Helena Codes, Lluís Sainz, Hector Corominas And Cesar Diaz-Torne
Background: The ACR/EULAR CPPD classification criteria group released the first-ever provisional classification criteria for calcium pyrophosphate deposition disease (CPPD) at the ACR Philadelphia congress in November 2022. These criteria are based on an adjusted domain scoring system that includes synovial fluid analysis and demographic, clinical and image characteristics. The differential diagnosis in CPPD must be mainly made with rheumatoid arthritis (RA) and gout.
Objectives: To study the percentage of patients diagnosed with seronegative RA who meet the new 2022 ACR/EULAR classification criteria for CPPD (final score ≥57). To determine the clinical and demographic differences between patients with a diagnosis of seronegative RA who meet or not the classification criteria for CPPD.
Methods: An observational retrospective cross-sectional study was performed including all the patients from a monographic RA clinic between September and December 2022. Demographic, clinical, analytical and image variables were collected. The 2022 ACR/EULAR provisional classification criteria for CPPD were applied. Patients fulfilling criteria were classified relating to the time-course of inflammatory arthritis in: persistent, 1 typical episode, >1 typical episode and others.
Results: Overall, 364 patients with RA were identified. 268 patients with positive RF and/or ACPAs were excluded. A total of 95 (24%) patients were included, 75% females, with a mean age at onset of symptoms of 59 (±16) years and 8 (±5) years of disease duration. A total of 18 patients (19%) met the classification criteria for CPPD. Of them 89% were female and the mean age was 69 years. Mean disease duration was 6 years. Time-course presentation was: 4 (21%) persistent arthritis, none with 1 typical episode, 13 (72%) >1 typical episode and 1 (6%) with other presentations. 44% presented radiological erosions. The patients who met the CPPD criteria were older (p=0.048) and had a different clinical presentation (p=0.010) relating to the time-course of inflammatory arthritis. No significant differences were observed between groups in the location of joint clinical involvement. There was a statistically significant association (p=0.000) between the presence of radiological chondrocalcinosis (CC) and the fulfillment of criteria for CPPD, being detected in 66.6% of patients with CPPD versus none with seronegative RA without CPPD. Similarly, there was a significant association (p=0.000) between osteoarthritis in typical locations for CPPD (bilateral radiocarpal, scaphoid/trapezium/trapezoid without rhizarthrosis, 2nd and 3rd MCF) and compliance with criteria for CPPD, being detected in 55.5% of patients with CPPD. A higher prevalence of erosions was detected in patients with CPPD (44.4%) versus seronegative RA without CPPD (27.3%), without statistical significance. No significant treatment differences were observed in both subgroups. Of the patients with criteria for CPPD, 74% were being treated with synthetic of biological DMARDs.
Conclusion: A total of 18 (19%) patients with seronegative RA from a monographic RA unit met the new 2022 ACR/EULAR provisional classification criteria for CPPD. Age at diagnosis and clinical presentation were different between patients with seronegative RA who met criteria for CPPD and those who did not.