calcium pyrophosphate crystals in synovial fluid

Crowned dens syndrome: CPP inflammatory arthritis of the C2 vertebra causes acute neck pain resembling meningitis or vertebral osteomyelitis.Pseudoneuropathic arthropathy: manifests with destructive monoarthritis similar to neuropathic arthropathy, but sensation and proprioception are preserved.In contrast to typical RA, joint involvement may be asymmetric and sequential.Manifests similarly to rheumatoid arthritis ( RA), with polyarticular distribution associated with morning stiffness.Rheumatoid arthritis-like presentation (chronic CPP crystal inflammatory arthritis).Often associated with pseudogout-like flares of acute inflammatory arthritis.Usually polyarticular can occur in joints not typically affected by OA.Characterized by progressive joint degeneration.Osteoarthritis-like presentation ( osteoarthritis with CPPD pseudo- osteoarthritis).Pseudogout refers to the acute, not chronic, form of CPPD disease. Triggers: can occur spontaneously or be triggered by joint trauma/ surgery or acute illness.Most commonly affects the knee and wrist can also affect other large joints (e.g., hips, ankles).Monoarthritis (occasionally oligoarthritis).Acute attack of pain and swelling in the affected joint (s).Acute CPP crystal arthritis ( pseudogout ) CPPD may also remain asymptomatic and be identified incidentally on imaging ( asymptomatic chondrocalcinosis). There are several distinct clinical phenotypes of CPPD disease. There is currently no specific treatment targeted at CPP crystals. Treatment is primarily symptomatic and consists of antiinflammatory medications (including intraarticular and systemic glucocorticoids, colchicine, and NSAIDs).

Identification of CPP crystals on synovial fluid analysis or on imaging in a patient with typical symptoms confirms the diagnosis. Chronic CPP crystal arthritis has many clinical phenotypes, the most common of which resembles severe osteoarthritis. Pseudogout refers to acute CPP crystal arthritis, which typically presents as sporadic flares of monoarticular synovitis affecting a large joint and can last for much longer than a typical gout flare. CPPD disease can be asymptomatic or manifest with acute or chronic symptoms. While it is typically idiopathic, it may also be caused by joint damage, various metabolic abnormalities, or a genetic predisposition. It results from the deposition of calcium pyrophosphate dihydrate ( CPP) crystals within articular cartilage. Age was the only significant influencing factor on CPPD crystal formation in patients with RA.Calcium pyrophosphate deposition (CPPD) disease is a crystalline inflammatory arthritis seen primarily in individuals over age 60. In conclusion, demographic, clinical and serological characteristics of patients with RA were not associated with the occurrence of CPPD crystals. An age-independent association of long-time treatment with diuretics and CPPD crystal formation was not found. Patients positively tested for CPPD crystals had a significantly higher age than CPPD-negative patients (p < 0.0001). CPPD-positive and CPPD-negative subjects did not differ significantly in sex, duration of disease, Steinbrocker radiologic stage, disease activity score 28, as well as serum rheumatoid factor and anti-CCP positivity.

CPPD crystals were observed in 20 of the 113 cases, representing 17.7%. Demographic, clinical and serological data, acquired from the medical records, were compared between crystal-positive and crystal-negative subjects. After cytocentrifugation, the sediments were examined by polarized microscopy for the occurrence of CPPD crystals. We examined 113 consecutive SF samples of patients with RA, obtained from therapeutic arthrocentesis of knee joints. The objectives of this study were to determine the prevalence of CPPD crystals in the synovial fluid (SF) of patients with RA and to investigate whether the detection of CPPD crystals is correlated with demographic, clinical and serological features. In particular, data determined by the cytospin technique, which is an effective tool to enhance the crystal detection rate, are lacking. There are only a few studies dealing with the detection and clinical impact of calcium pyrophosphate (CPPD) crystals in patients with rheumatoid arthritis (RA) published to date.

Calcium pyrophosphate crystals in synovial fluid