Potential Pitfalls in the Diagnosis of Crystal-Induced Arthritis and in the Sonographic Measurement of Hyaline Cartilage Due to the Presence of Joint Effusion

Russell, Eric J.; Checa, Angel

doi:10.1097/rhu.0b013e31828635c5

Cited by 6 publications

(4 citation statements)

References 7 publications

(4 reference statements)

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“…If hyperechoic depositions in CPPD are densely accumulated, they can appear as continuous lines running parallel to the articular surface, making it very challenging if not impossible to distinguish them from the classic DC (Figure 1 A-D). Other authors have come to similar conclusions 14,15 . It is our clinical experience that in acute arthritis with joint effusion, the definite allocation of sonographic hyperechoic cartilage enhancements to either the superficial margin as in gout or to the intracartilage area as in CPPD is rarely possible, even for experienced joint sonographers (Figure 1 E-F).…”

Section: Discussionsupporting

confidence: 70%

“…Recently, however, doubts have arisen as to the unequivocal interpretation of the DC sign and its seemingly high specificity for gout. Especially in the presence of joint effusion not compressible with the transducer head, the definite allocation of the hyperechoic enhancement to either the superficial margin or the intracartilage area proves difficult 14,15 . Moreover, intracartilage hyperechoic enhancement in CPPD can also appear as a hyperechoic band parallel to the articular surface 16 , making the distinction of the DC sign in gout even more tenuous (Figure 1).…”

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confidence: 99%

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Distinguishing Gouty Arthritis from Calcium Pyrophosphate Disease and Other Arthritides

Löffler

Sattler²,

Peters³

et al. 2014

J Rheumatol

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Objective.Differentiating gout, calcium pyrophosphate deposition disease (CPPD), and non–crystal-related inflammatory arthropathies (non-CRA) is essential but often clinically impossible. The sonographic double contour (DC) sign may have good specificity for gout in highly specialized centers, but it can be challenging to use it to distinguish gout from cartilage hyperenhancements in CPPD. We evaluated the diagnostic value of the DC sign alone and in combination with Doppler signals and uric acid (UA) levels in patients with acute arthritis.Methods.We retrospectively investigated 225 acutely inflamed joints and documented the presence of DC, Doppler hypervascularization, and serum UA (SUA) levels. All patients underwent synovial fluid (SF) analysis. Sensitivity, specificity, and positive predictive values were calculated, and correlation analyses and a binary regression model were used to investigate their diagnostic values.Results.The sensitivity of DC sign for crystalline arthritides was 85% and specificity 80%. Its specificity for gout was 64%, for CPPD 52%. In contrast to non-CRA hypervascularization, degree 2 and 3 Doppler signals were highly associated with gout and less with CPPD (p < 0.01). The combination of DC sign with hypervascularization and elevated UA levels increased specificity for gout to more than 90% and resulted in a 7-fold increase of the likelihood of diagnosis of gout (p < 0.01), but with a loss of sensitivity (42%).Conclusion.The DC sign alone is suitable for predicting crystal-related arthropathies, but it cannot reliably distinguish gout from CPPD in everyday clinical routine. Combining hypervascularization and SUA levels increases the diagnostic value, leading us to propose a diagnostic algorithm.

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Section: Discussionsupporting

confidence: 70%

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confidence: 99%

Distinguishing Gouty Arthritis from Calcium Pyrophosphate Disease and Other Arthritides

Löffler

Sattler²,

Peters³

et al. 2014

J Rheumatol

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“…More recently, ultrasonography was utilized for the study of micro crystals deposit diseases. Ultrasonography is useful to identify deposition of crystals in gout arthritis ( 21 - 23 ) and in the study of tendon involvement by gout ( 24 , 25 ) . The evaluation of enthesopathy in patients presenting with fibromyalgia can also be performed by ultrasonography ( 26 ) .…”

Section: Discussionmentioning

confidence: 99%

Retrospective study of sonographic findings in bone involvement associated with rotator cuff calcific tendinopathy: preliminary results of a case series

2015

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ObjectiveThe present study was aimed at investigating bone involvement secondary to rotator cuff calcific tendonitis at ultrasonography.Materials and MethodsRetrospective study of a case series. The authors reviewed shoulder ultrasonography reports of 141 patients diagnosed with rotator cuff calcific tendonitis, collected from the computer-based data records of their institution over a four-year period. Imaging findings were retrospectively and consensually analyzed by two experienced musculoskeletal radiologists looking for bone involvement associated with calcific tendonitis. Only the cases confirmed by computed tomography were considered for descriptive analysis.ResultsSonographic findings of calcific tendinopathy with bone involvement were observed in 7/141 (~ 5%) patients (mean age, 50.9 years; age range, 42-58 years; 42% female). Cortical bone erosion adjacent to tendon calcification was the most common finding, observed in 7/7 cases. Signs of intraosseous migration were found in 3/7 cases, and subcortical cysts in 2/7 cases. The findings were confirmed by computed tomography. Calcifications associated with bone abnormalities showed no acoustic shadowing at ultrasonography, favoring the hypothesis of resorption phase of the disease.ConclusionPreliminary results of the present study suggest that ultrasonography can identify bone abnormalities secondary to rotator cuff calcific tendinopathy, particularly the presence of cortical bone erosion.

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“…Table 1 provides information on the diagnostic modalities and EULAR evidence levels. Two studies examined CR, 6 7 12 studies examined U/S, [8][9][10][11][12][13][14][15][16][17][18][19] 1 study examined CT, 20 1 study examined DECT, 21 3 studies examined CCA, 22-24 4 studies examined Raman spectroscopy, 25-28 1 study examined elemental bioanalysis 29 and 2 studies examined metabolomic or other mass spectrometry. 30 31 Quality assessment Overall, the included studies met most of the quality indicators of the QUADAS-2 tool (figure 2).…”

Section: Study Identificationmentioning

confidence: 99%

Systematic review and quality analysis of emerging diagnostic measures for calcium pyrophosphate crystal deposition disease

Wu¹,

K²,

Terkeltaub³

2016

RMD Open

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ObjectivesCalcium pyrophosphate crystal deposition disease (CPPD) is common, yet prevalence and overall clinical impact remain unclear. Sensitivity and specificity of CPPD reference standards (conventional crystal analysis (CCA) and radiography (CR)) were meta-analysed by EULAR (published 2011). Since then, new diagnostic modalities are emerging. Hence, we updated 2009–2016 literature findings by systematic review and evidence grading, and assessed unmet needs.MethodsWe performed systematic search of full papers (PubMed, Scopus/EMBASE, Cochrane 2009–2016 databases). Search terms included CPPD, chondrocalcinosis, pseudogout, ultrasound, MRI, dual energy CT (DECT). Paper selection, data abstraction, EULAR evidence level, and Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 bias and applicability grading were performed independently by 3 authors.ResultsWe included 26 of 111 eligible papers, which showed emergence in CPPD diagnosis of ultrasound (U/S), and to lesser degree, DECT and Raman spectroscopy. U/S detected CPPD crystals in peripheral joints with sensitivity >80%, superior to CR. However, most study designs, though analytical, yielded low EULAR evidence level. DECT was marginally explored for CPPD, compared with 35 published DECT studies in gout. QUADAS-2 grading indicated strong applicability of U/S, DECT and Raman spectroscopy, but high study bias risk (in ∼30% of papers) due to non-controlled designs, and non-randomised subject selection.ConclusionsThough CCA and CR remain reference standards for CPPD diagnosis, U/S, DECT and Raman spectroscopy are emerging U/S sensitivity appears to be superior to CR. We identified major unmet needs, including for randomised, blinded, controlled studies of CPPD diagnostic performance and rigorous analyses of 4 T MRI and other emerging modalities.

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Potential Pitfalls in the Diagnosis of Crystal-Induced Arthritis and in the Sonographic Measurement of Hyaline Cartilage Due to the Presence of Joint Effusion

Cited by 6 publications

References 7 publications

Distinguishing Gouty Arthritis from Calcium Pyrophosphate Disease and Other Arthritides

Distinguishing Gouty Arthritis from Calcium Pyrophosphate Disease and Other Arthritides

Retrospective study of sonographic findings in bone involvement associated with rotator cuff calcific tendinopathy: preliminary results of a case series

Systematic review and quality analysis of emerging diagnostic measures for calcium pyrophosphate crystal deposition disease

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