SYNOVIAL FLUID CALCIUM PYROPHOSPHATE DIHYDRATE CRYSTALS AND ALIZARAN RED POSITIVITY: ANALYSIS OF 3000 SAMPLES

The aim of this study was to evaluate the accuracy of synovial fluid analysis in the identification of calcium pyrophosphate dihydrate crystals compared to microscopic analysis of joint tissues as the reference standard. This is an ancillary study of an international, multicentre cross-sectional study performed by the calcium pyrophosphate deposition disease (CPPD) subgroup of the OMERACT Ultrasound working group. Consecutive patients with knee osteoarthritis (OA) waiting for total knee replacement surgery were enrolled in the study from 2 participating centres in Mexico and Romania. During the surgical procedures, synovial fluid, menisci and hyaline cartilage were collected and analysed within 48 hours from surgery under transmitted light microscopy and compensated polarised light microscopy for the presence/absence of calcium pyrophosphate crystals. All slides were analysed by expert examiners on site, blinded to other findings. A dichotomic score (absence/ presence) was used for scoring both synovial fluid and tissues. Microscopic analysis of knee tissues was considered the gold standard. Sensitivity, specificity, accuracy, positive and negative predictive values of synovial fluid analysis in the identification of calcium pyrophosphate crystals were calculated. 15 patients (53% female, mean age 68 yo ± 8.4) with OA of grade 3 or 4 according to Kellgren-Lawrence scoring were enrolled. 12 patients (80%) were positive for calcium pyrophosphate crystals at the synovial fluid analysis and 14 (93%) at the tissue microscopic analysis. The overall diagnostic accuracy of synovial fluid analysis compared with histology for CPPD was 87%, with a sensitivity of 86% and a specificity of 100%, the positive predictive value was 100% and the negative predictive value was 33%. In conclusion synovial fluid analysis proved to be an accurate test for the identification of calcium pyrophosphate dihydrate crystals in patients with advanced OA.

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AB0635 A comparison of three different types of synovial fluid preservation to study the stability of monosodium urate and calcium pyrophosphate dihydrate crystals

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2013-eular.2957 ◽

2013 ◽

Vol 72 (Suppl 3) ◽

pp. A983.2-A983

Author(s):

L. Kienhorst ◽

R. Eijgelaar ◽

M. Janssen

Keyword(s):

Synovial Fluid ◽

Calcium Pyrophosphate ◽

Calcium Pyrophosphate Dihydrate ◽

Monosodium Urate ◽

Different Types ◽

Pyrophosphate Dihydrate ◽

The Stability ◽

Fluid Preservation ◽

Calcium Pyrophosphate Dihydrate Crystals

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Newly developed pseudogout arthritis after therapy with MAGE-A4 directed TCR T cells responded to treatment with tocilizumab

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2021-002716 ◽

2021 ◽

Vol 9 (7) ◽

pp. e002716

Author(s):

Sang T. Kim ◽

Jean Tayar ◽

Siqing Fu ◽

Danxia Ke ◽

Elliot Norry ◽

...

Keyword(s):

T Cells ◽

Synovial Fluid ◽

Th17 Cells ◽

Effector Cell ◽

Calcium Pyrophosphate ◽

Calcium Pyrophosphate Dihydrate ◽

Immune Effector Cell ◽

Cell Therapies ◽

Immune Effector ◽

Pyrophosphate Dihydrate

With durable cancer responses, genetically modified cell therapies are being implemented in various cancers. However, these immune effector cell therapies can cause toxicities, including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Pseudogout arthritis is an inflammatory arthritis induced by deposition of calcium pyrophosphate dihydrate crystals. Here, we report a case of pseudogout arthritis in a patient treated with MAGE-A4 directed T cell receptor T cells, for fallopian tube cancer. The patient developed CRS and ICANS 7 days after infusion of the T cells. Concurrently, the patient newly developed sudden onset of left knee arthritis. Synovial fluid analyses revealed the presence of calcium pyrophosphate dihydrate crystal. Notably, the pseudogout arthritis was resolved with tocilizumab, which was administered for the treatment of CRS and ICANS. Immunoprofiling of the synovial fluid showed that the proportion of inflammatory interleukin 17 (IL-17)-producing CD4+ T (Th17) cells and amount of IL-6 were notably increased, suggesting a potential role of Th17 cells in pseudogout arthritis after T-cell therapy. To the best of our knowledge, this is the first reported case of pseudogout arthritis after cell therapy. Clinicians, especially hematologists, oncologists and rheumatologists, should be aware that pseudogout arthritis can be associated with CRS/ICANS.

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