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.

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.

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 P100 Acute crystal arthritis: a leading cause of hospital admission, yet poorly recognised and mistreated

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
A Abdalla
Keyword(s):  
Synovial Fluid ◽  
Hospital Admission ◽  
Septic Arthritis ◽  
Acute Hospital ◽  
University Hospital ◽  
Acute Arthritis ◽  
Fluid Analysis ◽  
Synovial Fluid Analysis ◽  
Crystal Arthritis ◽  
Acute Hospital Admission

Abstract Background/Aims  Crystal arthritis is the commonest inflammatory arthritis in adults. A common mimic is septic arthritis. Without appropriate synovial fluid analysis, a mis-diagnosis of sepsis can be made with resultant unnecessary hospitalization, inappropriate intravenous antibiotic therapy and excess cost. Such cases are frequently described as ‘culture-negative’ septic arthritis. We aimed to examine and analyse the cases of acute arthritis requiring acute hospital admission in a tertiary referral centre in Dublin. Methods  A retrospective review of database between Jan - Dec 2019 at the Mater Misericordiae University Hospital, Dublin, was carried out. All cases of acute arthritis requiring acute hospital admission were identified. Cases treated at the Emergency Department, Acute Medical Unit or Outpatients which did not require hospital admission were excluded. Results  30 patients were identified during this period, 16 (53%) had an ultimate diagnosis of crystal arthritis, 8 (27%) had confirmed septic arthritis and 6 (20%) had other arthritides (e.g. haemoarthrosis). The median age for crystal arthritis was significantly higher (85.5 y) compared to septic arthritis (47 y). Apart from age, the clinical profile and biomarkers for crystal and septic arthritis were comparable. The majority of crystal arthritis cases were due to pseudogout (69 %), ultimately diagnosed by rheumatology. Septic arthritis led to more days in hospital than crystal arthritis (median 14 vs 5.5 days). All 30 patients received IV antimicrobial therapy for presumed septic arthritis. Conclusion  This retrospective study showed crystal arthritis, especially pseudogout, was the commonest cause of hospital admission (53%) with acute arthritis particularly among elderly patients. Accurate diagnosis by synovial fluid analysis with appropriate equipment is extremely useful in the assessment of these cases. More awareness and training among orthopedic, emergency and acute clinicians is needed in order to avoid unnecessary admissions and interventions. Disclosure  A. Abdalla: None.

scholarly journals THU0406 IDENTIFICATION OF INTRACELLULAR VACUOLES IN SYNOVIAL FLUID WITH CALCIUM PYROPHOSPHATE AND MONOSODIUM URATE CRYSTALS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 440.1-441
Author(s):  
M. L. Peral ◽  
I. Calabuig ◽  
A. Martín-Carratalá ◽  
M. Andrés ◽  
E. Pascual
Keyword(s):  
Clinical Practice ◽  
Synovial Fluid ◽  
Phase Contrast ◽  
Calcium Pyrophosphate ◽  
Monosodium Urate ◽  
Fluid Analysis ◽  
Cytoplasmic Vacuoles ◽  
Contrast Microscopy ◽  
Ordinary Light ◽  
Msu Crystals

Background:Synovial fluid analysis using polarized microscopy is the gold standard for the diagnosis of crystal-related arthritis. In our experience, we have noted that, when calcium pyrophosphate (CPP) crystals are observed, they sometimes appear within intracellular vacuoles. However, this phenomenon is not seen in those samples containing monosodium urate (MSU) crystals. This finding has been scantly reported in the literature, but may be useful in clinical practice to ensure accurate crystal identification.Objectives:Our study aims to assess whether the presence of vacuoles contributes to identifying the type of crystal, and also to gauge the frequency of their presentation.Methods:We conducted an observational study in a rheumatology unit between February and June of 2019. Synovial fluids containing CPP or MSU crystals, obtained in daily clinical practice, were consecutively included for analysis. Two observers simultaneously analyzed the presence of vacuoles by ordinary light and phase contrast microscopy in less than 24 hours after their extraction, using a microscope equipped with two viewing stations. The primary study variable was to determine whether CPP and MSU crystals are seen inside intracellular vacuoles, and to calculate the frequency of this finding for each type of crystal, estimating their 95% confidence interval (95% CI) and comparing rates using Fisher’s exact test.Results:Twenty-one samples were obtained. Data is given in the Table. MSU crystals were present in 7 (33.3%) and CPP crystals in 14 (66.6%). Interestingly, none of the MSU samples showed crystal-containing vacuoles (95% CI 0-35.4%). On the contrary, cytoplasmic vacuoles containing crystals were present in all of the CPP samples (95% CI 78.5-100%). The findings were confirmed by phase-contrast microscopy. Differences were statistically significant (p<0.001).Table.SAMPLES ACCORDING TO TYPE OF MICROCRYSTAL(n=21)SAMPLES WITH VACUOLS(UNDER ORDINARY LIGHT)SAMPLES WITH VACUOLS(UNDER PHASE CONTRAST)CPP (14; 66.6%)14 (100%)(95%CI 78.5-100%)14 (100%)(95%CI 78.5-100%)MSU (7; 33.3%)0 (0%)(95%CI 0-35.4%)0 (0%)(95%CI 0-35.4%)Conclusion:The presence of vacuoles may be a useful and easy way to differentiate MSU and CPP crystals when performing synovial fluid microscopy in clinical practice, since it appears to be a distinctive feature in CPP crystal fluids.References:[1]Kohn NN, Hughes RE, McCarty DJ Jr, Faires JS. The significance of calcium phosphate crystals in the synovial fluid of arthritic patients: the «pseudogout syndrome». II. Identification of crystals. Ann InternMed. 1962 May;56:738-45.[2]Pascual E, Sivera F, Andrés M. Synovial Fluid Analysis for Crystals. CurrOpRheumatol 2011;23:161-169.[3]McCarty DJ, Koopman WJ. Arthritis and allied conditions: A textbook of rheumatology, volumen 1. Lea &amp;Febiger. 1993.[4]Pascual E, Sivera F. Synovial fluid crystal Analysis. En Gout and other crystal arthropathies. Terkeltaub R ed. Elsevier; 2012: p.20-34.[5]Hwang HS, Yang CM, Park SJ, Kim HA. Monosodium Urate Crystal-Induced Chondrocyte Death via Autophagic Process. Int J Mol Sci. 2015 Dec 8;16(12):29265-77.Image 1. Microscopy with ordinary light. Cells with cytoplasmic vacuoles are observed, as well as abundant intra and extracellular CPP crystals.Image 2. Microscopy with phase contrast technique. Cells with intracellular vacuoles are observed inside which have microcrystals with parallelepiped morphology, compatible with CPP.Disclosure of Interests: :None declared

scholarly journals Lyme Arthritis: A Comparison of Presentation, Synovial Fluid Analysis, and Treatment Course in Children and Adults

2013 ◽  
Vol 65 (12) ◽  
pp. 1986-1990 ◽  
Author(s):  
Brian E. Daikh ◽  
Fred E. Emerson ◽  
Robert P. Smith ◽  
F. Lee Lucas ◽  
Carol A. McCarthy
Keyword(s):  
Synovial Fluid ◽  
Lyme Arthritis ◽  
Fluid Analysis ◽  
Synovial Fluid Analysis
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