scholarly journals Articular and periarticular spinal calcifications in relation to synovial fluid findings in patients with calcium pyrophosphate dihydrate deposition disease (CPPD)

2021 ◽  
Vol 48 (1) ◽  
Author(s):  
Mohamed Ismail Abdelkareem ◽  
Abdou Saad Taha Ellabban ◽  
Ahmed Hamed Ismail ◽  
Mohamed Moneer Rayan ◽  
Rasha Ali Abdel-Magied
Keyword(s):  
Synovial Fluid ◽  
Light Microscopy ◽  
Polarized Light ◽  
Calcium Pyrophosphate ◽  
Plain Radiography ◽  
Polarized Light Microscopy ◽  
Calcium Pyrophosphate Dihydrate ◽  
Fluid Analysis ◽  
Deposition Disease ◽  
Synovial Fluid Analysis

Abstract Background Calcium pyrophosphate dihydrate deposition disease (CPPD) is the second most common form of the crystal-associated arthritis. Diagnosis is achieved by detection of crystals by polarized light microscopy and/or detection of hyaline cartilage or fibrocartilage calcifications characteristic of CPPD deposition by musculoskeletal ultrasound (MSUS). Axial involvement with intervertebral disc calcification, sacroiliac erosions, and sub-chondral cysts of the facet joints occurs with CPPD deposition. Aim To assess the presence and relation between calcification of intervertebral discs, other articular and periarticular spinal structures, and synovial fluid analysis (SFA) and MSUS calcifications in patients with CPPD deposition disease. Methods One hundred patients with CPPD disease diagnosed according to the modified proposed diagnostic criteria by McCarty 1994 were included. Plain radiography on the spines, pelvis, and affected joints, MSUS on affected joints, and synovial fluid analysis (SFA) were done. Results Spinal calcification was present in 55% of patients. The commonest site was anterior longitudinal ligament (43%). Characteristic CPPD calcifications by plain radiography on the knee and wrist joints were present in 38% and 16% respectively. Characteristic CPPD calcifications by MSUS on the knee and wrist joints presented in 93% and 27% respectively. CPPD crystal detection by SFA was 97%. The accuracy of MSUS to diagnose CPPD deposition disease is more than double that of plain radiography, and it is comparable to that of synovial fluid analysis. The result of intra-rater analysis between SFA by polarized light microscopy and MSUS was kappa 0.767 (p < 0.001); this indicates substantial level of agreement between SFA and MSUS; between plain radiography and MSUS, it was kappa 0.188 (p = 0.32) which indicates slight agreement, and between plain radiography and SFA, it was kappa 0.037 (p = 0.1) which fails to reach a significant level of agreement. There was a significant positive relation between spinal calcification and wrist joint calcification by plain radiography. Conclusion Considerable spinal affection by CPPD deposition disease can be detected. Although the most definitive, reliable direct approach for CPPD deposition disease diagnosis is SFA using polarized light microscopy, MSUS is considered a useful non-invasive diagnostic tool in this situation. In CPPD deposition disease, MSUS has proven to be an excellent technique for detecting calcification in the articular tissue disease compared to conventional radiography.

scholarly journals Accuracy of synovial fluid analysis compared to histology for the identification of calcium pyrophosphate crystals: an ancillary study of the OMERACT US Working Group - CPPD subgroup

Reumatismo ◽  
2021 ◽  
Vol 73 (2) ◽  
pp. 106-110
Author(s):  
S. Sirotti ◽  
M. Gutierrez ◽  
C. Pineda ◽  
D. Clavijo-Cornejo ◽  
T. Serban ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Light Microscopy ◽  
Microscopic Analysis ◽  
Calcium Pyrophosphate ◽  
Calcium Pyrophosphate Dihydrate ◽  
Ancillary Study ◽  
Fluid Analysis ◽  
Synovial Fluid Analysis ◽  
Pyrophosphate Dihydrate ◽  
Calcium Pyrophosphate Dihydrate Crystals

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.

scholarly journals AB0629 ACCURACY OF SYNOVIAL FLUID ANALYSIS FOR THE IDENTIFICATION OF CALCIUM PYROPHOSPHATE CRYSTALS: AN ANCILLARY STUDY OF OMERACT CRITERION VALIDITY STUDY FOR ULTRASOUND IN CPPD

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1348.1-1348
Author(s):  
A. Adinolfi ◽  
S. Sirotti ◽  
M. Gutierrez ◽  
C. Pineda ◽  
D. Clavijo Cornejo ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Diagnostic Accuracy ◽  
Light Microscopy ◽  
Hyaline Cartilage ◽  
Microscopic Analysis ◽  
Calcium Pyrophosphate ◽  
Ancillary Study ◽  
Fluid Analysis ◽  
Synovial Fluid Analysis ◽  
Sensitivity Specificity

Background:Synovial fluid analysis (SFA) via compensated polarized light microscopy is still considered the gold standard for the identification and diagnosis of Calcium Pyrophosphate Deposition disease (CPPD)-related arthropathies[1], but very few studies have been published about its diagnostic accuracy.Objectives:The aim of this study was to evaluate the accuracy of SFA in the identification of calcium pyrophosphate dihydrate (CPP) crystals compared to microscopic analysis of joint tissues as the reference standard.Methods:This is an ancillary study of an international, multicentre cross-sectional study performed by the CPPD subgroup of the OMERACT Ultrasound working group[2]. Consecutive patients with knee osteoarthritis (OA) waiting for total knee replacement surgery were enrolled in the study from 2 participating centres, Mexico and Romania. During surgical procedures synovial fluid (SF), menisci and hyaline cartilage were collected and analysed within 48 hours after surgery under transmitted light microscopy and compensated polarised light microscopy for the presence/absence of CPP crystals. All slides were analysed by expert examiners on site, blinded to other findings. A dichotomic score (absence/presence) was used for scoring both SF and tissues. Microscopic analysis of knee tissues was considered the gold standard. Sensitivity, specificity, accuracy, positive and negative predictive values (PPV and NPV) of SFA in the identification of CPP crystals were calculated.Results:15 patients (53% female, mean age 68yo ± 8.4) with OA of grade 3 or 4 according to Kellgren-Lawrence scoring were enrolled. 12 patients (80%) were positive for CPP crystals at SFA and 14 (93%) at tissues microscopic analysis. Among 12 SFA positive patients, all were positive for CPP crystals in either medial or lateral meniscus, and 11 were positive in both; 10 patients were positive at the hyaline cartilage, and all 10 were also positive for at least one meniscus. Regarding the 3 SFA negative patients, only one had no crystals in the examined tissues, while the other 2 patients had CPP crystals in both menisci and hyaline cartilage. The overall diagnostic accuracy of SFA compared to histology analysis for CPPD was 87%, with a sensitivity of 86% and a specificity of 100%, the PPV was 100% and the NPV was 33% (Table 1).Table 1.sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of synovial fluid analysis compared to the reference standard. CI: Confidential Interval. SF: synovial fluid, in parentheses: numerators and denominators for all percentages provided.SensitivitySpecificityPPVNPVAccuracySF analysis86% (12/14)100% (1/1)100% (12/12)33% (1/3)87% (13/15)(0.65-0.99) CI 95%(0.0-0.25) CI 95%(0.65-0.99) CI 95%(0.0-0.25) CI 95%Conclusion:SFA demonstrated to be an accurate test for the identification of CPP crystals in patients with advanced OA. However, is not always feasible and carries some risks for the patient. Considering the availability of validated imaging techniques for the detection of CPPD, such as US, SFA could be used in those patients where imaging and clinical data are not definitely confirmatory of the disease.References:[1]W. Zhang et al., ‘European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis’, Ann Rheum Dis, vol. 70, no. 4, pp. 563–570, Apr. 2011, doi: 10.1136/ard.2010.139105.[2]G. Filippou et al., ‘Criterion validity of ultrasound in the identification of calcium pyrophosphate crystal deposits at the knee: an OMERACT ultrasound study’, Ann Rheum Dis, p. annrheumdis-2020-217998, Sep. 2020, doi: 10.1136/annrheumdis-2020-217998.Disclosure of Interests:None declared.

Persistence of Crystals in Stored Synovial Fluid Samples

2020 ◽  
Vol 47 (9) ◽  
pp. 1416-1423
Author(s):  
Sonia Pastor ◽  
José-Antonio Bernal ◽  
Rocío Caño ◽  
Silvia Gómez-Sabater ◽  
Fernando Borras ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Light Microscopy ◽  
Room Temperature ◽  
Polarized Light ◽  
Calcium Pyrophosphate ◽  
Polarized Light Microscopy ◽  
Tetraacetic Acid ◽  
Monosodium Urate ◽  
Prospective Longitudinal ◽  
Msu Crystals

Objective.Lack of access to polarized light microscopy is often cited as an argument to justify the clinical diagnosis of crystal-related arthritis. We assessed the influence of time since sampling and preservation methods on crystal identification in synovial fluid (SF) samples under polarized light microscopy.Methods.This was a prospective, longitudinal, observational factorial study, analyzing 30 SF samples: 12 with monosodium urate (MSU) crystals and 18 with calcium pyrophosphate (CPP) crystals. Each SF sample was divided into 4 subsamples (120 subsamples in total). Two were stored in each type of preserving agent, heparin or ethylenediamine tetraacetic acid (EDTA), at room temperature or at 4°C. Samples were analyzed the following day (T1), at 3 days (T2), and at 7 days (T3) by simple polarized light microscopy, and the presence of crystals was recorded.Results.The identification of crystals in the MSU group was similar between groups, with crystals observed in 11/12 (91.7%) room temperature samples and in 12/12 (100%) refrigerated samples at T3. Identification of CPP crystals tended to decrease in all conditions, especially when preserved with EDTA at room temperature [12/18 (66.7%) at T3], while less reduction was seen in refrigerated heparin-containing tubes.Conclusion.Preserving samples with heparin in refrigerated conditions allows delayed microscopic examination for crystals. Avoiding crystal-proven diagnosis because of the immediate unavailability of microscopy no longer appears justified.

scholarly journals An Unusual Association: Iliopsoas Bursitis Related to Calcium Pyrophosphate Crystal Arthritis

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Marco Di Carlo ◽  
Antonella Draghessi ◽  
Marina Carotti ◽  
Fausto Salaffi
Keyword(s):  
Synovial Fluid ◽  
Imaging Techniques ◽  
Calcium Pyrophosphate ◽  
Left Colectomy ◽  
Fluid Analysis ◽  
Unusual Association ◽  
Hip Arthritis ◽  
Synovial Fluid Analysis ◽  
Crystal Arthritis ◽  
Iliopsoas Bursitis

A 71-year-old man with osteoarthritis and chondrocalcinosis came to our observation developing a swelling in the groin region after a recent left colectomy for adenocarcinoma. The imaging techniques revealed the presence of an iliopsoas bursitis in connection with the hip. The synovial fluid analysis detected the presence of calcium pyrophosphate (CPP) crystals and allowed the final and unusual diagnosis of iliopsoas bursitis related to acute CPP crystal hip arthritis.

Clinical investigation

2010 ◽  
pp. 3559-3570
Author(s):  
Michael Doherty ◽  
Peter C. Lanyon
Keyword(s):  
Synovial Fluid ◽  
Light Microscopy ◽  
Septic Arthritis ◽  
Clinical Assessment ◽  
Clinical Management ◽  
Ultrasound Guidance ◽  
Clinical Investigation ◽  
Polarized Light ◽  
Polarized Light Microscopy ◽  
Imaging Markers

Laboratory and imaging markers are an adjunct to competent clinical assessment and should not be used as a substitute. Tests should only be ordered if the results will alter diagnosis, prognosis, or clinical management. Synovial fluid examination—this is the key investigation to confirm the diagnosis of either acute crystal or septic arthritis. Fluid can usually be obtained by direct aspiration from any peripheral joint, or alternatively under ultrasound guidance. The identification of crystals requires compensated polarized light microscopy....

scholarly journals Coexistent Pseudogout andMycobacterium avium-intracellulareSeptic Arthritis in a Patient with HIV and ESRD

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Wais Afzal ◽  
Omer M. Wali ◽  
Kelly L. Cervellione ◽  
Bhupinder B. Singh ◽  
Farshad Bagheri
Keyword(s):  
Synovial Fluid ◽  
Septic Arthritis ◽  
Mycobacterium Avium ◽  
Immunosuppressive Drugs ◽  
Calcium Pyrophosphate ◽  
Initial Assessment ◽  
Calcium Pyrophosphate Dihydrate ◽  
Immunocompromised Patients ◽  
Fluid Analysis ◽  
Mycobacterium Avium Intracellulare

Pseudogout is a crystal-induced arthropathy characterized by the deposition of calcium pyrophosphate dihydrate (CPPD) crystals in synovial fluid, menisci, or articular cartilage. Although not very common, this entity can be seen in patients with chronic kidney disease (CKD). Septic arthritis due toMycobacterium avium-intracellulare(MAI) is a rare entity that can affect immunocompromised patients such as those with acquired immunodeficiency syndrome (AIDS) or those who are on immunosuppressive drugs. Here, we describe a 51-year-old female who presented with fever, right knee pain, swelling, warmth, and decreased range of motion for several days. The initial assessment was consistent with pseudogout, with negative bacterial and fungal cultures. However, due to high white blood cell (WBC) count in the synovial fluid analysis, she was empirically started on intravenous (IV) vancomycin and piperacillin-tazobactam and discharged on IV vancomycin and cefepime, while acid-fast bacilli (AFB) culture was still in process. Seventeen days later, AFB culture grewMycobacterium avium-intracellulare(MAI), and she was readmitted for relevant management. This case illustrates that septic arthritis due to MAI should be considered in the differential diagnosis of septic arthritis in immunocompromised patients.

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