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Images in rheumatology
CPPD disease presenting with acute arthritis of the first metatarsophalangeal joint
  1. Matteo Ferrito1,2,
  2. Silvia Sirotti3,
  3. Piercarlo Sarzi Puttini1,3,
  4. Roberto Caporali1,2,
  5. Georgios Filippou3,4
  1. 1 Department of Clinical Science and Community Health, University of Milan, Milano, Italy
  2. 2 Department of Rheumatology and Medical Sciences, ASST Gaetano Pini-CTO, Milano, Italy
  3. 3 Rheumatology Department, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milano, Italy
  4. 4 Department of Biomedical and Clinical Sciences, University of Milan, Milano, Italy
  1. Correspondence to Dr Matteo Ferrito; matteo.ferrito{at}gmail.com

https://doi.org/10.1136/ard-2024-225892

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    A 79-year-old man with no concurrent relevant diseases presented with severe pain and swelling of the left first metatarsophalangeal (MTP) joint and severe functional limitation, abruptly onset a week before during the evening, with no preceding trauma. Blood tests performed 1 month before showed neutrophilic leucocytosis and normal acute phase reactants. Uricaemia levels were not available. Physical examination revealed tenderness, swelling and erythema of the left first MTP joint and ultrasound (US) showed severe synovitis at that level. Hyperechoic deposits not forming acoustic shadowing were present on the cartilage on the plantar side of all the MTP joints (figure 1). The dynamic scan reveals the capsular localisation of the deposits, showcasing hyperechoic deposits sliding discordantly with the metatarsal head (online supplemental file 1). 1.5 mL of serum-haemorrhagic synovial fluid (SF) has been collected and microscopic analysis confirmed the presence of weakly positively birefringent crystals. The …

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    Footnotes

    • Handling editor Josef S Smolen

    • Contributors MF, SS and GF contributed to the acquisition, analysis and interpretation of data for the article; SS and RC to the interpretation of data; ⁠MF and GF drafted and critically revised the article; SS, PSP and RC revised thearticle critically for important intellectual content;⁠ ⁠MF, SS, PSP, RC and GF approved the version to bepublished;⁠ ⁠MF, SS, PSP, RC and GF agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; MF is the garantor of the study.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.