Öz
Amaç
Önceki eklem hasarı, kalsiyum pirofosfat dihdirat birikimine (CPPD) yatkınlık yaratır. Bu çalışmada eroziv bir eklem hastalığına sahip romatoid artrit (RA) olgularında radyografik CPPD bulgulagrının sıklığını ve ilişkili faktörleri tanımlamayı amaçladık.
Yöntem
Ocak 2023 ile Aralık 2024 tarihleri arasında üçüncü basamak romatoloji kliniğimize başvuran erişkin RA hastaları çalışmaya dahil edildi. Sekonder romatolojik hastalıklara ve CPPD hastalığı için predispozan hastalıklara sahip olan olgular çalışmadan dışlandı. Anteroposterior el radyografilerinde kondrokalsinozis, skafo-lunat eklemde kollaps ve skafoid-trapezyum-trapezoid eklemde kollaps ve kanca benzeri osteofitler “CPPD bulguları” olarak tanımlandı. Röntgenler, hastalara kör iki romatolog tarafından değerlendirildi.
Bulgular
Çalışmaya toplam 1.318 hasta alındı ve bunların %83’ü kadındı. Ortalama yaş 55,2 yıl, ortalama hastalık süresi ise 8,6 yıldı. Romatoid faktör ve anti-CCP pozitifliği sırasıyla %56,2 ve %52,7 idi. Hastaların %95,5’inde RA’ya özgü eroziv değişiklikler mevcuttu. Çalışma grubunda CPPD sıklığı %10,5 idi (n=139). En sık görülen CPPD bulgusu distal interfalangeal eklemlerde kondrokalsinozis (n=70) olup, ikinci en sık bulgu kanca benzeri osteofitlerdi (n=48). Yaşı (p<0,001), hastalık süresi (p=0,002), anti-siklik sitrüline peptit (CCP) negatifliği (p<0,001) ve RA tipi ciddi eklem tutulumu (p=0,008) CPPD+ grupta anlamlı olarak daha yüksektir. Çok değişkenli analizde ise yaş (p<0,001), hastalık süresi (p=0,007) ve anti-CCP negatifliğini (p=0,002) RA olgularında için bağımsız prediktif faktörler olarak saptadık.
Sonuç
Bulgularımız, RA olgularındaki eklem hasarının hastaları CPPD birikimine yatkın hale getirebileceğini öne süren önceki literatürle uyumludur. Ayrıca, CPPD, RA yönetiminde akılda tutulması gereken bir klinik antitedir.
Anahtar Kelimeler: Kondrokalsinozis, kristal artropatileri, el, romatoid artrit, risk faktörleri
Kaynakça
Rosenthal AK, Ryan LM. Calcium pyrophosphate deposition disease. N Engl J Med. 2016;374:2575-84.
Dieppe PA, Alexander GJ, Jones HE, et al. Pyrophosphate arthropathy: a clinical and radiological study of 105 cases. Ann Rheum Dis. 1982;41:371-6.
Ishida T, Dorfman HD, Bullough PG. Tophaceous pseudogout (tumoral calcium pyrophosphate dihydrate crystal deposition disease). Hum Pathol. 1995;26:587-93.
Menkes CJ, Simon F, Delrieu F, Forest M, Delbarre F. Destructive arthropathy in chondrocalcinosis articularis. Arthritis Rheum. 1976;19:329-48.
Zhang W, Doherty M, Bardin T, et al. European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann Rheum Dis. 2011;70:563-70.
Smolen JS, Aletaha D, Barton A, et al. Rheumatoid arthritis. Nat Rev Dis Primers. 2018;4:18001.
Grassi W, De Angelis R, Lamanna G, Cervini C. The clinical features of rheumatoid arthritis. Eur J Radiol. 1998;27:18-24.
Fleming A, Benn RT, Corbett M, Wood PH. Early rheumatoid disease. II. Patterns of joint involvement. Ann Rheum Dis. 1976;35:361-4.
Kleiber Balderrama C, Rosenthal AK, Lans D, Singh JA, Bartels CM. Calcium pyrophosphate deposition disease and associated medical comorbidities: a national cross-sectional study of US veterans. Arthritis Care Res (Hoboken). 2017;69:1400-6.
Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2010;69:1580-8.
Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H; CASPAR Study Group. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006;54:2665-73.
Shiboski CH, Shiboski SC, Seror R, et al. 2016 American College of Rheumatology/European League Against Rheumatism Classification Criteria for primary Sjögren’s syndrome: a consensus and data-driven methodology involving three international patient cohorts. Arthritis Rheumatol. 2017;69:35-45.
van den Hoogen F, Khanna D, Fransen J, et al. 2013 classification criteria for systemic sclerosis: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis Rheum.2013;65:2737-47.
Neogi T, Jansen TL, Dalbeth N, et al. 2015 Gout Classification Criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheumatol. 2015;67:2557-68.
Zhang W, Doherty M, Leeb BF, et al. EULAR evidencebased recommendations for the diagnosis of hand osteoarthritis: report of a task force of ESCISIT. Ann Rheum Dis. 2009;68:8-17.
Sharp JT, Young DY, Bluhm GB, et al. How many joints in the hands and wrists should be included in a score of radiologic abnormalities used to assess rheumatoid arthritis? Arthritis Rheum. 1985;28:1326-35.
Knevel R, Lukas C, van der Heijde D, Rincheval N, Combe B, van der Helm-van Mil AH. Defining erosive disease typical of RA in the light of the ACR/EULAR 2010 criteria for rheumatoid arthritis; results of the data driven phase. Ann Rheum Dis. 2013;72:590-5.
Steinbach LS. Calcium pyrophosphate dihydrate and calcium hydroxyapatite crystal deposition diseases: imaging perspectives. Radiol Clin North Am. 2004;42:185-205.
Paalanen K, Rannio K, Rannio T, Asikainen J, Hannonen P, Sokka T. Prevalence of calcium pyrophosphate deposition disease in a cohort of patients diagnosed with seronegative rheumatoid arthritis. Clin Exp Rheumatol. 2020;38:99-106.
Sabchyshyn V, Konon I, Ryan LM, Rosenthal AK. Concurrence of rheumatoid arthritis and calcium pyrophosphate deposition disease: a case collection and review of the literature. Semin Arthritis Rheum. 2018;48:9-11.
Gerster JC, Varisco PA, Kern J, Dudler J, So AK. CPPD crystal deposition disease in patients with rheumatoid arthritis. Clin Rheumatol. 2006;25:468-9.
Theiler G, Quehenberger F, Rainer F, Neubauer M, Stettin M, Robier C. The detection of calcium pyrophosphate crystals in the synovial fluid of patients with rheumatoid arthritis using the cytospin technique: prevalence and clinical correlation. Rheumatol Int. 2014;34:137-9.
Galozzi P, Oliviero F, Frallonardo P, et al. The prevalence of monosodium urate and calcium pyrophosphate crystals in synovial fluid from wrist and finger joints. Rheumatol Int. 2016;36:443-6.
Oliviero F, Scanu A, Galozzi P, et al. Prevalence of calcium pyrophosphate and monosodium urate crystals in synovial fluid of patients with previously diagnosed joint diseases. Joint Bone Spine. 2013;80:287-90.
Neame RL, Carr AJ, Muir K, Doherty M. UK community prevalence of knee chondrocalcinosis: evidence that correlation with osteoarthritis is through a shared association with osteophyte. Ann Rheum Dis. 2003;62:513-8.
Ciesielski O, Biesiekierska M, Panthu B, Soszyński M, Pirola L, Balcerczyk A. Citrullination in the pathology of inflammatory and autoimmune disorders: recent advances and future perspectives. Cell Mol Life Sci. 2022;79:94.
Krekeler M, Braliakos X, Tsiami S, Braun J. High prevalence of chondrocalcinosis and frequent comorbidity with calcium pyrophosphate deposition disease in patients with seronegative rheumatoid arthritis. RMD Open. 2022;8:e002383.
Smolen JS, Landewé RBM, Bergstra SA, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023;82:3-18.
Parperis K, Papachristodoulou E, Kakoullis L, Rosenthal AK. Management of calcium pyrophosphate crystal deposition disease: a systematic review. Semin Arthritis Rheum. 2021;51:84-94.
Abhishek A, Tedeschi SK, Pascart T, et al. The 2023 ACR/EULAR classification criteria for calcium pyrophosphate deposition disease. Ann Rheum Dis. 2023;82:1248-57.
Bergstra SA, Chopra A, Saluja M, et al. Evaluation of the joint distribution at disease presentation of patients with rheumatoid arthritis: a large study across continents RMD Open. 2017;3:e000568.
Pekdiker M, Oğuzman H. The first involved joints and associated factors in patients with rheumatoid arthritis Arch Rheumatol. 2024;39:274-84.
Miksanek J, Rosenthal AK. Imaging of calcium pyrophosphate deposition disease. Curr Rheumatol Rep. 2015;17:20.
Cabral AR, Loya BL, Alarcón-Segovia D. Bone remodeling and osteophyte formation after remission of rheumatoid arthritis. J Rheumatol. 1989;16:1421-7.
Cipolletta E, Filippou G, Scirè CA, et al. The diagnostic value of conventional radiography and musculoskeletal ultrasonography in calcium pyrophosphate deposition disease: a systematic literature review and meta-analysis. Osteoarthritis Cartilage. 2021;29:619-32.
McCarty DJ. Calcium pyrophosphate dihydrate crystal deposition disease--1975. Arthritis Rheum. 1976;19:275-85.
