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Case Presentation: We describe a case of an elderly female patient with a history of pseudogout who presented to the emergency department with atraumatic neck pain, fever, and malaise, who was found to have crowned dens syndrome on computed tomography imaging. Discussion: It is important that emergency physicians consider crowned dens syndrome in elderly patients presenting with neck pain and signs of inflammation to ensure timely diagnosis, treatment, and to minimize unnecessary invasive testing.

Objective. Acute and chronic calcium pyrophosphate (CPP) crystal arthritis is characterized by the presence of synovial CPP crystals within a clinically inflamed joint. CPP crystals may be situated intracellularly or extracellularly; however, the clinical significance of their location remains understudied. The objective of this retrospective cohort study was to assess the relevance of the CPP crystal location in diagnosing acute/chronic CPP crystal arthritis. Methods. Data were collected from Waikato District Health Board to identify a study population with synovial fluid samples positive for CPP crystals. The cohort was stratified into 2 groups based on crystal location: intracellular and extracellular. The proportions of acute/chronic CPP crystal arthritis cases were compared between these groups. Acute/chronic CPP crystal arthritis was diagnosed when synovial CPP crystals were present, with objective evidence of joint inflammation and no other alternative diagnosis. Further analysis was made with respect to demographics, other laboratory results, and cartilage calcification. Results. This study included 134 patients: 108 with intracellular CPP crystals and 26 with extracellular CPP crystals. Acute/chronic CPP crystal arthritis was diagnosed in 85% of cases in the intracellular and 50% in the extracellular group (P < 0.001). Following exclusion of septic arthritis cases, acute/chronic CPP crystal arthritis was diagnosed in 97% of patients in the intracellular group and in 62% of those in the extracellular group (P < 0.001). Conclusion. The presence of intracellular CPP crystals is more strongly associated with acute/chronic CPP crystal arthritis than with extracellular CPP crystals alone. [ABSTRACT FROM AUTHOR]

Pseudogout is characterized by the deposition of calcium pyrophosphate dihydrate crystals (CPPD), primarily affecting large joints. Extra‐articular manifestations, particularly in the head and neck region, are exceedingly rare. We report a unique case of bilateral isolated pseudogout of the middle ear manifesting with progressive conductive hearing loss as the first and only symptom of pseudogout. Otoscopy and CT scan often yield a differential diagnosis that includes tumors or cholesteatoma, necessitating surgery with histopathological examination. The definitive diagnosis is confirmed upon identification of calcium pyrophosphate dihydrate crystals. In most cases, removal of the crystals results in resolution of conductive hearing loss. Laryngoscope, 134:5131–5134, 2024 [ABSTRACT FROM AUTHOR]

Purpose of the Review: This review provides an overview of medical conditions and risk factors associated with CPPD. Recent Findings: Recent studies have indicated that CPPD patients may have a higher risk for systemic conditions such as cardiovascular diseases. Summary: Calcium pyrophosphate deposition disease (CPPD) is a common crystal arthropathy that primarily affects older adults, and, in most cases, the aetiology is idiopathic. Age is the most remarkable risk factor and due to the aging population, the prevalence of this condition is expected to increase. Strong evidence supports an association between CPPD and several metabolic and endocrine conditions, including hemochromatosis, hyperparathyroidism, hypomagnesemia, and hypophosphatasia. Additionally, there is growing evidence of an increased risk for cardiovascular diseases among CPPD patients, alongside potential links to rheumatic disorders, gender, medications, and joint trauma. Further research is needed to explore the underlying mechanisms linking CPPD to associated conditions and to develop targeted therapies with the aim of improving patient outcomes. [ABSTRACT FROM AUTHOR]

Calcium pyrophosphate dihydrate (CPPD) deposition disease is an inflammatory arthritis induced by calcium pyrophosphate (CPP) crystals and clinically it is called pseudogout. It usually deposits in articular cartilage and in periarticular soft tissues. But no cases of pseudogout in the rotator cuff without cartilage deposition or destruction have been reported so far. We present a case of a 57-year-old woman who was diagnosed as pseudogout with rotator cuff tear. [ABSTRACT FROM AUTHOR]

Calcium pyrophosphate dihydrate deposition disease (CPDD or pseudogout) is a degenerative joint disease. It is defined by the presence of calcium pyrophosphate dihydrate crystals. It usually manifests in the knee and wrist. Manifestation in the temporomandibular joint (TMJ) is only reported in case reports. We present a patient with CPDD mimicking a malignant tumor of the TMJ. A 53-year-old woman presented with progressive pain and a slow-growing swelling of the left TMJ. Imaging showed an extensive mass in the infratemporal fossa extending into the middle cranial fossa and compressing the temporal lobe. Assuming a potential malignancy, we excised the growth, which extended into the dura. We covered the resulting tissue defect within the primary surgery using a microsurgically anastomosed scapular flap and performed further reconstructive surgeries. Calcium pyrophosphate dihydrate crystals were found in the histopathologic examination of the excised tissue, resulting in the diagnosis of CPDD. That is a benign diagnosis, but we treated it like a malignancy. This leads us to the question, was there overtreatment? Tumoral CPDD in the TMJ can be a difficult diagnosis to obtain. The treatment remains controversial, but complete excision of the mass was performed in most reported cases. [ABSTRACT FROM AUTHOR]

Calcium pyrophosphate deposition (CPPD) is a condition where calcium pyrophosphate crystals cause arthritis. Its occurrence in the temporomandibular joint (TMJ) is sparingly reported in the literature. Non-surgical treatment modalities consist of non-steroidal anti-inflammatory drugs, colchicine, and intra-articular cortisone injection. In the TMJ, previous reports have described resection of affected joint with reconstruction. We present a case of an extensive CPPD lesion affecting the left TMJ requiring surgical resection and reconstruction with a custom made TMJ prosthesis alongside with a review of the existing literature.

Calcium pyrophosphate crystal deposition disease (CPPD), also known as pseudogout, with spinal involvement, is associated with clinical manifestations of acute nerve compression or chronic spinal stenosis. Precipitation of crystals of calcium pyrophosphate dihydrate in connective tissues can lead to acute inflammatory arthritis, degenerative chronic arthropathies, and radiographic evidence of cartilage calcification.

CPPD disease can affect patients’ quality of life through its various clinical presentations. This mini-review discusses the evolution of CPPD from its discovery to current knowledge of its pathogenesis, genetic associations, diagnostics, and treatment options. Despite extensive research, the exact mechanisms of CPPD are not well understood, and there is a notable lack of knowledge about psychosocial impacts and patient experiences. This study aims to present a CPPD Disease Timeline identifying gaps in current knowledge and potential directions for future research. These findings contribute to a broader understanding of CPPD disease and emphasize the importance of continued research and innovation in this field.

Background: Spinal epidural abscess (SEA) is a rare condition that may result in catastrophic outcomes. On the other hand, calcium pyrophosphate (CPP) deposition disease (CPPD) causes inflammatory arthritis. Spinal involvement of a crystal-induced inflammation caused by CPPD is also common. Surgery is a common risk factor for both SEA and CPPD; however, the postoperative acute onset of SEA complicated with CPPD is extremely rare. Case Description: A man in his 70s presented to our hospital, complaining of right upper limb weakness, loss of dexterity, and gait disturbance. The diagnosis of cervical spondylotic myelopathy was made, and he performed laminectomy at C3, C4, and C5 levels. Four days after the laminectomy, he suffered from acute neck pain, weakness, and hypoesthesia in his arms and legs. Magnetic resonance imaging revealed a mass occupying the dorsal epidural space of C6 and C7, compressing the cervical spinal cord. Considering the acute symptomatology, an acute spinal epidural hematoma after surgery was suspected; therefore, emergency C6 and C7 laminectomy was performed. Surgical findings indicated that the pressure inside the spinal canal was elevated, and the mass was purulent exudate. Pathological examination showed suppurative inflammation with concomitant deposition of CPP. SEA complicated with CPPD was considered; therefore, antibiotics and non-steroidal anti-inflammatory drugs were administered. The motor weakness and hypoesthesia were improved despite a slight residual deficit in his dexterity. Conclusion: An acute onset of SEA complicated with CPPD after cervical surgery has rarely been reported. The suppurative inflammation fostered by the crystal-induced inflammation may account for the acute symptomatology. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to compare the efficacy of non‐loading versus loading low‐dose colchicine in patients with acute crystal‐associated arthritis. Materials and Methods: All in‐patients who were admitted to Chiang Mai University Hospital with non‐arthritis disease and developed acute crystal‐associated arthritis during admission (within 48 h after arthritis onset) were invited to join this study. The patients were randomized into two groups. Patients in Group I (non‐loading group) and Group II (loading group) received colchicine at 1.2 and 2.4 mg in the first 24 h, respectively. The primary outcome was the patients' pain response at 24 h after treatment. Results: Of 80 patients, 49 were acute gouty arthritis, and 31 acute calcium pyrophosphate (CPP) arthritis. The mean [95% CI] pain score was no different between Groups I and II at the baseline level (6.46[5.72–7.19] vs. 6.654[5.85–7.44], p =.867) and at 24 h (3.13[2.43–3.82] vs. 3.18[2.42–3.93], p =.907). The proportion of patients with ≥50% pain reduction was not different (57.50% vs. 55.00%, p =.822). Sensitivity analysis among patients with a baseline pain score of ≥4 showed the same pattern of response. Mild diarrhea was common and comparable in both groups. Subgroup analysis according to renal function (eGFR < 60 vs. ≥60 mL/min/1.73 m2) or type of crystals (acute gouty arthritis vs. acute CPP arthritis) also showed the same pattern of response. Conclusion: Non‐loading low‐dose colchicine was as effective as loading low‐dose colchicine in patients with acute crystal‐associated arthritis, regardless of renal function or type of crystals. [ABSTRACT FROM AUTHOR]

Purpose of Review: This article aims to review the challenges to diagnosis and management of calcium crystal deposition diseases and evaluate the literature published over the past 3 years. Recent Findings: The awaited development of classification criteria is an essential step in the progression of calcium crystal deposition disease clinical research. There have been recent improvements in the accuracy of imaging for the diagnosis of crystal deposition diseases with published definitions of characteristic features. Factors associated with acute flares of disease have been identified and an association with increased cardiovascular risk has been demonstrated. Targeted treatment options for calcium crystal diseases remain elusive. However, there have been advances in understanding the molecular mechanisms of disease revealing potential targets for future drug development. Summary: Calcium-crystal deposition diseases are increasing in incidence and prevalence as populations age and continue to associate with a high burden of disability. Despite this, calcium crystal deposition disease remains under-studied with a paucity of evidence-based treatment guidelines. [ABSTRACT FROM AUTHOR]

Abstract Background The coexistence of calcium pyrophosphate dihydrate crystal deposition (CPP) and synovial chondromatosis (SC) in the temporomandibular joint (TMJ) is rarely reported. CPP disease (CPPD) is complex arthritis synonymous with excessive pyrophosphate production and variable aberrations in mineral and organic phase metabolism of the joint cartilage, leading to local inundated CPP and crystal deposition of partially deciphered predispositions. Meanwhile, SC is a rare benign synovial joint proliferative disease of unclear etiology and has a low risk of malignant transformation. However, SC manifests severe joint disability and dysfunction because of connective tissue metaplasia of the synovial membrane, which forms cartilaginous nodules with or without calcifications or ossifications. These nodules often detach and form intra-articular loose bodies and very rarely within extraarticular spaces. Case presentation We report the case of a 61-year-old man to expand the body of literature on these unusual coexisting arthropathies of the TMJ. The patient presented to our hospital in 2020 with complaints of pain in the right TMJ and trismus for over 6 months. Radiographic assessments of the TMJ provided a preoperative provisional diagnosis of SC. However, the histopathology of the open biopsy revealed tumor-like lesions comprising several deposits of rhomboid and rod-shaped crystals that displayed positive birefringence in polarized light, confirming a coexistence of CPPD. A second-stage operation was performed for the complete removal of the loose bodies and chalk-like lesions including synovectomy. No evidence of recurrence was recorded after a follow-up of nearly 1.5 years. Conclusions Isolated CPPD and SC of the TMJ are prevalent in the literature however, monoarticular coexistence of these diseases is rare, due to the lack of consistency in the diagnostic criteria in clinical practice. Moreover, optimal treatment depends on several considerations. This report delineated the molecular etiopathology and underscored the need for continued deciphering of the causal mechanisms of coexisting CPPD and SC of the TMJ. In addition, the importance of confirmatory testing for accurate diagnosis, and appropriate management of these diseases were discussed.

In this 2-year retrospective case series, we characterise the calcium pyrophosphate deposition disease (CPPD) inpatient cohort at a single centre and assess the efficacy and safety of anakinra in its treatment. Adult inpatients with CPPD between 1st September 2020 and 30th September 2022 were identified by ICD-10 codes and confirmed based on clinical diagnosis and either CPP crystals on aspirate or chondrocalcinosis on imaging. Charts were reviewed for demographic, clinical, biochemical data, treatment choice, and response. Response to treatment was determined from chart documentation and calculated from time of first CPPD treatment. Daily responses to anakinra were recorded if anakinra was used. Seventy patients accounting for 79 cases of CPPD were identified. Twelve cases received anakinra, whilst 67 cases received conventional therapy only. Patient receiving anakinra were predominantly male, had multiple comorbidities, and had higher CRPs and serum creatinine when compared to the non-anakinra group. Anakinra was rapidly effective with the mean time to substantial and complete response being 1.7 and 3.6 days respectively. Anakinra was well tolerated. This study adds to the small amount of retrospective data present about the use of anakinra in CPPD. We observed a rapid response to anakinra in our cohort with minimal adverse drug reactions. Key Points • Treatment of CPPD with anakinra appears to be rapidly efficacious without safety concerns. [ABSTRACT FROM AUTHOR]

Background: Calcium pyrophosphate deposition disease (CPPD), also known as "pseudogout," is a crystal deposition arthropathy involving the synovial and periarticular tissues. Pseudogout rarely presents in the axial spine. Here, we present the case of an 80-year-old female patient admitted after a mechanical fall, initially misdiagnosed on computed tomography (CT)/magnetic resonance studies with cervical osteodiscitis/ventral epidural abscess that proved to be pseudogout. Case Description: An 80-year-old female was admitted after a mechanical fall. The initial cervical CT scan showed multilevel degenerative changes with an acute C6 anterior wedge compression fracture, focal kyphosis, C5-6 disc space collapse, and endplate destruction. The magnetic resonance imaging showed marked contrast enhancement of the C5-6 vertebral bodies and disc space. An interventional radiology-guided biopsy of the C5-6 vertebral bodies and disc space was consistent with calcium pyrophosphate deposits, was diagnostic for pseudogout, and was negative for infection. She was managed conservatively with a rigid collar and seven days of oral prednisone. Conclusion: CPPD involvement in the axial spine is rare. Prompt pathologic diagnosis should be pursued to rule out an infectious process. [ABSTRACT FROM AUTHOR]

An 86-year-old male presented to the emergency department with fevers and tachycardia. Given concern for sepsis, a broad infectious workup was pursued. Though no source of infection was identified, the patient was found to have an elevated procalcitonin level. The patient subsequently developed painful joint effusions of the knees, which on arthrocentesis were consistent with calcium pyrophosphate deposition (CPPD) or "pseudogout". His symptoms of fevers and arthralgias resolved with anti-inflammatory agents. CPPD is a known cause of systemic inflammatory response syndrome (SIRS) in elderly patients. Procalcitonin has been studied as a biomarker for distinguishing infectious from non-infectious causes of SIRS, although its use in CPPD and other crystal arthropathies is not well-defined. The current case is the first to describe elevated procalcitonin specifically attributable to acute pseudogout flare and highlights the need for further study of this biomarker in non-infectious, pro-inflammatory states.

Pseudogout (PG) is an inflammatory arthropathy that develops due to the accumulation of calcium pyrophosphate dihydrate crystals in synovial structures. Herein, we present a 59-year-old male patient with PG developed as a result of zoledronic acid (ZA) infusion, which was administered due to primary hyperparathyroidism. The patient with parathyroid adenoma was given ZA since the calcium level did not decrease despite intravenous saline and loop diuretic. One day after ZA administration, the patient had severe pain, fever, and swelling in joints. The radiograph showed chondrocalcinosis. Calcium pyrophosphate deposition were observed in the arthrocentesis fluid under polarized light. The patient's symptoms regressed after anakinra and colchicine treatment. To the best of our knowledge, this is the first case report of a PG attack after ZA treatment for primary hyperparathyroidism. Additionally, there have been few cases of PG after bisphosphonate treatment for osteoporosis in the literature, signifying that more care should be taken when administering bisphosphonate therapy in patients with risk factors. [ABSTRACT FROM AUTHOR]

Case Pseudogout in a total joint arthroplasty is rare and can be difficult to distinguish from a prosthetic joint infection (PJI). In this unique case, we present a patient who developed her first episode of pseudogout 17 years after her primary total knee arthroplasty at age 75. Conclusion With similar clinical and laboratory findings, it is important to distinguish the presence of PJI and inflammatory arthropathy. The use of diagnostic tools available, consideration of patient co-morbidities, and timing of symptoms can help guide surgeons’ treatment. [ABSTRACT FROM AUTHOR]

Background: The coexistence of calcium pyrophosphate dihydrate crystal deposition (CPP) and synovial chondromatosis (SC) in the temporomandibular joint (TMJ) is rarely reported. CPP disease (CPPD) is complex arthritis synonymous with excessive pyrophosphate production and variable aberrations in mineral and organic phase metabolism of the joint cartilage, leading to local inundated CPP and crystal deposition of partially deciphered predispositions. Meanwhile, SC is a rare benign synovial joint proliferative disease of unclear etiology and has a low risk of malignant transformation. However, SC manifests severe joint disability and dysfunction because of connective tissue metaplasia of the synovial membrane, which forms cartilaginous nodules with or without calcifications or ossifications. These nodules often detach and form intra-articular loose bodies and very rarely within extraarticular spaces. Case presentation: We report the case of a 61-year-old man to expand the body of literature on these unusual coexisting arthropathies of the TMJ. The patient presented to our hospital in 2020 with complaints of pain in the right TMJ and trismus for over 6 months. Radiographic assessments of the TMJ provided a preoperative provisional diagnosis of SC. However, the histopathology of the open biopsy revealed tumor-like lesions comprising several deposits of rhomboid and rod-shaped crystals that displayed positive birefringence in polarized light, confirming a coexistence of CPPD. A second-stage operation was performed for the complete removal of the loose bodies and chalk-like lesions including synovectomy. No evidence of recurrence was recorded after a follow-up of nearly 1.5 years. Conclusions: Isolated CPPD and SC of the TMJ are prevalent in the literature however, monoarticular coexistence of these diseases is rare, due to the lack of consistency in the diagnostic criteria in clinical practice. Moreover, optimal treatment depends on several considerations. This report delineated the molecular etiopathology and underscored the need for continued deciphering of the causal mechanisms of coexisting CPPD and SC of the TMJ. In addition, the importance of confirmatory testing for accurate diagnosis, and appropriate management of these diseases were discussed. [ABSTRACT FROM AUTHOR]

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. The expert opinion of an independent rheumatologist was the reference standard. We developed definitions based on multivariable logistic regression model with backward selection of predictors and classification and regression tree (CART) approaches., Results: 246 patients (mean age 73.2 years (SD 10.7), 65.9% female) were enrolled. At the time of the assessment, acute CPP crystal arthritis was diagnosed in 96/246 (39.0%) participants.Patient-reported joint warmth, patient-reported joint swelling, time from pain-onset-to-peak, and self-reported acute CPP crystal inflammatory arthritis were included in the multivariable logistic model. This model had good discrimination (optimism-adjusted c-index: 0.92, 95%CI: 0.89-0.95) and calibration (optimism-adjusted calibration-slope: 0.95, 95%CI: 0.71-1.19, optimism-adjusted calibration-in-the-large: 0.005, 95%CI: -0.37-0.37) in the internal validation. Probability threshold ≥0.53 had sensitivity of 0.83 (95%CI: 0.74-0.90) and specificity of 0.86 (95%CI: 0.79-0.91). Performances were similar in the internal-external cross-validation. The CART identified patient-reported acute CPP crystal inflammatory arthritis, followed by joint swelling, and joint warmth as the most informative variables for ascertaining acute CPP crystal arthritis [sensitivity 0.83 (95%CI: 0.72-0.91) and specificity 0.83 (95%CI: 0.74-0.90)]., Conclusion: We developed and initially validated easy-to-use patient-reported definitions for acute CPP crystal arthritis for use in clinical trials and observational research in CPPD., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology.)

Chondrocalcinosis, commonly associated with aging, is characterized by the deposition of calcium pyrophosphate dihydrate (CPPD) crystals in cartilage and periarticular tissues. Early-onset cases are rare and not well-documented. We report a case of a 60-year-old woman with a probable onset of CPP deposition (CPPD) disease during adolescence, presenting with inflammatory flare-ups and erosive progression following minor trauma. This case highlights the atypical presentation of chondrocalcinosis in a younger individual and emphasizes the potential for erosive joint damage, contributing to the understanding of disease progression and management strategies in similar patients., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Nigro et al.)

Crystalline arthropathies are among the most frequently encountered conditions in medicine. Joint aspiration and microscopy used to be the diagnostic gold standard, but recent recommendations mention that this may not be necessary if typical findings are seen on imaging. Ultrasound, dual-energy computed tomographic (CT) scan, and conventional radiography are recommended in the assessment of gout, calcium pyrophosphate crystal deposition disease, and basic calcium phosphate-related disease. Ultrasound can identify the tophus and its associated tissues that participate in the inflammatory response, and dual-energy CT can find tophaceous material in regions that are difficult to access by physical examination or ultrasound., Competing Interests: Disclosure Clario (consulting), Radmetrix (consulting), and Janssen (grant support)., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Twenty percent of the population globally is affected by musculoskeletal conditions. These conditions significantly impair mobility and dexterity. Pseudogout is similarly a debilitating disease that significantly increases morbidity and the disability adjusted life years. We report a case of pseudogout in its advanced stage, causing total joint destruction of the knees and shoulders, which manifested and presented as a windswept deformity. The Case: Our patient is a 69 year old man who complained of bilateral knee pain, shoulder pain during active flexion and an obvious knee deformity. His familial history was not significant, and there was no history of injuries, infection or congenital diseases. His knees were severely deformed, with extremely laxed collateral ligaments. Both of his shoulders had a limited range of movement with coarse crepitation on passive movement. X-ray of his knees showed a completely destroyed joint, reduced joint space, subchondral cysts and chondrocalcinosis. X-ray of his shoulder joint showed a subluxated joint, subchondral cyst and subchondral sclerosis. His joint aspirate had positive rhomboid crystals on the birefringence test, consistent with pseudogout. Joint replacement surgery is the definitive management, but the patient and caretaker were not able to afford the implants. Conclusion: We discussed the diagnosis of pseudogout in this patient and how the policies in place do not provide adequate coverage for these populations. This marginalizes those who need surgery and limits their access to affordable surgical care when needed.

• Monoarthritis of the shoulder joint may indicate pseudogout. • Gram staining can detect crystals in joint fluid. • Gram staining of joint fluid is useful in the diagnosis of pseudogout. [ABSTRACT FROM AUTHOR]

Tophaceous pseudogout is a rare variant of the calcium pyrophosphate dihydrate (CPPD) disorder, with predilection for the TMJ. It is characterized by calcific deposits composed of rhomboid- or rectangular-shaped crystals that exhibit birefringence when examined under polarized light. We hereby present a case of a 65-year-old man with left pre-auricular tenderness and malocclusion. CT imaging was notable for a left TMJ mineralized mass with erosion of the condylar head. Treatment involved excision of the mass with eminectomy, condylectomy, and a stock total TMJ reconstruction. In this report, important considerations for diagnosis, biopsy, and surgical treatment with emphasis on reconstruction for tophaceous pseudogout of the TMJ have been highlighted by the authors. [ABSTRACT FROM AUTHOR]

Recent studies have shown that CPPD might be associated with a higher risk of cardiovascular events related to inflammation. Thus, we aim to examine the outcomes of patients admitted for acute coronary syndrome (ACS) with and without CPPD. We used data from the US National Inpatient Sample (NIS) Database to identify patients who were admitted for ACS between 2006 and 2019. The ICD-9 and -10 codes were used to determine the patients with ACS related hospitalizations and of those, we classified two groups of patients: those with and those without any CPPD code. Data collection included demographics and comorbidities. Outcomes were in-hospital mortality, length of stay, hospital charges, and in-hospital complications. Associations between CPPD and specific morbidity were evaluated with chi-square tests. T-tests were used for continuous variables. We have also presented odds ratio (OR) along with 95 % confidence intervals (CI) for the outcomes of interest. A total of 17,322,362 patients were admitted for ACS. Among them, 7,458 had CPPD, with a mean age of 75 years and 48 % were females. CPPD patients were more likely to be older (75 vs 68 years; p < 0.001) compared to non-CPPD patients. Among the comorbidities, chronic kidney disease was more frequently observed in CPPD patients. Regarding the inpatient complications, acute ischemic stroke and post-procedural hemorrhage were more frequently seen in CPPD patients. Interestingly, the in-hospital mortality was lower in the CPPD patients than the non-CPPD patients (OR: 0.77; CI 95 % 0.70–0.85). ACS in CPPD patients was associated with a longer mean length of stay than those without CPPD (OR: 3.35; 95 % CI 3.17–3.53). In addition, mean total charges were higher in the CPPD group (OR: 1.04; 95 % CI 1.01–1.10). ACS in CPPD patients is associated with higher healthcare utilization, including cost and length of hospital stay, and lower in-hospital mortality than non-CPPD patients [ABSTRACT FROM AUTHOR]

The calcium pyrophosphate deposition (CPPD) disease is a common form of crystal arthropathy. It usually affects elderly patients. The clinical and radiological features of CPPD vary widely, so CPPD is a great mimicker of other musculoskeletal conditions. Asymptomatic and destructive forms can present at the same time in the same patients. Several diseases have been proposed to be related to CPPD, but hematologic disorders have not been reported to occur concurrently. Charcot arthropathy (CA) is associated with neuropathy and is characterized by erosive joint disease. Here, we report an interesting CPPD case presenting as pseudo-CA in a patient with myelodysplastic syndrome. [ABSTRACT FROM AUTHOR]

Pseudogout is a disease characterized by calcium pyrophosphate crystal deposition. Involvement of the temporomandibular joint (TMJ) is rare. We herein report a case of tophaceous pseudogout of the TMJ with cranial extension. An 83-year-old woman was referred to our institution for treatment of right TMJ pain. The patient's medical and family histories were unremarkable. Magnetic resonance imaging showed a mass of about 35 mm in diameter compressing the bottom of the right temporal lobe of the brain. Based on a clinical diagnosis of a right TMJ tumour, biopsy was performed under general anaesthesia. The histopathological diagnosis was pseudogout. Considering the risk of surgically induced brain damage, the patient's advanced age and her relatively good quality of life, the treatment plan simply involved the observation of the lesion. Fourteen months after biopsy, the patient's activities of daily living remained unchanged and she had no TMJ pain. [ABSTRACT FROM AUTHOR]

Calcium pyrophosphate dihydrate (CPPD) deposition disease is a benign disorder characterized by acute gouty arthritis-like attacks and first reported by McCarty. CPPD deposition disease rarely occurs in the temporomandibular joint (TMJ), and although confirmation of positive birefringence by polarized light microscopy is important for diagnosis, it is not reliable because other crystals also show birefringence. We reported a case of CPPD deposition disease of the TMJ that was diagnosed by chemical analysis. A 47-year-old man with a chief complaint of persistent pain in the right TMJ and trismus was referred to our department in 2020. Radiographic examination revealed destruction of the head of the mandibular condyle and cranial base with a neoplastic lesion involving calcification tissue. We suspected CPPD deposition disease and performed enucleation of the white, chalky masses. Histopathologically, we confirmed crystal deposition with weak birefringence. SEM/EDS revealed that the light emitting parts of Ca and P corresponded with the bright part of the SEM image. Through X-ray diffraction, almost all peaks were confirmed to be CPPD-derived. Inductively coupled plasma atomic emission spectroscopy revealed a Ca/P ratio of nearly 1. These chemical analyses further support the histological diagnosis of CPPD deposition disease. [ABSTRACT FROM AUTHOR]

Objectives: Arthritis is a common clinical manifestation of hereditary hemochromatosis (HH), and HH is one of a handful of conditions linked to calcium pyrophosphate deposition (CPPD) in joints. The connection between these two types of arthritis has not yet been fully elucidated. In light of new pathogenic pathways recently implicated in CPPD involving bone, we reviewed the literature on the etiology of hemochromatosis arthropathy (HHA) seeking shared pathogenic mechanisms. Results: Clinical observations reinforce striking similarities between HHA and CPPD even in the absence of CPP crystals. They share a similar joint distribution, low grade synovial inflammation, and generalized bone loss. Excess iron damages chondrocytes and bone cells in vitro. While direct effects of iron on cartilage are not consistently seen in animal models of HH, there is decreased osteoblast alkaline phosphatase activity, and increased osteoclastogenesis. These abnormalities are also seen in CPPD. Joint repair processes may also be impaired in both CPPD and HHA. Conclusions: Possible shared pathogenic pathways relate more to bone and abnormal damage/repair mechanisms than direct damage to articular cartilage. While additional work is necessary to fully understand the pathogenesis of arthritis in HH and to firmly establish causal links with CPPD, this review provides some plausible hypotheses explaining the overlap of these two forms of arthritis. [ABSTRACT FROM AUTHOR]

Calcium pyrophosphate deposition disease is characterized by the deposition of pyrophosphate crystals in various joint structures. Calcium pyrophosphate deposition disease can be linked to underlying metabolic disorders such as hemochromatosis, hyperparathyroidism, hypophosphatemia, hypomagnesaemia, and hypothyroidism, all of which increase the risk of calcium pyrophosphate deposition. We present the case of a 55-year-old male who underwent diagnostic examination for the onset of recurrent joint pain in the right knee.

Crystalline arthropathies are well-known pathologies in a native knee; however, the literature is scarce with regards to crystalline arthropathies in a total knee arthroplasty (TKA). The presentation of crystalline arthropathy in a TKA can be similar to a periprosthetic joint infection (PJI), making it difficult to distinguish between the 2 diagnoses. We present 1 case highlighting the similarity between crystalline arthropathy and PJI. A 71-year-old man with a history of bilateral TKAs presented with bilateral painful knee effusions and was initially presumed to have PJIs; however, he was later diagnosed with gout and successfully treated medically. A complete review of the literature demonstrates that crystalline arthropathies after TKA are infrequently reported and can be difficult to decipher from PJIs, and there is a lack of standardized treatment.

The development of microcrystalline arthritides is most frequently associated with the formation of monosodium urate (MSU) and calcium pyrophosphate (CPP) crystals. Their identification is of crucial importance in recognizing these diseases. Objective: to determine the possibilities of histological techniques in identifying MSU and CPP crystals and to evaluate the effectiveness of the techniques. Subjects and methods. Twenty-four tissue blocks (fragments of the affected areas of the elbow joint, the interphalangeal joint of the index finger, and hip joint) from 7 patients were examined. Paraffin sections were stained with a 0.5% alcohol solution of eosin, as well as with hematoxylin and eosin. Tissue specimens were examined and digitized using an AxioScope.A1 stereo microscope with Zenblue software (Carl Zeiss MicroImaging GmbH, Germany). Results and discussion. When staining the tissue sections with hematoxylin and eosin, microcrystals were not visualized; the major portions of MSU crystals was dissolved during fixation and staining, whereas CPP crystals were masked with hematoxylin as focal basophilic aggregates. The staining technique with an alcohol solution of eosin and short formalin fixation (within 12 hours) made it possible to avoid dissolution of MSU crystals and to visualize both MSU and CPP crystals, and to determine their shape and color. Conclusion. Light microscopy of the tissue sections stained with an alcohol solution of eosin along with short formalin fixation is a reliable method to differentiate MSU and CPP crystals. In patients undergoing endoprosthetic replacement, the significance of this technique for the pathomorphological study of surgical material consists in assessing inflammatory activity and in eliminating a disease, such as microcrystalline arthropathy.

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. We present two patients who were both being treated for breast cancer. They underwent spine surgery and were subsequently diagnosed with isolated CPPD of the spine by pathology specimens. Neither patient had a history of CPPD prior to the surgery. We hypothesize there is a potential link between breast cancer and its treatment and isolated spinal CPPD; however, more research and case reports are needed to begin making conclusions and understand the relevance., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Todd et al.)