenerative changes with periarticular calcifications in non-weight-bearing joints should be suspected for pseudogout. It may be associated with compressive neuropathy.

Incidental findings involving the temporomandibular joint on computed tomography and magnetic resonance imaging.

The temporomandibular joint (TMJ) is frequently imaged in head and neck computed tomography (CT) and magnetic resonance imaging (MRI) studies. Depending on the indication for the study, an abnormality of the TMJ may be an incidental finding. These findings encompass both intra- and extra-articular disorders. They may also be related to local, regional or systemic conditions. Familiarity with these findings along with pertinent clinical information helps narrow the list of differential diagnoses. While definitive diagnosis may not be immediately apparent, a systematic approach contributes to improved discussions between clinicians and radiologists and better patient management.

Extensive concomitant optic nerve sheath and sclerochoroidal calcifications

Computed tomography revealed tram track–like calcifications within bilateral optic nerve sheaths and large, amorphous calcific plaques on the sclera of a 91-year-old man (Fig. 1). His past medical history was significant for calcium pyrophosphate dihydrate deposition disease, chronic renal failure, and hypothyroidism. To the best of our knowledge, there is only 1 reported case describing concomitant optic nerve sheath and sclerochoroidal calcifications that were idiopathic.1 Disorders of calcium-phosphorus homeostasis are another known etiology of these calcifications.

Calcium pyrophosphate dihydrate of the ligamentum flavum in the cervical spine - A review of the literature.

Calcium pyrophosphate dihydrate (CPPD) deposition, also known as pseudogout, in the cervical ligamentum flavum (CLF), is a rare disease which can cause spinal cord signaling changes leading to rapid deterioration in function. The natural history of cervical myelopathy as a result of CPPD deposition within the CLF is not well understood. Our objective is to describe the presentation, imaging findings, and treatment options of CPPD deposition or pseudogout of the cervical spine. Using PubMed, we analyzed studies published from 1978 to 2022. Key words used were "pseudogout," "CPPD deposit disease," "cervical yellow ligament," "CLF," and "cervical spine." We excluded "crowned dense syndrome" and "ossification of ligament flavum." Using a department database, we queried for patients treated for CPPD of the cervical spine. Twenty clinical studies on CPPD of the cervical spine with 69 patients aged between 15 and 92 years (mean = 72) were identified. Neck pain and numbness of the hands were the most common symptoms. Diabetes mellitus and hypertension were the most common comorbidities. Males and females were affected at equal rates. C4-C5 and C5-C6 were the most affected segments. Earlier surgical treatment produced better outcomes. A laminectomy and fusion or laminoplasty were the most common procedures performed with most patients experiencing some return of neurologic function. Although rare, CPPD deposit disease in the CLF should be readily considered as a differential diagnosis due to the continuously aging population. CPPD's progressively worsening nature makes an early diagnosis and treatment important in improving the patient's overall quality of life.

Case Report: Posterolateral Epidural Supra-C2-Root Approach (PESCA) for Biopsy of a Retro-Odontoid Lesions in Same Sitting After Occipitocervical Fixation and Decompression in a Case of Crowned Dens Syndrome With Brainstem Compression and Displacement

Background‘Crowned dens syndrome' (CDS) is a special form of calcium pyrophosphate dihydrate deposition disease which is characterized radiologically by a halo-like or crown-like distribution in the periodontoid region and clinically by cervical pain. Herein, we will describe our experience of posterolateral epidural supra-C2-root approach (PESCA) for biopsy of retro-odontoid lesions in one surgical session after occipitocervical fixation and decompression in a patient with CDS and massive brainstem compression.Case PresentationA 70-year-old woman presented to our department with a 4-week history of progressive walking impairment, neck pain, neck rigidity, fever, dizziness, slight palsy of the left hand, and multiple fall episodes. Magnetic resonance imaging (MRI) of the craniovertebral junction (CVJ) and cervical spine revealed a lesion of the odontoid process and the retro-odontoid region with mainly solid components, as well as small cystic components, and brainstem compression and displacement. In first step, fusion surgery of the CVJ C0–C4 was performed with occiptocervical decompression. After fusion and decompression the lower lateral part of the C1 arc and the lateral superior part of the left side of the C2 arc were removed. The entry point was located directly above the superior part of the C2 root. A biopsy of the lateral portions of the lesions was obtained by bioptic forceps under microscope guidance. Pathologic examination of the mass revealed deposition of birefringent crystals compatible with calcium pyrophosphate. In addition to the clinical symptoms (especially neck pain), the diagnosis of CDS was made. Non-steroidal inflammatory drugs (NSAIDs) and colchicine (and later magnesium) were started. At follow-up examination 6 months after surgery, an MRI scan of the cervical spine revealed regression of the pannus and the cyst with replacement of the brainstem, clinical improvement of walking, and increased strength of the left hand.ConclusionsThis study demonstrates that PESCA can be used to obtain tissue for pathological analysis in one surgical sitting after fusion and decompression and that fusion, decompression, and PESCA (in the same session) together with subsequent conservative management could be a good alternative for the treatment of CDS.

Symptomatic retro-odontoid pseudotumor causing calcium pyrophosphate dihydrate deposition combined with multilevel cervical spondylotic myelopathy.

IntroductionSymptomatic retro-odontoid pseudotumor (ROP) caused by cervical compression and myelopathy is rare. Pathological diagnosis is recommended for differential diagnosis including the following: inflammatory disease, primary bone tumor, metastatic disease and calcium pyrophosphate dihydrate deposition (CPPD) also known as “crowned dens syndrome”. The authors report a rare case of ROP caused by CPPD deposition combined with multilevel cervical spondylotic myelopathy (MCSM) which was treated by tumor resectioning using a transoral approach combined with posterior decompression and fusion.Case presentationA 66-year-old male presented with progressive neck pain and spastic gait with no history of trauma. Radiographic imaging revealed degenerative change involving the atlanto-axial and atlanto-occipital joints with calcified enhancing soft tissue around the odontoid process causing cord compression and cervical instability at the C1-C2 level combined with MCSM and spinal cord compression at C3 to C7. Microscopic assisted transoral tumor resection combined with posterior decompression and fusion was performed at the occiput to T2. The pathology report describes a rhomboid-shaped crystal caused by calcium pyrophosphate dihydrate deposition (CPPD) disease. At the 6-month follow-up following the operation, the patient's neck pain and spastic gait were improved compared to the preoperative examination.DiscussionCervical compression and myelopathy from ROP causing CPPD combined with MCSM is rare. Pathology diagnosis and surgical management are highly recommended.ConclusionIn this case, a combined surgical approach: tumor resection using a transoral approach and a posterior approach for decompression and fusion at occiput to T2 was an effective option for this condition.

Multilevel calcium pyrophosphate dihydrate deposition in cervical ligamentum flavum: clinical characteristics and imaging features

BackgroundInvolvement in cervical ligamentum flavum is a rare manifestation of the calcium pyrophosphate dihydrate deposition disease. Only few cases of this condition have been reported. We revealed eighteen cases of CPPD in cervical ligamentum flavum that diagnosed at a single medical center. In our case series, clinical characteristics and magnetic resonance imaging findings of patients are described.MethodsWe retrospectively reviewed the medical charts and imaging studies of the eighteen patients with pseudogout attack of the cervical ligamentum flavum. In addition, we discussed the differences between this disease and ossification of ligamentum flavum in image manifestations.ResultsThere were fourteen men and four women aged between 59 and 87 years. Diabetes mellitus and hypertension were the most common comorbidities. Myelopathy and neck pain were presented in most patients. C4–5 and C5–6 were attacked most frequently, and multiple- rather than single-level involvement could be observed in our series. “Acute on chronic phenomenon” was a specific magnetic resonance image finding in patients whose symptom durations were between 2 to 5 months. Compared to ossification of ligamentum flavum, calcium pyrophosphate dihydrate crystal deposition had different image signs, including morphology, side of the involved ligament, no continuity with the lamina, acute on chronic phenomenon, and presence of retro-odontoid mass.ConclusionsNodular calcifications in cervical ligamentum flavum raise highly suspicion for calcium pyrophosphate dihydrate deposition and must be diagnosed by histological examination and polarized light microscopy. This disease is different from ossification of ligamentum flavum, and it could be recognized by specific image features.

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.

Chondrocytes From Osteoarthritic and Chondrocalcinosis Cartilage Represent Different Phenotypes.

Basic calcium phosphate (BCP)-based calcification of cartilage is a common finding during osteoarthritis (OA) and is directly linked to the severity of the disease and hypertrophic differentiation of chondrocytes. Chondrocalcinosis (CC) is associated with calcium pyrophosphate dihydrate (CPPD) deposition disease in the joint inducing OA-like symptoms. There is only little knowledge about the effect of CPPD crystals on chondrocytes and the signaling pathways involved in their generation. The aim of this study was to investigate the chondrocyte phenotype in CC cartilage and the effect of CPPD crystals on chondrocytes. Cartilage samples of patients with CC, patients with severe OA, and healthy donors were included in this study. The presence of CC was evaluated using standard X-ray pictures, as well as von Kossa staining of cartilage sections. OA severity was evaluated using the Chambers Score on cartilage sections, as well as the radiological Kellgren–Lawrence Score. Patients with radiologically detectable CC presented calcification mainly on the cartilage surface, whereas OA patients showed calcification mainly in the pericellular matrix of hypertrophic chondrocytes. OA cartilage exhibited increased levels of collagen X and matrix metalloproteinase 13 (MMP13) compared with CC and healthy cartilage. This observation was confirmed by qRT-PCR using cartilage samples. No relevant influence of CPPD crystals on hypertrophic marker genes was observed in vitro, whereas BCP crystals significantly induced hypertrophic differentiation of chondrocytes. Interestingly, we observed an increased expression of p16 and p21 in cartilage samples of CC patients compared with OA patients and healthy controls, indicating cellular senescence. To investigate whether CPPD crystals were sufficient to induce senescence, we incubated chondrocytes with BCP and CPPD crystals and quantified senescence using β-gal staining. No significant difference was observed for the staining, but an increase of p16 expression was observed after 10 days of culture. Primary chondrocytes from CC patients produced CPPD crystals in culture. This phenotype was stabilized by mitomycin C-induced senescence. Healthy and OA chondrocytes did not exhibit this phenotype. BCP and CPPD crystals seem to be associated with two different chondrocyte phenotypes. Whereas BCP deposition is associated with chondrocyte hypertrophy, CPPD deposition is associated with cellular senescence.

Weight-bearing CT for Knee Osteoarthritis Assessment: A Story Unfolds

Weight-bearing CT for Knee Osteoarthritis Assessment: A Story Unfolds

Calcified chondroid mesenchymal neoplasms with FN1-receptor tyrosine kinase gene fusions including FGFR2, FGFR1, MERTK, NTRK1, and TEK: a molecular and clinicopathologic analysis.

Translocations involving FN1 have been described in a variety of neoplasms that share the presence of a cartilage matrix and may also contain a variable extent of calcification. Fusions of FN1 to FGFR1 or FGFR2 have been reported in nine soft tissue chondromas, mostly demonstrated indirectly by FISH analysis. Delineation of FN1 fusions with various partner genes will facilitate our understanding of the pathogenesis and diagnostic classification of these neoplasms. In this study, we present molecular, clinical, and pathologic features of 12 cartilaginous soft tissue neoplasms showing a predilection for the TMJ region and the distal extremities. We analyzed for gene fusions with precise breakpoints using targeted RNA-seq with a 115-gene panel. We detected gene fusions in ten cases, including three novel fusions, FN1-MERTK, FN1-NTRK1, and FN1-TEK, each in one case, recurrent FN1-FGFR2 fusion in five cases, FN1-FGFR1 in one case, and FGFR1-PLAG1 in one case. The breakpoints in the 5' partner gene FN1 ranged from exons 11-48, retaining the domains of a signal peptide, FN1, FN2, and/or FN3, while the 3' partner genes retained the transmembrane domain, tyrosine kinase (TK) domains, and/or Ig domain. The tumors are generally characterized by nodular/lobular growth of polygonal to stellate cells within a chondroid matrix, often accompanied by various patterns of calcification, resembling those described for the chondroblastoma-like variant of soft tissue chondroma. Additional histologic findings include extensive calcium pyrophosphate dihydrate deposition in two cases and features resembling tenosynovial giant cell tumor (TGCT). Overall, while the tumors from our series show significant morphologic overlap with chondroblastoma-like soft tissue chondroma, we describe findings that expand the morphologic spectrum of these neoplasms and therefore refer to them as "calcified chondroid mesenchymal neoplasms." These neoplasms represent a spectrum of chondroid/cartilage matrix-forming tumors harboring FN1-receptor TK fusions that include those classified as soft tissue chondroma as well as chondroid TGCT.

The Incidence and Significance of Calcium Pyrophosphate Dihydrate Deposits in Histologic Examinations of Total Hip, Knee, and Shoulder Joint Arthroplasties.

The incidence, distribution, and significance of calcium pyrophosphate dihydrate deposition (CPPD) disease have not been extensively compared among various total joint resections. To investigate and define the clinical and pathologic features of CPPD in hip, shoulder, and knee arthroplasties. We retrospectively reviewed consecutive total hip, knee, and shoulder arthroplasty cases (N = 3195) confirmed pathologically between January 1, 2017, and October 10, 2018, comparing clinical and pathologic data. Among 2004 hip arthroplasties, 61 (3%) had CPPD on pathologic examination; the majority had a histologic diagnosis of osteoarthritis, followed by fracture and avascular necrosis. Of 1113 knee arthroplasties, 98 (9%) had CPPD; all had a histologic diagnosis of osteoarthritis. Among 78 shoulder arthroplasties, 10 (13%) had CPPD; all but one had a histologic diagnosis of osteoarthritis. Patients with hip and knee CPPD were significantly older than those without CPPD. Of the 169 pathologically detected CPPD cases, only 35 (21%) were documented on preoperative radiologic images or by other clinical means; radiology reports were significantly more likely to document chondrocalcinosis in the knees than in the hips. Histologically, CPPD was noted almost exclusively in the separately submitted soft tissues/joint capsule, concomitantly involving the articular cartilage surface in only 3.0% (5 of 169) of cases. Calcium pyrophosphate dihydrate deposition is more than twice as likely to occur in the knees and shoulders compared with the hips. Patients with CPPD in the knees or hips are usually not recognized preoperatively/radiologically and constitute a significantly older population. Reliably establishing the diagnosis of CPPD requires pathologic examination of the submitted soft tissue/joint capsule.

Articular and periarticular spinal calcifications in relation to synovial fluid findings in patients with calcium pyrophosphate dihydrate deposition disease (CPPD)

BackgroundCalcium pyrophosphate dihydrate deposition disease (CPPD) is the second most common form of the crystal-associated arthritis. Diagnosis is achieved by detection of crystals by polarized light microscopy and/or detection of hyaline cartilage or fibrocartilage calcifications characteristic of CPPD deposition by musculoskeletal ultrasound (MSUS). Axial involvement with intervertebral disc calcification, sacroiliac erosions, and sub-chondral cysts of the facet joints occurs with CPPD deposition.AimTo assess the presence and relation between calcification of intervertebral discs, other articular and periarticular spinal structures, and synovial fluid analysis (SFA) and MSUS calcifications in patients with CPPD deposition disease.MethodsOne hundred patients with CPPD disease diagnosed according to the modified proposed diagnostic criteria by McCarty 1994 were included. Plain radiography on the spines, pelvis, and affected joints, MSUS on affected joints, and synovial fluid analysis (SFA) were done.ResultsSpinal calcification was present in 55% of patients. The commonest site was anterior longitudinal ligament (43%). Characteristic CPPD calcifications by plain radiography on the knee and wrist joints were present in 38% and 16% respectively. Characteristic CPPD calcifications by MSUS on the knee and wrist joints presented in 93% and 27% respectively. CPPD crystal detection by SFA was 97%. The accuracy of MSUS to diagnose CPPD deposition disease is more than double that of plain radiography, and it is comparable to that of synovial fluid analysis. The result of intra-rater analysis between SFA by polarized light microscopy and MSUS was kappa 0.767 (p < 0.001); this indicates substantial level of agreement between SFA and MSUS; between plain radiography and MSUS, it was kappa 0.188 (p = 0.32) which indicates slight agreement, and between plain radiography and SFA, it was kappa 0.037 (p = 0.1) which fails to reach a significant level of agreement. There was a significant positive relation between spinal calcification and wrist joint calcification by plain radiography.ConclusionConsiderable spinal affection by CPPD deposition disease can be detected. Although the most definitive, reliable direct approach for CPPD deposition disease diagnosis is SFA using polarized light microscopy, MSUS is considered a useful non-invasive diagnostic tool in this situation. In CPPD deposition disease, MSUS has proven to be an excellent technique for detecting calcification in the articular tissue disease compared to conventional radiography.

Imaging of Calcifying and Ossifying Disorders of the Spine

Substantial advances in the availability of spinal imaging have led to the increasing use of spinal imaging in the evaluation of patients with neck and back pain. This has resulted in the recognition of a diverse collection of spinal disorders, characterized by heterotopic calcification and ossification. Despite the increasing frequency at which these conditions are being diagnosed, there still exists a lack of awareness of the imaging characteristics of some of these calcifying and ossifying spinal disorders. Here, we review the imaging characteristics of ankylosing spondylitis, arachnoiditis ossificans, calcific discitis, calcific tendonitis of the longus colli, calcium pyrophosphate dihydrate deposition, crowned dens syndrome, diffuse idiopathic skeletal hyperostosis, ossification of the ligamentum flavum, and ossification of the posterior longitudinal ligament. Radiologists and clinicians alike should be familiar with these calcifying and ossifying spinal disorders to aid in an accurate diagnosis and to guide clinical management.Learning Objectives: Recognize the clinical features and imaging findings of various calcifying and ossifying disorders of the spine.

Cervical myelopathy due to subaxial calcium pyrophosphate dihydrate (CPPD) deposition with simultaneous asymptomatic crowned dens syndrome: two case reports

BackgroundThere are few reports of cervical myelopathy caused by an attack of subaxial calcium pyrophosphate dihydrate (CPPD) deposition. Moreover, there has been no report on cervical myelopathy by subaxial CPPD deposition with simultaneous asymptomatic crowned dens syndrome (CDS) at the same time.Case presentationThe first case was a 68-year-old male complaining of cervical myelopathic symptoms. Plain radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) findings revealed spinal cord compression by calcified round lesions at C4 as well as a calcified lesion behind the dens. The second case was a 77-year-old female complaining of cervical myelopathic symptoms. Plain radiographs, CT and MRI findings revealed spinal cord compression by calcified round lesions at C3 and C4 as well as a calcified lesion behind the dens. In both cases, we believed that the calcified lesion behind the dens was an asymptomatic lesion. Therefore, the first patient received decompressive laminectomy of C3 and C4, removal of calcified round lesions, and posterior fixation from C3 to C5 due to associated kyphosis. The second patient underwent decompressive laminectomy of C3 and C4 and removal of calcified round lesions. Microscopic examination under polarized light showed dark blue calcifications with rhomboid crystals that were positively birefringent. The findings were consistent with those of CPPD.ConclusionsThis is the first study to report cervical myelopathy caused by subaxial CPPD deposition with simultaneous asymptomatic CDS. Surgical removal of the subaxial CPPD deposition alone achieved a satisfactory surgical outcome without recurrence.

Lumbar Facet Joint Cyst Caused by Calcium Pyrophosphate Arthropathy of the Spine: Case Report and Review of Literature

Background Data: Calcium pyrophosphate dihydrate (CPPD) deposition disease is a metabolic disorder caused by the deposition of CPPD crystals in the articular or periarticular structures that leads to inflammation of the joints. Spine affection is rare. Purpose: To present a rare case of lumbar facet joint cyst caused by calcium pyrophosphate arthropathy. Study Design: A case report with a brief review of the literature. Patient and Methods: Seventy-three-year-old man, who underwent PLIF L5/S1 ten years ago, presented with right L4 nerve root compression symptoms that have started two months ago. Clinical examination revealed no motor function disturbance but hypoesthesia in the L4 dermatome. He has no history of crystal deposition disorder. The patient underwent decompression and fusion at this level. Results: The symptoms were completely resolved postoperatively and after one-year follow-up. Histopathological examination of the cyst revealed fibrous granulation tissue. Examination of the tissue under polarized light showed positively birefringent, short blunt crystals of calcium pyrophosphate dihydrate. Conclusion: Calcium pyrophosphate arthropathy, although rare, should be incorporated into the differential diagnosis of cystic lesions of the facet joints. (2020ESJ221)

Spinal pseudogout is a joker. Commentary on “Calcium pyrophosphate deposition disease of the cervical and thoracolumbar spine: A report of two cases”

In this issue, Moon et al. provide a detailed report on two cases of Calcium pyrophosphate deposition disease (CPDD), causing compression of the spinal cord and conus medullaris requiring surgical decompression and reconstruction [[1]Moon A.S. Mabry S. Pittman J.L. Calcium pyrophosphate deposition disease of the cervical and thoracolumbar spine: a report of two cases.North American Spine Society J (NASSJ). 2020; 3: 100026https://doi.org/10.1016/j.xnsj.2020.100026Abstract Full Text Full Text PDF Scopus (1) Google Scholar]. Both cases presented on elderly patients, with known advanced degenerative disease of the spine. In both cases the mass was likely forming from the facet joint and both cases presented with a combination of severe pain and symptoms of neural compression (in different degrees, causing alteration of the spinal cord motor tracts in one case and unilateral lower limb pain mimicking radiculopathy in the second one). Both patients gained full resolution of symptoms and neurological function after surgery. A number of cases of CPDD affecting the spine have been described in the literature, but most reports include one or few cases, which suggests that CPDD requiring surgery is relatively unfrequent. This is in contrast with the finding of high prevalence (as high as 25%) of deposits of calcium pyrophosphate in the cervical spine of patients with pseudogout affecting peripheral joints [[2]Moshrif A. Laredo J.D. Bassiouni H. et al.Spinal involvement with calcium pyrophosphate deposition disease in an academic rheumatology center: a series of 37 patients.Semin Arthritis Rheum. 2019; 48: 1113-1126https://doi.org/10.1016/j.semarthrit.2018.10.009Crossref PubMed Scopus (31) Google Scholar]. While the association of pseudogout with lumbar and cervical stenosis has been well described, some aspects of this condition deserve some attention. The prognosis of spinal canal decompression in patients with CPDD does not seem to be worse than that on patients with degenerative lumbar stenosis [[3]Ariyawatkul T. Pichaisak W. Chavasiri C. Vamvanij V. Wilartratsami S. Luksanapruksa P. The role of calcium pyrophosphate dihydrate deposition in the postoperative outcome of lumbar spinal stenosis patients.Asian Spine J. 2019; 13: 1001-1009https://doi.org/10.31616/asj.2018.0280Crossref PubMed Scopus (2) Google Scholar]. CPDD can also need to be distinguished from other spinal conditions, such as tumors [[4]Turaga S. Thomas M. Savy L. Schreiber B.E. Pseudogout or pseudolymphoma? Calcium pyrophosphate deposition disease of the cervical spine: a rare presentation and literature review.BMJ Case Rep. 2019; 12 (Published 2019 Dec 2)e231508https://doi.org/10.1136/bcr-2019-231508Crossref PubMed Scopus (6) Google Scholar], spinal infection [[5]Bridges K.J. Bullis C.L. Wanchu A. Than K.D. Pseudogout of the cervical and thoracic spine mimicking infection after lumbar fusion: case report.J Neurosurg Spine. 2017; 27: 145-149Crossref PubMed Scopus (12) Google Scholar], hematoma of the yellow ligament [[6]Cruz-Conde R. Berjano P. Buitron Z. Ligamentum flavum hematoma presenting as progressive root compression in the lumbar spine.Spine. 1995; 20: 1506-1509https://doi.org/10.1097/00007632-199507000-00012Crossref PubMed Scopus (42) Google Scholar]. One of the two cases in this report presented with severe spinal sagittal misalignment that might be related to either the spinal cord compression or inflammation of the facet joints, and resolved after surgery, which suggests that CPDD can also be misinterpreted as spinal deformity of functional nature [[7]Redaelli A. Berjano P. Aebi M. Focal disorders of the spine with compensatory deformities: how to define them.Eur Spine J. 2018; 27: 59-69https://doi.org/10.1007/s00586-018-5501-8Crossref PubMed Scopus (9) Google Scholar]. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Download .pdf (.12 MB) Help with pdf files Calcium pyrophosphate deposition disease of the cervical and thoracolumbar spine: A report of two casesNorth American Spine Society Journal (NASSJ)Vol. 3PreviewSpinal calcium pyrophosphate deposition disease (CPPD) is uncommon, and often resembles more common spine pathologies causing pain and neural compression. Here, we present two unusual cases of CPPD of the cervical and thoracolumbar spines. Full-Text PDF Open Access

Dual-energy CT collagen density mapping of wrist ligaments reveals tissue remodeling in CPPD patients: first results from a clinical cohort

ObjectivesTo evaluate differences in collagen density as detected by dual-energy computed tomography (DECT) of wrist ligaments between patients with calcium pyrophosphate-dihydrate deposition disease (CPPD) and a control group in order to gain insight into changes of the extracellular matrix in response to crystal deposition.Materials and methodsThis retrospective study included 28 patients (18 with CPPD, 10 controls) who underwent DECT of the wrist. Collagen density maps were reconstructed from the DECT datasets and used to measure densities in regions of interest (ROIs) placed in the scapholunate (SL) ligament (dorsal, palmar, proximal), lunotriquetral (LT) ligament, and extensor carpi radialis (ECR) tendon, (n = 260 measurements). The presence of calcifications on standard CT images in these regions was assessed by a blinded reader. Densities were compared with nonparametric tests, and linear regression analysis was performed to investigate the impact of age, sex, and CT- detected calcium deposition on collagen density.ResultsCollagen density in the SL ligament was significantly higher in CPPD patients than in controls (overall mean: 265.4 ± 32.1 HU vs. 196.3 ± 33.8 HU; p < 0.001). In the ECR tendon, collagen densities did not differ significantly (p = 0.672): 161.3 ± 20.1 HU in CPPD vs. 163.6 ± 12.0 HU in controls. Regression analysis showed that diagnosis, but not age or calcification, had a significant impact on collagen density.ConclusionCollagen density of the SL ligament is significantly higher in CPPD patients than in control patients. Further research is needed to understand these changes in the extracellular matrix of ligaments in CPPD.

Clinical manifestations of the patients with glenohumeral osteoarthritis who underwent shoulder arthroplasty ーa comparison with cuff tear arthropathy

Purpose: Mechanisms underlying development and progression of primary glenohumeral osteoarthritis (GHOA) have not been proven conclusively yet. As an anatomical factor, Critical Shoulder Angle (CSA) has been received attention and Bjarnison AO et al. recently reported that CSA < 30 degree was a significant risk factor for developing GHOA. Meanwhile, GHOA is possibly a part of generalized OA affected in multiple joints. The aim of this study was to investigate clinical manifestations of the patients with GHOA who underwent shoulder arthroplasty compared with cuff tear arthropathy (CTA) patients. Methods: In 40 consecutive cases who underwent shoulder arthroplasty (TSA/RSA/Hemiarthroplasty) in our hospital, patients with RA, humeral head necrosis, fracture, hemodialysis, and who underwent contralateral shoulder arthroplasty before were excluded, and remaining 27 cases (20 female), with a mean age of 78 years (64−86) were retrospectively analyzed. Patients were allocated to GHOA group (n=16) and CTA group (n=11) according to preoperative imaging studies. 1) Age, sex, 2) Bilateral CSA, 3) Serum CRP, 4) Detection of calcium pyrophosphate dihydrate (CPPD) crystals in ipsilateral synovial fluid, 5) Motion pain and radiological change in contralateral shoulder, and 6) History of TKA/THA, were assessed and compared between the groups. Mann-Whitney U test and Fisher’s exact test were used for statistical analyses and P<0.05 was considered significant. Results: 1) Age and sex were similar between the groups. 2) CSA was bilaterally smaller in GHOA (Figure 1) and patients with CSA < 30 degree was more frequent in GHOA (13/16) compared with CTA (3/11). 3) Serum CRP was similar between the groups. 4) Positive CPPD shoulder was more frequent in GHOA (10/16) compared with CTA (2/11). 5) Motion pain and radiological change in contralateral shoulder were more frequent in GHOA compared with CTA (Figure 2). 6) History of TKA/THA was more frequent in GHOA (11/16) compared with CTA (3/11). All patients in GHOA group had at least 1 factor in 2), 4), 5), 6). Mean number of these factors was significantly higher in GHOA (2.9) than in CTA (1.0). Conclusions: Both anatomical and systemic factors possibly associate with pathogenesis for developing end stage GHOA, which are completely different from CTA. CSA is an important anatomical factor as reported, however, severe GHOA possibly underlies generalized OA, and CPPD deposition disease would associate with the pathology. Although multicenter study including larger number of patients is warranted, our results would provide better understanding for GHOA development and progression. When clinicians undertake arthroplasty for severe GHOA, it should be careful for contralateral shoulder and other joints to achieve better clinical outcome after the surgery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)