Spinal involvement with calcium pyrophosphate deposition disease in an academic rheumatology center: A series of 37 patients.
CT scan
MRI
chondrocalcinosis
discitis
sacroiliitis
Journal
Seminars in arthritis and rheumatism
ISSN: 1532-866X
Titre abrégé: Semin Arthritis Rheum
Pays: United States
ID NLM: 1306053
Informations de publication
Date de publication:
06 2019
06 2019
Historique:
received:
09
07
2018
revised:
17
09
2018
accepted:
09
10
2018
pubmed:
13
11
2018
medline:
21
4
2020
entrez:
13
11
2018
Statut:
ppublish
Résumé
Calcium pyrophosphate dihydrate deposition disease (CPPD) has been reported to involve the spine, but few systematic studies have been published. To further characterize the spinal involvement with CPPD by a review of CPPD patients hospitalized in a rheumatology department. We retrospectively reviewed data for patients consecutively admitted with a diagnosis of CPPD in the rheumatology department of Lariboisière hospital in Paris, France over 5 years by using a standardized protocol and electronic case report forms. Imaging studies were also reviewed. Spinal CPPD was diagnosed in 37/152 (24.3%) CPPD patients. Patient with spinal involvement had more widespread peripheral CC. The cervical (n = 21) and lumbar (n = 19) segments were most involved. CT-scan was more sensitive than plain radiographs for detecting spinal calcifications. Crown dens syndrome was a prominent feature of cervical involvement. Inflammatory sterile spondylo-discitis was observed in 6 patients. Lesions were frequently multiple and were classified into 4 types. Ruling out septic discitis required image-guided biopsies in 3 patients. Sacroiliac involvement included calcification in 5 patients and severe sterile destructive arthropathy and joint fusion in one patient each. Degenerative changes were common, and CPPD could not be implicated because of the patients 'age and lack of a control population. In 12 patients, severe clinical features requiring hospitalization were related to such degenerative changes. Symptomatic involvement of the spine was observed in 24% of this series of hospitalized CPPD patients. Specific entities were the cause of hospitalisation in 25 of the 37 patients with spinal calcification and included inflammatory pain related to crystal deposits and destructive arthropathy of the spine and sacroiliac joints. Discitis exhibited a wide range of MRI features and biopsies were needed to rule out infection in 3 of the 6 discitis.
Sections du résumé
BACKGROUND
Calcium pyrophosphate dihydrate deposition disease (CPPD) has been reported to involve the spine, but few systematic studies have been published.
OBJECTIVE
To further characterize the spinal involvement with CPPD by a review of CPPD patients hospitalized in a rheumatology department.
METHODS
We retrospectively reviewed data for patients consecutively admitted with a diagnosis of CPPD in the rheumatology department of Lariboisière hospital in Paris, France over 5 years by using a standardized protocol and electronic case report forms. Imaging studies were also reviewed.
RESULTS
Spinal CPPD was diagnosed in 37/152 (24.3%) CPPD patients. Patient with spinal involvement had more widespread peripheral CC. The cervical (n = 21) and lumbar (n = 19) segments were most involved. CT-scan was more sensitive than plain radiographs for detecting spinal calcifications. Crown dens syndrome was a prominent feature of cervical involvement. Inflammatory sterile spondylo-discitis was observed in 6 patients. Lesions were frequently multiple and were classified into 4 types. Ruling out septic discitis required image-guided biopsies in 3 patients. Sacroiliac involvement included calcification in 5 patients and severe sterile destructive arthropathy and joint fusion in one patient each. Degenerative changes were common, and CPPD could not be implicated because of the patients 'age and lack of a control population. In 12 patients, severe clinical features requiring hospitalization were related to such degenerative changes.
CONCLUSION
Symptomatic involvement of the spine was observed in 24% of this series of hospitalized CPPD patients. Specific entities were the cause of hospitalisation in 25 of the 37 patients with spinal calcification and included inflammatory pain related to crystal deposits and destructive arthropathy of the spine and sacroiliac joints. Discitis exhibited a wide range of MRI features and biopsies were needed to rule out infection in 3 of the 6 discitis.
Identifiants
pubmed: 30415946
pii: S0049-0172(18)30437-2
doi: 10.1016/j.semarthrit.2018.10.009
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1113-1126Informations de copyright
Copyright © 2018 Elsevier Inc. All rights reserved.