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Objective: To develop and validate a patient-reported definition of acute calcium pyrophosphate (CPP) crystal arthritis in people with crystal-proven CPP deposition (CPPD) disease.

Methods: Consecutive patients with crystal-proven CPPD disease from seven centres across four countries were enrolled in a cross-sectional study. In each centre, patient-reported outcomes on the features of acute CPP crystal arthritis were collected.

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Calcium pyrophosphate disease (CPPD) is a commonly diagnosed crystal-induced disease that typically presents as acute monoarticular or oligoarticular arthritis. It is less commonly seen in the spine, and its clinical importance in this area is still relatively understudied. Isolated spinal CPPD is quite rare; a diagnosis of spinal CPPD is almost always accompanied by peripheral CPPD.

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Calcium pyrophosphate dihydrate deposition (CPPD), or pseudogout, typically affects joints like the knee and shoulder but can also deposit in spinal structures, sometimes leading to myeloradiculopathy with severe neck pain and upper limb weakness. Mild cases are managed with anti-inflammatory drugs, while severe cases require surgical decompression. We report a rare case of pseudogout causing cervical spine myelopathy at the C1-2 level, discovered during spine surgery and confirmed by pathology.

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Article Synopsis
  • A study was conducted to compare the effectiveness and safety of 10-mg and 30-mg daily doses of prednisolone for treating acute calcium pyrophosphate (CPP) crystal arthritis.
  • In this trial, 79 patients received either dose for 7 days, with the primary focus on symptom resolution time and secondary outcomes including recurrence rates and adverse events.
  • Results showed no significant differences between the two doses in terms of symptom resolution time, recurrence rates, or safety, indicating that both doses are equally effective for managing acute CPP crystal arthritis.
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The Significance of Intracellular Versus Extracellular Calcium Pyrophosphate Crystals in Diagnosing Calcium Pyrophosphate Crystal Arthritis.

J Rheumatol

January 2025

D.H.N. White, MBChB, U.M. Arad, MD, PhD, Health New Zealand Waikato District, Hamilton, and Waikato Clinical School, University of Auckland, Hamilton, New Zealand.

Article Synopsis
  • The study aims to investigate the significance of the location of calcium pyrophosphate (CPP) crystals (intracellular vs. extracellular) in diagnosing arthritis.
  • Data was collected from patients with synovial fluid samples positive for CPP crystals, revealing that 85% of patients with intracellular crystals had CPP crystal arthritis compared to 50% with extracellular crystals.
  • The conclusion is that intracellular CPP crystals are more strongly linked to acute and chronic CPP crystal arthritis than extracellular crystals, indicating their potential importance in diagnosing the condition.
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