Calcium pyrophosphate dihydrate and basic calcium phosphate crystalinduced arthropathies: Update on pathogenesis, clinical features, and Therapy

Abstract

Calcium-containing crystals are the most common class for the osteoarthritic joint. They are responsible for acute periarthritis and destructive arthropathies, and for tissue deposits mimicking tumor-like masses. These crystals encompassed mainly calcium pyrophosphate dihydrate and basic calcium phosphate crystals, with the latter being related to hydroxyapatite, carbonate-substituted apatite, and octacalcium phosphate. Calcification deposit mechanisms will be reviewed with respect to extracellular inorganic pyrophosphate dysregulation mainly caused by modulation of specific membrane channel disorders. Genetic defects have been extensively studied and identified mutation of specific genes such as ANKH and COL. Pathogenesis of crystal-induced inflammation is related to synovial tissue and direct cartilage activation. Besides classical knee or wrist pseudogout attacks or Milwaukee shoulder arthropathies, clinicians should be aware of other specific common presentations, such as erosive calcifications, spinal cord compression by intraspinal masses, ligamentum flavum calcification, or atypical calcified tophus. Promising clinical results for preventing calcium crystal deposits and cartilage degradation are lacking. Practical imaging tools are needed to monitor reduction of calcification of fibrocartilage and articular cartilage as markers of drug efficacy.

The Inflammasome in Liver Injury and Non-Alcoholic Fatty Liver Disease

“…Many DAMPs have been identified as endogenous factors that can be released or generated into the extracellular environment by dying cells, or by abnormal metabolism, and trigger sterile inflammation under conditions of cellular stress or injury [3]. Examples of DAMPs derived from necrotic cells include intracellular proteins, such as the chromatin-associated protein high-mobility group box 1 (HMGB1), heat-shock proteins (HSPs) [4,5], and proteins derived from the extracellular matrix that are generated following tissue injury, such as hyaluronan, heparin sulfate and biglycan. These are generated as a result of proteolysis by enzymes released from dying cells or by proteases activated to promote tissue repair and remodeling [6].…”

Calcium Pyrophosphate Dihydrate Deposition Disease in Young Patients: Two Case Reports

“…15 Methotrexate has been attempted only in patients with pseudorheumatoid presentation. 16 Anakinra may have a role in controlling flairs of CPPD when conventional therapies are contraindicated or ineffective. 17 Our patients were managed with steroid injections and nonsteroidal anti-inflammatory drug for acute attacks and physiotherapy to reduce pain and keep the joints flexible.…”

Enfermedad por depósito de cristales de pirofosfato de calcio como ejemplo de forma de manifestación de la enfermedad en el adulto mayor

“…La pseudogota es una causa poco común de fiebre y elevación de parámetros inflamatorios, sin embargo, es la causa más común de monoartritis en el adulto mayor 9 . El término condrocalcinosis se utiliza para denominar a la calcificación del cartílago hialino y/o fibrocartílago evidenciada mediante una radiografía convencional [10][11][12] . El depósito de cristales se produce principalmente en el cartíla-go pero también puede producirse en el espacio articular.…”