Para médicos · reumatologia
Resumos de artigos, podcasts e newsletters sobre Doença por Depósito de Pirofosfato de Cálcio, para atualização médica.
A newsletter analisa uma meta-análise que indica benefícios significativos da metformina na redução da dor e melhora funcional em pacientes com osteoartrite de joelho. Outro destaque é a discussão sobre o mimetismo clínico entre a artrite reumatoide soronegativa e a doença por depósito de pirofosfato de cálcio (CPPD), especialmente em pacientes idosos. O conteúdo também revisa os principais avanços terapêuticos de 2025 em doenças como lúpus, esclerose sistêmica e IgG4-RD.
To assess the effect of calcium pyrophosphate deposition disease (CPPD; chondrocalcinosis) on the axial skeleton and compare it with degenerative disc disease (DDD). Conventional radiographs (CR) and magnetic resonance imaging (MRI) of patients with CPPD or DDD were retrospectively assessed by 2 independent readers for vacuum phenomena, disc calcification, endplate erosion, osteophytes, disc height changes, and spondylolisthesis. Available follow-up CR were assessed. CR from 140 patients with CPPD (1171 discovertebral units [DVU]) and 99 with DDD (803 DVU) were evaluated (mean [SD] age 74.4 [9.9] vs 71 [6.2] years; 20% vs 20.2% male individuals, respectively). Disc calcification, osteophytes, and erosions were noted significantly more frequently in CPPD vs DDD (16.5% vs 5.2%, 73.5% vs 59.8%, and 13.6% vs 3.2%, respectively; all P ≤ 0.002). Follow-up CR from 29 patients with CPPD and 46 with DDD were available. Significant progression of endplate erosions and osteophytes was seen (P ≤ 0.02) in both groups. CR follow-up in the CPPD group was shorter than that in DDD (median [IQR] 1.9 [0.6-3.0] vs 3.0 [1.6-4.7] years, respectively; P = 0.03), but CPPD compared with DDD showed more frequent radiographic erosive changes in the thoracic spine (6.8% vs 0.6%; P = 0.02) and lumbar disc calcification (5.8% vs 0.6%; P = 0.01). CPPD is associated with more severe and progressive structural changes in the lower spine compared to DDD. Differentiating CPPD from DDD has clinical implications, influencing both appropriate management strategies and clinical course estimation.
Inflammatory arthritis, especially rheumatoid arthritis (RA), imposes substantial morbidity that diminishes quality of life and escalates health care costs when left untreated. Timely diagnosis and treatment are pivotal. However, limited access to rheumatologists underscores the importance of triaging referrals based on symptom severity. We developed a protocol for using infrared thermography (IRT) to detect joint inflammation and implemented it in an academic primary care clinic as a screening tool for rheumatology referrals. We enrolled people with RA, osteoarthritis (OA), and controls to undergo joint power doppler ultrasound (PDUS) and IRT. IRT image analysis employed manual segmentation with specialized software to determine surface joint temperatures. IRT temperature cutoff points using PDUS as the gold standard for joint inflammation were established. Subsequently, we recruited people with hand or foot joint pain and fast-tracked to rheumatology those surpassing IRT cutoff points for joint inflammation. Thirty-two people with RA, 10 with OA, and 9 controls were enrolled. Most participants (86.3%) were females, and 37.3% were black. Temperature measurements showed robust interrater reliability. Cutoff points at metacarpophalangeal (MCP) (T center ≥32.93 °C, T mean ≥32.67 °C) and wrist (T center ≥33.76 °C, T mean ≥33.79 °C) joints discriminated between inflamed and noninflamed joints. Of the 20 pilot participants, N = 10 (50%) were referred to rheumatology using IRT findings, with N = 8 (80%) seen within 4 weeks. Diagnoses included osteoarthritis, gout, and calcium pyrophosphate deposition disease. IRT demonstrates potential as a reliable tool for identifying inflamed joints and offers a feasible pathway for identifying patients with joint-level thermal abnormalities who may benefit from expedited rheumatologic evaluation. Further research is needed to refine IRT-based rheumatology referral protocols and optimize their utilization.
A systematic literature review (SLR) of publications from 2000 to 2022 identified terminology for calcium pyrophosphate crystal deposition (CPPD) and revealed substantial heterogeneity and poor adherence to recommendations. This study aimed to standardise CPPD terminology by developing an international consensus on labels and definitions. Members of the Gout, Hyperuricemia and Crystal-Associated Disease Network (G-CAN) were invited by email to participate in a 3-round Delphi exercise. A steering committee identified key components of CPPD aetiology, pathophysiology, and clinical presentation among elements appearing in >10% of SLR papers, adding or removing items when scientifically justified. Participants selected preferred labels for each element. Respondents to the first round were invited to subsequent rounds. This paper reports the resulting G-CAN CPPD nomenclature. Consensus was reached for 'calcium pyrophosphate (CPP) crystal' and 'calcium pyrophosphate crystal deposition (CPPD)' to describe the deposition process. The unified term 'calcium pyrophosphate crystal deposition on imaging' was adopted across imaging modalities, whereas 'chondrocalcinosis' was redefined as conventional radiographic cartilage calcification consistent with CPPD. Four clinical manifestations were identified: 'acute CPP crystal arthritis' (with 'flare' for acute episodes), 'chronic CPP crystal arthritis', 'crowned dens syndrome', and 'osteoarthritis with CPPD'; the term 'pseudogout' received no support. The condition is now classified as 'asymptomatic CPPD' or 'CPPD disease' for symptomatic presentations. This G-CAN nomenclature is the first systematic effort to align CPPD terminology with contemporary biological and imaging evidence. By resolving longstanding ambiguities-particularly regarding 'chondrocalcinosis'-it provides a framework for consistent research definitions, clinical trial homogeneity, and improved patient care.
OBJECTIVES: To develop OMERACT core domain sets for chronic and recurrent calcium pyrophosphate deposition (CPPD) disease and acute calcium pyrophosphate (CPP) crystal arthritis. METHODS: Following OMERACT methodology, the CPPD Working Group (comprising of patient research partners, fellows, clinicians, and methodologists) defined the core domain sets. The development of the core sets occurred through a scoping review, qualitative study, Delphi surveys, and ranking exercises to identify the most relevant domains. A virtual e-module was developed to enable members of the OMERACT community to discuss and vote for endorsement of the OMERACT CPPD core domain sets. RESULTS: The core domains for chronic and recurrent CPPD are pain intensity, joint tenderness, joint swelling, acute CPP crystal arthritis flares, overall function, patient global assessment of disease activity, physician global assessment of disease activity, and adverse events including death. In voting, this core domain set was endorsed by 14/14 (100%) patient research partners and 85/87 (98%) other participants. The core domains for acute CPP crystal arthritis are pain intensity, joint tenderness, joint swelling, duration of acute CPP crystal arthritis flare, overall function, patient global assessment of disease activity, and adverse events including death. In voting, this core domain set was endorsed by 14/14 (100%) patient research partners and 83/86 (97%) other participants. Definitions for all core domains have been developed. CONCLUSION: These core domains provide a foundation for future clinical trials and longitudinal studies in CPPD by defining the minimum outcomes that should be assessed and reported to ensure relevance and comparability across studies.