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16-05-2015 | Crystal arthropathies | Book Chapter | Article

7. Crystal-Induced Arthritis

Authors: Rodina Nestorova, MD, Prof. Daniela Fodor, MD, PhD

Publisher: Springer International Publishing

Abstract

Crystal-induced arthritis is associated with intra-articular (and periarticular) deposits of monosodium urate, calcium pyrophosphate (CPP), basic calcium phosphate (BCP), including hydroxyapatite and calcium oxalate crystals. High-resolution ultrasonography (US) is able to detect these deposits and their consequences: cartilage pathology, effusions, synovitis, bone erosions, tendons, bursal, and other soft tissues involvement. Moreover, there are characteristic findings of these aggregates which can also be US detected, helping the clinician in positive and differential diagnosis. This chapter presents the main US findings in gout, CPP deposition disease, and BCP deposition disease. The utility of the method in diagnosis and treatment response is discussed. Comparison with other imaging techniques in sensibility and specificity of the methods in these pathological situations is also made.

Annemans L, Spaepen E, Gaskin M, Bonnemaire M, Malier V, Gilbert T, Nuki G. Gout in the UK and Germany: prevalence, comorbidities and management in general practice 2000–2005. Ann Rheum Dis. 2008;67(7):960–6.CrossRefPubMedCentralPubMed

Ramonda R, Musacchio E, Perissinotto E, Sartori L, Punzi L, Corti MC, et al. Prevalence of chondrocalcinosis in Italian subjects from northeastern Italy. The Pro. V. A. (PROgetto Veneto Anziani) study. Clin Exp Rheumatol. 2009;27:981–4.PubMed

Lillicrap M. Crystal arthritis: contemporary approaches to diseases of antiquity. Clin Med. 2007;7:60–4.CrossRefPubMed

Ramonda R, Frallonardo P, Oliviero F, Lorenzin MG, Ortolan A, Scanu A, Punzi L. Pain and microcrystalline arthritis. Reumatismo. 2014;66(1):48–56.CrossRefPubMed

Olivieri F, Punzi L. L’inflammazione articolare da microcristalli. Reumatismo. 2003;55:16–27.

Gerster JC, Landry M, Dufresne L, Meuwly JY. Imaging of tophaceous gout: computed tomography provides specific images compared with magnetic resonance imaging and ultrasonography. Ann Rheum Dis. 2002;61:52–54.CrossRefPubMedCentralPubMed

Perez-Ruiz F, Martin I, Canteli B. Ultrasonographic measurement of tophi as an outcome measure for chronic gout. J Rheumatol. 2007;34:1888–93.PubMed

Zhang W, Doherty M, Bardin T, Barskova V, Guerne PA, Jansen TL, et al. European league against rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann Rheum Dis. 2011;70:563–70.CrossRefPubMed

Dieppe P, Doherty M, Macfarlane D. Introduction. Crystal-related arthropathies. Ann Rheum Dis. 1983;42(Suppl 1):1–3.CrossRefPubMedCentralPubMed

10.

Nuki G, Simkin PA. A concise history of gout and hyperuricemia and their treatment. Arthritis Res Ther. 2006;8(Suppl 1):S1.CrossRefPubMedCentralPubMed

11.

Sivera F, Andrés M, Carmona L, et al. Multinational evidence-based recommendations for the diagnosis and management of gout. Ann Rheum Dis. 2014;73(2):328–35.CrossRefPubMedCentralPubMed

12.

Girish G, Glazebrook K, Jacobson J. Advanced imaging in gout. AJR Am J Roentgenol. 2013;20193:515–25.CrossRef

13.

Ottaviani S, Bardin T, Richette P. Usefulness of ultrasonography for gout. Joint Bone Spine. 2012;79(5):441–5.CrossRefPubMed

14.

Thiele RG, Schlesinger N. Diagnosis of gout by ultrasound. Rheumatology. 2007;46(7):1116–21.CrossRefPubMed

15.

Delle Sedie A, Riente L, Iagnocco A, et al. Ultrasound imaging for the rheumatologist X. Ultrasound imaging in crystal-related arthropathies. Clin Exp Rheumatol. 2007;25(4):513–7.PubMed

16.

Naredo E, Uson J, Jiménez-Palop M, et al. Ultrasound-detected musculoskeletal urate crystal deposition: which joints and what findings should be assessed for diagnosing Gout? Ann Rheum Dis. 2014;73(8):1522–8.CrossRefPubMed

17.

Fodor D, Albu A, Gherman C. Crystal associated synovitis—ultrasonographic feature and clinical correlation. OTR. 2008;2(6):99–110.

18.

Grassi W, Gutierrez M, Filippucci E. Crystal associated synovitis. In: Wakefield RJ, D’Agostino MA, editors. Essential applications of musculoskeletal ultrasound in rheumatology. Philadelphia: Saunders Elsevier; 2011. p. 187–97.

19.

Filippucci E, Di Geso L, Grassi W. Tips and tricks to recognize microcrystalline arthritis. Rheumatology (Oxford). 2012;51(Suppl 7):vii18–21.

20.

Grassi W, Meenagh G, Pascual E, et al. ‘Crystal clear’-sonographic assessment of gout and calcium pyrophosphate deposition disease. Semin Arthritis Rheum. 2006;36(3):197–202.CrossRefPubMed

21.

Howard RG, Pillinger M, Gyftopoulos S, Thiele R, Swearingen C, Samuel S. Reproducibility of musculoskeletal ultrasound for determining monosodium urate deposition: concordance between readers. Arthritis Care Res. 2011;63(10);1456–62.CrossRef

22.

Rettenbacher T, Ennemoser S, Weirich H, et al. Diagnostic imaging of gout. Comparison of high-resolution US versus conventional X-ray. Eur Radiol. 2008;18(3):621–30.CrossRefPubMed

23.

Chowalloor PV, Keen HI. A systematic review of ultrasonography in gout and asymptomatic hyperuricaemia. Ann Rheum Dis. 2013;72(5):638–45.CrossRefPubMed

24.

Filippucci E, Meenagh G, Sedie AD, et al. Ultrasound imaging for the rheumatologist XXXVI. Sonographic assessment of the foot in gout patients. Clin Exp Rheumatol. 2011;29(6):901–5.PubMed

25.

Perez-Ruiz F, Naredo E. Imaging modalities and monitoring measures of gout. Curr Opin Rheumatol. 2007;19(2):128–33.CrossRefPubMed

26.

Perez-Ruiz F, Urresola A, Miguel E, Schlesinger N. Gout. Imaging of gout: findings and utility. Arthritis Res Ther. 2009;11(3):232.CrossRefPubMedCentralPubMed

27.

Thiele R. Ultrasound in the diagnosis of crystal deposition disease. In: Terkeltaub R, editor. Gout and other crystal arthropathies. Philadelphia: Saunders Elsevier; 2012. p. 331–42.

28.

Gutierrez M, Smith W, Thiele R, et al. Defining elementary ultrasound lesions in gout. Preliminary results of delphi consensus and web-exercise reliability. Ann Rheum Dis. 2014;73(Supp l2):302.

29.

Schlesinger N, Thiele RG. The pathogenesis of bone erosions in gouty arthritis. Ann Rheum Dis. 2010;69(11):1907–12.CrossRefPubMed

30.

Wright SA, Filippucci E, McVeigh C, et al. High-resolution ultrasonography of the first metatarsal phalangeal joint in gout: a controlled study. Ann Rheum Dis. 2007;66(7):859–64.CrossRefPubMedCentralPubMed

31.

Filippucci E, Gutierrez M, Georgescu D, et al. Hyaline cartilage involvement in patients with gout and calcium pyrophosphate deposition disease: an ultrasound study. Osteoarthr Cartil. 2009;17(2):178–81.CrossRefPubMed

32.

McQueen FM, Reeves Q, Dalbeth N. Advanced imaging in the diagnosis and management of gout. Postgrad Med J. 2013;89(1048):87–93.CrossRefPubMed

33.

Pineda C, Amezcua-Guerra LM, Solano C, et al. Joint and tendon subclinical involvement suggestive of gouty arthritis in asymptomatic hyperuricemia: an ultrasound controlled study. Arthritis Res Ther. 2011;13(1):R4.CrossRefPubMedCentralPubMed

34.

Thiele RG, Schlesinger N. Ultrasonography shows disappearance of monosodium urate crystal deposition on hyaline cartilage after sustained normouricemia is achieved. Rheumatol Int. 2010;30(4):495–503.CrossRefPubMed

35.

Dalbeth N, Pool B, Gamble GD, et al. Cellular characterization of the gouty tophus: a quantitative analysis. Arthritis Rheum. 2010;62(5):1549–56.CrossRefPubMed

36.

Dalbeth N, Schauer C, MacDonald P, et al. Methods of tophus assessment in clinical trials of chronic gout: a systematic literature review and pictorial reference guide. Ann Rheum Dis. 2011;70:597–604.CrossRefPubMed

37.

Puig JG, de Miguel E, Castillo MC, et al. Asymptomatic hyperuricemia: impact of ultrasonography. Nucleosides Nucleotides Nucleic Acids. 2008;27(6):592–5.CrossRefPubMed

38.

Fernandes EA, Lopes MG, Mitraud SA, Ferrari AJ, Fernandes AR. Ultrasound characteristics of gouty tophi in the olecranon bursa and evaluation of their reproducibility. Eur J Radiol. 2012;81(2):317–23.CrossRefPubMed

39.

Rodas G, Pedret C, Catala J, Soler R, Orozco L, Cusi M. Intratendinous gouty tophus mimics patellar tendonitis in an athlete. J Clin Ultrasound. 2013;41(3):178–82.CrossRefPubMed

40.

Abate M, Schiavone C, Salini V, Andia I. Occurrence of tendon pathologies in metabolic disorders. Rheumatology. 2013;52(4):599–608.CrossRefPubMed

41.

Nalbant S, Corominas H, Hsu B, et al. Ultrasonography for assessment of subcutaneous nodules. J Rheumatol. 2003;30(6):1191–5.PubMed

42.

De Miguel E, Puig JG, Castillo C, et al. Diagnosis of gout in patients with asymptomatic hyperuricaemia: a pilot ultrasound study. Ann Rheum Dis. 2012;71(1):157–8.CrossRefPubMed

43.

Felson DT, Anderson JJ, Naimark A, et al. The prevalence of chondrocalcinosis in the elderly and its association with knee osteoarthritis: the Framingham study. J Rheumatol. 1989;16:1241–5.PubMed

44.

Salaffi F, De Angelis R, Grassi W, MArche Pain Prevalence, INvestigation Group (MAPPING) study. Prevalence of musculoskeletal conditions in an Italian population sample: results of a regional community-based study. I. The MAPPING study. Clin Exp Rheumatol. 2005;23(6):819–28.PubMed

45.

Ciancio G, Bortoluzzi A, Govoni M. Epidemiology of gout and chondrocalcinosis. Reumatismo. 2012;63(4):207–20.CrossRefPubMed

46.

Doherty M, Watt I, Dieppe PA. Localised chondrocalcinosis in post-meniscectomy knees. Lancet. 1982;1(8283):1207–10.CrossRefPubMed

47.

Oliviero F, Scanu A, Punzi L. Metabolism of crystals within the joint. Reumatismo. 2012;63(4):221–9.CrossRefPubMed

48.

Ferrone C, Andracco R, Cimmino MA. Calcium pyrophosphate deposition disease: clinical manifestations. Reumatismo. 2012;63(4):246–52.CrossRefPubMed

49.

Filippou G, Filippucci E, Tardella M, Bertoldi I, Di Carlo M, Adinolfi A, et al. Extent and distribution of CPP deposits in patients affected by calcium pyrophosphate dihydrate deposition disease: an ultrasonographic study. Ann Rheum Dis. 2013;72(11):1836–9.CrossRefPubMed

50.

Abhishek A, Doherty S, Maciewicz R, Muir K, Zhang W, Doherty M. Chondrocalcinosis is common in the absence of knee involvement. Arthritis Res Ther. 2012;14:R205.CrossRefPubMedCentralPubMed

51.

Ciapetti A, Filippucci E, Gutierrez M, Grassi W. Calcium pyrophosphate dihydrate crystal deposition disease: sonographic findings. Clin Rheumatol. 2009;28:271–6.CrossRefPubMed

52.

Filippucci E, Di Geso L, Girolimetti R, Grassi W. Ultrasound in crystal-related arthritis. Clin Exp Rheumatol. 2014; 32(1 Suppl 80):S42–7.PubMed

53.

Gutierrez M, Filippucci E, Salaffi F, Grassi W. The current role of ultrasound in the assessment of crystal-related arthropathies. Reumatismo. 2009;61(3):216–21.PubMed

54.

Frediani B, Filippou G, Falsetti P, et al. Diagnosis of calcium pyrophosphate dihydrate crystal deposition disease: ultrasonographic criteria proposed. Ann Rheum Dis. 2005;64:638–40.CrossRefPubMedCentralPubMed

55.

Brandes A, Muller KM. Calcinosis of the meniscus. Morphologic and roentgenographic findings for zonal classification. Pathologe. 1995;16:269–77.CrossRefPubMed

56.

MacMullan PA, McCarthy GM. The meniscus, calcification and osteoarthritis: a pathologic team. Arthritis Res Ther. 2010;12(3):116.CrossRefPubMedCentralPubMed

57.

Ea HK, Chobaz V, Nguyen C, Nasi S, van Lent P, Daudon M, et al. Pathogenic role of basic calcium phosphate crystals in destructive arthropathies. PLoS ONE. 2013;8(2):e57352.CrossRefPubMedCentralPubMed

58.

Sun Y, Mauerhan DR, Honeycutt PR, Kneisl JS, Norton HJ, Zinchenko N, et al. Calcium deposition in osteoarthritic meniscus and meniscal cell culture. Arthritis Res Ther. 2010;12(2):R56.CrossRefPubMedCentralPubMed

59.

Fam AG. Calcium pyrophosphate crystal deposition disease and other crystal deposition diseases. Curr Opin Rheumatol. 1992;4:574–82.PubMed

60.

Filippou G, Frediani B, Lorenzini S, Galeazzi M, Marcolongo R. A “new” technique for the diagnosis of chondrocalcinosis of the knee: sensitivity and specificity of high-frequency ultrasonography. Ann Rheum Dis. 2007;66:1126–8.CrossRefPubMedCentralPubMed

61.

Filippou G, Adinolfi A, Bozios P, Lorenzini S, Picerno V, Di Sabatino V, et al. Do not hallow until you are out of the wood! Ultrasonographic detection of CPP crystal deposits in menisci: facts and pitfalls. Sci World J. 2013:181826.

62.

Falsetti P, Frediani B, Acciai C, et al. Ultrasonographic study of Achilles tendon and plantar fascia in chondrocalcinosis. J Rheumatol. 2004;31(11):2242–50.PubMed

63.

Ellabban AS, Kamel SR, Abo Omar HA, El-Sherif AM, Abdel-Magied RA. Ultrasonographic findings of Achilles tendon and plantar fascia in patients with calcium pyrophosphate deposition disease. Clin Rheumatol. 2012;31(4):697–704.CrossRefPubMed

64.

Filippucci E, Delle Sedie A, Riente L, Di Geso L, Carli L, Ceccarelli F, Sakellariou G, Iagnocco A, Grassi W. Ultrasound imaging for the rheumatologist. XLVII. Ultrasound of the shoulder in patients with gout and calcium pyrophosphate deposition disease. Clin Exp Rheumatol. 2013;31(5):659–64.PubMed

65.

Genant HK. Roentgenographic aspects of calcium pyrophosphate dihydrate crystal deposition disease (pseudogout). Arthritis Rheum. 1976;19:307–28.CrossRefPubMed

66.

Ryan LM, McCarty DJ. Calcium pyrophosphate crystal deposition disease, pseudogout and articular chondrocalcinosis. In: McCarty DJ, Koopman WJ, editors. Arthritis and allied conditions. 13th edn. Philadelphia: Lea & Febiger; 1997. p. 2103–2125.

67.

Barskova VG, Kudaeva FM, Bozhieva LA, Smirnov AV, Volkov AV, Nasonov EL. Comparison of three imaging techniques in diagnosis of chondrocalcinosis of the knees in calcium pyrophosphate deposition disease. Rheumatology (Oxford). 2013;52(6):1090–4.CrossRef

68.

Bardin T, Richette P. Basic calcium phosphate crystal deposition disease. Presse Med 2011;40:850–5.CrossRefPubMed

69.

McCarthy GM, Cheung HS. Point: hydroxyapatite crystal deposition is intimately involved in the pathogenesis and progression of human osteoarthritis. Curr Rheumatol Rep. 2009;11:141–7.CrossRefPubMed

70.

Pritzker KP. Counterpoint: hydroxyapatite crystal deposition is not intimately involved in the pathogenesis and progression of human osteoarthritis. Curr Rheumatol Rep. 2009;11:148–53.CrossRefPubMed

71.

Garcia GM, McCord GC, Kumar R. Hydroxyapatite crystal deposition disease. Semin Musculoskelet Radiol. 2003;7(3):187–93.CrossRefPubMed

72.

Ohira T, Ishikawa K. Hydroxyapatite deposition in osteoarthritic articular cartilage of the proximal femoral head. Arthritis Rheum. 1987;30:651–60.CrossRefPubMed

73.

Chiou HJ, Chou YH, Wu JJ, et al. Evaluation of calcific tendonitis of the rotator cuff. Role of color Doppler ultrasonography. J Ultrasound Med. 2002;21:289–95.PubMed

74.

Halverson PB. Crystal deposition disease of the shoulder (including calcific tendonitis and Milwaukee shoulder syndrome). Curr Rheumatol Rep. 2003;5:244–7.CrossRefPubMed

75.

Le Goff B, Berthelot JM, Guillot P, Glémarec J, Maugars Y. Assessment of calcific tendonitis of rotator cuff by ultrasonography: comparison between symptomatic and asymptomatic shoulders. Joint Bone Spine. 2010;77(3):258–63.CrossRefPubMed

76.

Bureau NJ. Calcific tendinopathy of the shoulder. Semin Musculoskelet Radiol. 2013;17(1):80–4.CrossRefPubMed

77.

Carcia CR, Scibek JS. Causation and management of calcific tendonitis and periarthritis. Curr Opin Rheumatol. 2013;25(2):204–9.CrossRefPubMed

78.

Sconfienza LM, Viganò S, Martini C, Aliprandi A, Randelli P, Serafini G, Sardanelli F. Double-needle ultrasound-guided percutaneous treatment of rotator cuff calcific tendinitis: tips & tricks. Skeletal Radiol. 2013;42(1):19–24.CrossRefPubMed

79.

de Witte PB, Selten JW, Navas A, Nagels J, Visser CP, Nelissen RG, Reijnierse M. Calcific tendinitis of the rotator cuff: a randomized controlled trial of ultrasound-guided needling and lavage versus subacromial corticosteroids. Am J Sports Med. 2013;41(7):1665–73.CrossRefPubMed

80.

Jensen KL, Williams GR, Russell IJ, Rockood CA. Rotator cuff tear arthropathy. J Bone Joint Surg. 1999;9:1312–22.

81.

Popov HI, Gherman C, Rogojan L, Botar-Jid C, Barna C, Fodor D. Milwaukee shoulder syndrome associated with pigmented villonodular synovitis. Case report. Med Ultrason. 2012;14:67–70.PubMed

82.

Iagnocco A, Filippucci E, Meenagh G, et al. Ultrasound imaging for the rheumatologist III. Ultrasonography of the hip. Clin Exp Rheumatol. 2006;24:229–32.PubMed

83.

Nestorova R, Vlad V, Petranova T, Porta F, Radunovic G, Micu MC, Iagnocco A. Ultrasonography of the hip. Med Ultrason. 2012;14(3):217–24.PubMed

84.

Maldonado I, Prasad V, Reginato AJ. Oxalate crystal deposition disease. Curr Rheumatol Rep. 2002;4:257–64.CrossRefPubMed

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