Ultrasound findings of calcium pyrophosphate deposition disease at metacarpophalangeal joints

Abstract

Objective To explore the spectrum of articular and peri-articular ultrasound (US) findings at metacarpophalangeal (MCP) joints in calcium pyrophosphate (CPP) deposition disease (CPPD). Methods Consecutive CPPD patients (chronic CPP crystal inflammatory arthritis or osteoarthritis (OA) with CPPD), and age- and sex-matched controls with rheumatoid arthritis (RA) were prospectively enrolled. Patients underwent bilateral US examination of MCP joints. CPP deposits, synovial inflammation, osteophytes, cartilage damage, and bone erosions were recorded. Results Sixty CPPD patients (33, 55.0% with osteoarthritis with CPPD and 27, 45.0% with chronic CPP crystal inflammatory arthritis) and 40 RA patients were enrolled. CPP deposits were detected in 24 (40.0%) CPPD patients and in 3 (7.5%) RA patients (p< 0.01). In CPPD patients, different types of CPP deposits were identified at MCP joints: 17 (28.3%) patients had dorsal capsuloligamentous deposits, 14 (23.3%) intra-cartilaginous deposits, 13 (21.7%) lateral capsuloligamentous deposits, 12 (20.0%) intra-articular deposits, 8 (13.3%) double contour sign, and 5 (8.3%) flexor digitorum tendons’ deposits. CPPD patients with chronic CPP crystal inflammatory arthritis showed more US findings indicating synovial inflammation and CPP deposits than those with osteoarthritis with CPPD. Conversely, a higher prevalence of US features indicating structural damage was noted in this latter phenotype. CPP deposits and bone erosions were the US findings with the highest value for diagnosing chronic CPP crystal inflammatory arthritis and RA, respectively. Conclusion This study provides pictorial evidence of the broad spectrum of US findings indicating CPP deposits at MCP joints in CPPD. Furthermore, we reported different US patterns in different CPPD phenotypes.

Case report: crowned dens syndrome in a patient with seronegative rheumatoid arthritis

“…2 Even though the difference in the degree of the erosiveness is not well defined in the literature, nevertheless the item 'erosiveness' cannot be fully discriminative, though much more relevant in RA. 6 However, the erosions at the craniocervical region (atloepistrophic joint) are quite distinctive; we showed they may occur already in early RA 7 and have very rarely been described in CPPD. Therefore, one possibility to discriminate between an acute attack of RA or an acute arthritis episode CPPD-related, may be the demonstration of CC at the craniocervical region, in the presence of an acute flare of pain.…”

Describing calcium pyrophosphate deposition: undoing the tower of Babel!

“…Beyond CPP deposits, radiographic features associated with CPPD include osteoarthritis distribution in specific joints, distinct from the typical osteoarthritis involvement [12 ▪ ]. These include particularly second and third metacarpophalangeal joints, characterized by prominent ‘hook-like’ osteophytes and the wrist, with joint space narrowing or osteophyte at the scapho-trapezium joint, and scapho-lunate advanced collapse (SLAC) [37]. These features aid in distinguishing CPPD from other conditions even if they do not appear to be universally present in all patients with CPPD.…”

Dynamic assessment of the double contour sign by ultrasonography helps to distinguish between gout and calcium pyrophosphate deposition disease

“…Nevertheless, some studies have questioned the specificity of the DC sign for gout as it has been reported in calcium pyrophosphate deposition (CPPD), [4][5][6] with a prevalence ranging from 7.1% 6 to 20.2%. 5 A previous case report has demonstrated that the deposition of CPP crystals in capsules and/or ligaments appearing to be located on top of the hyaline cartilage generates a pseudo DC sign in CPPD disease.…”