ObjectiveCalcium pyrophosphate deposition (CPPD) disease is prevalent and has diverse presentations, but there are no validated classification criteria for this symptomatic arthritis. The American College of Rheumatology (ACR) and EULAR have developed the first-ever validated classification criteria for symptomatic CPPD disease.MethodsSupported by the ACR and EULAR, a multinational group of investigators followed established methodology to develop these disease classification criteria. The group generated lists of candidate items and refined their definitions, collected de-identified patient profiles, evaluated strengths of associations between candidate items and CPPD disease, developed a classification criteria framework, and used multi-criterion decision analysis to define criteria weights and a classification threshold score. The criteria were validated in an independent cohort.ResultsAmong patients with joint pain, swelling, or tenderness (entry criterion) whose symptoms are not fully explained by an alternative disease (exclusion criterion), the presence of crowned dens syndrome or calcium pyrophosphate crystals in synovial fluid are sufficient to classify a patient as having CPPD disease. In the absence of these findings, a score>56 points using weighted criteria, comprising clinical features, associated metabolic disorders, and results of laboratory and imaging investigations, can be used to classify as CPPD disease. These criteria had a sensitivity of 92.2% and specificity of 87.9% in the derivation cohort (190 CPPD cases, 148 mimickers), whereas sensitivity was 99.2% and specificity was 92.5% in the validation cohort (251 CPPD cases, 162 mimickers).ConclusionThe 2023 ACR/EULAR CPPD disease classification criteria have excellent performance characteristics and will facilitate research in this field.
ObjectiveCalcium pyrophosphate deposition (CPPD) disease is prevalent and has diverse presentations, but there are no validated classification criteria for this symptomatic arthritis. The American College of Rheumatology (ACR) and EULAR have developed the first‐ever validated classification criteria for symptomatic CPPD disease.MethodsSupported by the ACR and EULAR, a multinational group of investigators followed established methodology to develop these disease classification criteria. The group generated lists of candidate items and refined their definitions, collected de‐identified patient profiles, evaluated strengths of associations between candidate items and CPPD disease, developed a classification criteria framework, and used multi‐criterion decision analysis to define criteria weights and a classification threshold score. The criteria were validated in an independent cohort.ResultsAmong patients with joint pain, swelling, or tenderness (entry criterion) whose symptoms are not fully explained by an alternative disease (exclusion criterion), the presence of crowned dens syndrome or calcium pyrophosphate crystals in synovial fluid are sufficient to classify a patient as having CPPD disease. In the absence of these findings, a score >56 points using weighted criteria, comprising clinical features, associated metabolic disorders, and results of laboratory and imaging investigations, can be used to classify as CPPD disease. These criteria had a sensitivity of 92.2% and specificity of 87.9% in the derivation cohort (190 CPPD cases, 148 mimickers), whereas sensitivity was 99.2% and specificity was 92.5% in the validation cohort (251 CPPD cases, 162 mimickers).ConclusionThe 2023 ACR/EULAR CPPD disease classification criteria have excellent performance characteristics and will facilitate research in this field.
This is a unique case that signifies the importance to look beyond the genitourinary system for causes of hydronephrosis. In addition, we outline the manner in which a fecalith should be addressed. KeywordsConstipation, fecalith, hydronephrosis, polyethylene glycol electrolyte solution. Case ReportWe report a case of a rectal fecalith resulting in bilateral hydronephrosis and hydroureter. A 76-year-old woman presented with minimal urine output and generalized weakness. She was diagnosed with septic shock secondary to a urinary source. Laboratory studies were consistent with acute renal failure (4.0 mg/dL on presentation-baseline creatinine 0.7) and uremia (BUN 108 mg/dL). A noncontrast computed tomography (CT) scan of her pelvis showed bilateral hydronephrosis and hydroureter secondary to a large (14 cm) rectal fecalith ( Figs. 1 and 2). Manual disimpaction was performed, and an aggressive bowel regimen of fiber laxatives, stool softeners, and enemas were given. Large amounts of stool were fragmented. A polyethylene glycol electrolyte solution at a rate of 100 mL/h for 24 h was administered for fecalith resolution. A repeat CT scan of her abdomen and pelvis on hospital day 2, revealed a decrease in size of the fecalith to approximately 4 cm. Persistent bilateral hydronephrosis and hydroureter were observed; however, slow resolution postdisimpaction was an expected outcome (Figs. 3 and 4). While the patient's creatinine trended down to 1.53 mg/dL by hospital day 9, her hospital course was complicated by aspiration pneumonia, and she was discharged to hospice care.
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