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Abstract
Background: In recent years, ultrasonography (US) has emerged as an accurate and reliable tool for the diagnosis of calcium pyrophosphate (CPP) deposition disease (CPPD) in daily practice. Previous studies analyzed the diagnostic value of US findings in different tissues and joints. However, no studies have investigated the optimal US scanning protocol in the diagnosis of CPPD at patient level.
Objectives: To assess the diagnostic value of the combinations of OMERACT-defined US findings of CPPD in the upper and lower limbs and to select the best minimal combination of anatomic structures to be scanned for diagnosing CPPD in inter-critical periods.
Methods: Patients with a crystal-proven diagnosis of CPPD and age- and sex-matched disease-controls were prospectively enrolled in this cross-sectional, monocentric, case-control study. All subjects underwent a bilateral US examination of 9 hyaline cartilages (HC), 6 fibrocartilages (FC), 5 tendons, 1 joint recess and 1 ligament as follows: shoulder (glenoid FC, humeral HC and acromioclavicular FC), elbow (humeral HC and triceps tendon), wrist (triangular FC, scapho-lunate ligament, volar recess of the radio-lunate joint), hand (HC of the metacarpophalangeal joints from 2nd to 5th finger), hip (acetabular FC and femoral HC), knee (femoral condyles’ HC, meniscal FC, patellar and quadriceps tendons), ankle (talar HC, Achilles tendon and plantar fascia). US assessment was carried-out by a rheumatologist blinded to clinical data. CPP deposits were identified as presence/absence, according to the OMERACT definitions [1].
Results: Ninety-five patients were enrolled: 45 CPPD patients (age: 72±10.6 years, disease duration: 5.6±7.8 years, female/male ratio: 1.3) and 50 age- and sex-matched disease-controls (18 with rheumatoid arthritis, 13 with osteoarthritis, 10 with psoriatic arthritis and 9 with gout).
The FC of the medial and lateral meniscus were the most frequently involved targets of CPP deposits in cases (81.8% and 77.3% of patients, respectively), followed by the triangular FC of the wrist (68.2%), the HC of the femoral condyles (54.5%), the scapho-lunate ligament (52.3%) and the acetabular FC (50.0%). In all these anatomical targets, US findings indicative of CPP deposits were detected in a significantly higher percentage of cases than controls (p<0.01).
The US scanning protocols that showed the best balance between sensitivity and specificity, the most sensitive and the most specific were shown in Table 1.
Diagnostic performances of different US scanning protocols
Figure 1 includes representative pictures showing CPP crystal deposits in different anatomical targets.
A: Wrist, longitudinal scan of the triangular FC complex.
B: Knee, longitudinal scan of the lateral meniscus.
C: Hip, longitudinal scan of the acetabular labrum FC,
D: Knee, longitudinal scan of the medial femoral condyle’s HC.
Arrows: CPP crystal deposits at FC, arrowhead: CPP crystal deposits at HC.
Conclusion: Our results suggest that bilateral US assessment of knee, wrist and hip provided acceptable sensitivity and specificity for diagnosing CPPD.
References: [1]Filippou G, et al. Identification of calcium pyrophosphate deposition disease (CPPD) by ultrasound: reliability of the OMERACT definitions in an extended set of joints-an international multiobserver study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound Subtask Force. Ann Rheum Dis. 2018;77:1194-9.
Disclosure of Interests: Edoardo Cipolletta: None declared, Jacopo Di Battista: None declared, Walter Grassi Speakers bureau: Walter Grassi has received speaking fees from AbbVie, Celgene, Grünenthal, Pfizer and Union Chimique Belge Pharma., Emilio Filippucci Speakers bureau: Emilio Filippucci. has received speaking fees from AbbVie, Bristol-Myers Squibb, Janssen-Cilag, Novartis, Pfizer, Roche and Union Chimique Belge Pharma.