[Diastolic dysfunction of ventricles in patients with calcium pyrophosphate crystal deposition disease while receiving anti-inflammatory therapy].

BACKGROUND: Calcium pyrophosphate crystal deposition disease (CPPD) may be associated with developing of diastolic dysfunction (DD). AIM: To determine the variability of echocardiographic parameters in patients with CPPD receiving anti-inflammatory therapy. MATERIALS AND METHODS: Twenty six patients with CPPD and osteoarthritis (OA) from 18 to 65 years old were included in the case-control study. All patients underwent echocardiography, laboratory parameters at baseline and after 6 months. Patients with CPPD received methotrexate 15 mg per week or hydroxychloroquine 200 mg once a day, or colchicine 1 mg per day. Diastolic function according to echocardiography was assessed. RESULTS: Diastolic dysfunction was detected in 19 patients: in 11 (42%) patients with CPPD and 8 (31%) patients with OA (p=0.39). The baseline serum CRP level was higher in the CPPD group (p=0.03), no differences were found for other indicators. Twenty-two patients with CPPD and 19 patients with OA completed the study. In patients with OA, there were no significant changes in indicators reflecting the diastolic function of ventricles. CONCLUSION: CPPD therapy with colchicine, hydroxychloroquine and methotrexate has a positive effect on indicators of diastolic ventricular function.

Acute Calcium Pyrophosphate Crystal Arthritis of the Wrist Elicited by Anti-COVID-19 Vaccination After Carpal Tunnel Release.

BACKGROUND Calcium pyrophosphate dihydrate deposition disease includes a variety of clinical syndromes, including acute calcium pyrophosphate (CPP) crystal arthritis. Most patients with CPP crystal arthritis have a primary/idiopathic form presenting with severe pain, swelling, and stiffness. COVID-19 infection, which originated in China in December 2019, required extraordinary efforts to develop and test new vaccines to halt the pandemic. The Vaxzervria vaccine has shown excellent safety and efficacy in phase 3 trials with a mechanism based on the expression of the SARS-CoV-2 spike protein gene coding for the S-antigen, which stimulates the immune response. CASE REPORT We describe an acute event of crystal arthritis after a carpal tunnel syndrome release followed by administration of the second dose of anti-COVID-19 Vaccine Oxford-AstraZeneca (ChAdOx1 nCoV-19). Medical treatment resulted in full resolution of the symptoms in 2 weeks. CONCLUSIONS Although most episodes of acute arthritis happen spontaneously, certain factors may trigger the acute CPP crystal arthritis such as intercurrent illnesses or surgeries. Although the association between carpal tunnel syndrome and CPP arthritis has been known for over 40 years, surgical release of the carpal ligament has always been associated with full resolution of symptoms. This is the first case report describing an exacerbation after carpal canal release, concomitant with the administration of the vaccine. According to our opinion, the vaccination associated with a prior surgery in the same anatomical site could have synergically triggered the arthritis flare-up, in a predisposed patient, with a mechanism still unknown.

Subchondroplasty for Bone Marrow Lesions in the Arthritic Knee Results in Pain Relief and Improvement in Function.

Subchondroplasty is a relatively new joint preserving procedure, which involves the localized injection of calcium pyrophosphate bone substitute into the bone marrow lesion. The advent of magnetic resonance imaging (MRI) has greatly facilitated the identification of these bone marrow lesions. We investigated the clinical efficacy of subchondroplasty in the treatment of symptomatic bone marrow lesions in the knee, including knees with preexisting osteoarthritis. This study comprised of 12 patients whose knees were evaluated with standard radiographs and MRI to identify and localize the bone marrow lesions. They then underwent subchondroplasty under intraoperative radiographic guidance. Preoperative and postoperative visual analog scale (VAS) pain scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and Knee Injury and Arthritis Outcome Scores (KOOS) were obtained. VAS scores improved significantly from 7.5 ± 1.8 before surgery to 5.2 ± 2.7 after surgery. This further improved to 2.1 ± 2.4 at the one-year follow-up. KOOS scores improved significantly from 38.5 ± 17.0 before surgery to 73.2 ± 19.0 at the one-year follow-up. WOMAC scores improved significantly from 47.8 ± 20.5 before surgery to 14.3 ± 13.2 at the one-year follow-up. Subchondroplasty offers an effective way to treat subchondral bone marrow lesions in the arthritic knee, resulting in improvement in symptoms and early return to activity. Long-term studies are required to evaluate if these benefits can last. This is a Level II study.

Sintered dicalcium pyrophosphate treatment attenuates estrogen deficiency-associated disc degeneration in ovariectomized rats.

BACKGROUND: Estrogen deficiency is associated with musculoskeletal disorders. Sintered dicalcium pyrophosphate (SDCP) is a novel antiosteoporotic agent. In this study, we examined its use for restoration of bone quality and attenuation of disc degeneration in ovariectomy rats. METHODS: Sixty female Sprague Dawley rats were randomly divided into 3 groups, namely sham group undergoing sham surgery, ovariectomy (OVX) group receiving an equivalent volume of isotonic sodium chloride solution, and OVX/SDCP group orally administered with 0.25 mg/mL SDCP. Animals were sacrificed at 3 and 6 months post ovariectomy and lumbar vertebrae and intervertebral discs were harvested. Bone mineral density, micro-computed tomography analysis, and biomechanical testing were performed to assess bone quality. Histological analysis with hematoxylin and eosin, Alcian blue, and Masson's trichrome stain were conducted to determine disc degeneration. Immunohistochemistry and real-time PCR were carried out to measure the expressions of aggrecan, type I collagen, type II collagen, and MMP-1, MMP-3, and MMP-13. RESULTS: SDCP improved bone quality as observed by the results of increased bone mineral density and stiffness in OVX rats. The improvement in disc degeneration induced by estrogen withdrawal was associated with reduced gene expressions of MMPs and increased production of collagen type II. CONCLUSION: SDCP prevents osteoporosis and ameliorates disc degeneration in OVX rats. It represents a favorable therapeutic agent for osteoporotic and osteoarthritic conditions in clinical practice.

Artropatía por pirofosfato cálcico como causa de hombro doloroso: valor de la ecografía en el abordaje diagnóstico / Pyrophosphate arthropathy causing shoulder pain: value of ultrasound in its therapeutic approach

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Pseudogota tofacea de articulación temporomandibular: reporte de un caso / Tophaceous pseudogout of the temporomandibular joint: report of a case

La pseudogota tofacea es una enfermedad articular que generalmente aparece en rodillas, caracterizada por el depósito de cristales de pirofosfato de calcio en el cartílago articular o fibrocartílago. Se presenta el caso de una mujer de 62 años con aumento de volumen a nivel de articulación temporomandibular derecha, de 2 años de evolución. En la tomografía axial computarizada se observó una gran masa de radioopacidad mixta que rodea la cabeza del cóndilo. Se realizó la exéresis total de la lesión. Con el estudio histopatológico y antecedentes clínicos se obtiene el diagnóstico de pseudogota tofacea. La paciente se encuentra 2 años después de la cirugía en buenas condiciones y sin signos de recidiva. La baja incidencia de esta enfermedad y su rara localización en la articulación temporomandibular pueden hacer difícil el diagnóstico, por lo que estudios específicos se requieren para dar un diagnóstico acertado (AU)

Tophaceous pseudogout is a joint disease in which there is deposition of crystals of calcium pyrophosphate in articular cartilage or fibrocartilage, and usually occurs in the knees. The case is presented of a 62-year-old woman with increase in volume in the right temporomandibular joint of 2 years onset. A large mass of mixed radio-opacity surrounding the head of the condyle was observed on the computerized axial tomography. Total excision of the lesion was performed. The diagnosis of tophaceous pseudogout was obtained, by means of the histopathological examination and medical history. Two years after surgery, the patient is in good condition without signs of recurrence. The low incidence of this disease and its rare location in the temporomandibular joint can it difficult to diagnosis, thus specific studies are required to make an accurate diagnosis (AU)

Comparative study of bone regeneration in critical cranial bone defects using bone marrow adult stem cells and calcium phosphate / Estudio comparativo sobre regeneración ósea en defectos óseos craneales con células madre adultas de la médula ósea y fosfato cálcico (BoneSource(R))

Objective. To compare the use of Bone Marrow adult Stem Cells (BMSCs), differentiated in vitro into osteoblasts, associated to calcium phosphate versus autogenous bone graft, in the repair process of critical size bone defects. Materials and method. On 36 Wistar adult rats, bilateral full-thickness defects on parietal bone were created. The defects were either repaired with calcium phosphate (group I), calcium phosphate + (BMSCs) (group II) or autogenous bone graft (group III), and the opposite side with blood clot (Control Group). In all cases a collagen membrane was used. The animals were sacrificed at 30 and 60 days, and all specimens were collected for further histological and histomorfometric study. Results. At 30 days, group III (autogenous bone graft) evidences a statistical difference on bone formation when compared to the experimental and control groups (p ≤ 0.05). At 60 days group II (BS + BMSCs) and group III (autogenous bone) showed a similar bone formation and has only a statistical difference when compared to group I (BS) and control group. Conclusion. The use of calcium phosphate in conjunction with BMSCs resulted in a similar behavior in the process of bone repair in critical size defects, when compared with autogenous bone graft (AU)

Objetivo. Comparar el uso de células madre adultas de la médula ósea (CMMO), diferenciadas in vitro en osteoblastos, asociadas a fosfato cálcico, frente a injerto de hueso autólogo, en el proceso de reparación de defectos óseos de tamaño crítico. Material y Método. En 36 ratas adultas Wistar, se crearon defectos bilaterales de todo el grosor en el hueso parietal. Los defectos se repararon con fosfato de calcio (BoneSource®) (grupo I), fosfato de calcio (BoneSource®) + (CMMO) (grupo II) o injerto de hueso autólogo (grupo III), y en el lado contralateral con coágulo de sangre (grupo de control). En todos los casos se utilizó membrana de colágeno. Los animales fueron sacrificados a las 30 y 60 días y se obtuvieron todas las muestras para el estudio histológico y el análisis histomorfométrico. Resultados. A los 30 días, en el grupo III (injerto de hueso autólogo) se puso de manifiesto una diferencia estadísticamente significativa en la formación de hueso en comparación con el grupo experimental y el de control (p < 0,05). A los 60 días, en el grupo II (BoneSource®) + CMMO) y el grupo III (hueso autólogo) se demostró una formación ósea similar, y sólo se evidenció una diferencia estadísticamente significativa en comparación con el grupo I (BoneSource®) y el grupo de control. Conclusión. El uso de fosfato de calcio en combinación con CMMO indujo un comportamiento similar en el proceso de reparación ósea en defectos de tamaño crítico, en comparación con injerto de hueso autólogo (AU)

Better Osteoporotic Fracture Healing with Sintered Dicalcium Pyrophosphate (SDCP) Treatment: A Rat Femoral Fracture Model.

The aim of this study was to evaluate the effect of sintered dicalcium pyrophosphate (SDCP) on fracture healing in an osteoporotic rat model. Female Sprague-Dawley rats (8 weeks old) were randomly allocated into five groups: sham-operated group, and bilateral ovariectomized group treated with SDCP, alendronate, calcitonin, or no treatment. Rats were sacrificed at 6 or 16 weeks after fracture. Fracture sites were examined by microcomputed tomography (microCT), histology, and mechanical testing. The results showed that SDCP mildly suppressed callus remodeling at 6 weeks, but not at 16 weeks. The lamellar bone in the callus area and new cortical shell formation in SDCP-treated group were similar to that of the sham group at 16 weeks after fracture, indicating there was no delayed callus remodeling into lamellar bone. At both 6 and 16 weeks after fracture, ultimate stress and elastic modulus were similar between the SDCP and sham groups, and the mechanical strength in these groups was better than that in other groups. Finally, analysis of the serum bone markers CTX-1 and P1NP suggested that SDCP decreased the bone turnover rate and promoted proper fracture healing. The effect of SDCP is superior to that of alendronate and calcitonin in the healing of osteoporotic fractures.

Stannous fluoride dentifrices.

PURPOSE: Stannous fluoride has a long history of use in the improvement of oral health, and was the fluoride source first proven to provide anti-caries benefits when delivered from a dentrifrice formulation. This paper provides an account of the early use of stannous fluoride, primarily for an anti-caries benefit, and the subsequent attempts to formulate stannous fluoride into stable formulations where additional benefits of the stannous cation can be realized.

A comparison of increment and incidence density analyses in evaluating the anticaries effects of two dentifrices.

This study aimed to determine whether incidence density (ID) calculations of caries incidence rates would provide a more sensitive means of detecting caries-preventive effects than would traditional techniques. A secondary analysis was conducted using data from a 1981 study in which three dentifrices were compared in a double-blind randomized clinical trial. Subjects were examined at baseline and 1, 2 and 3 years after baseline. Three-year DMFS increments were calculated for 1,754 subjects attending the baseline and 3-year examinations. Caries ID rates then were calculated for 2, 661 subjects who had at least two examinations, using each surface's net increment (-1, 0 or +1) as the numerator and the surface's time at risk as the denominator. Despite theoretical advantages, the ID method did not alter the conclusions drawn using DMFS increments, apparently because (a) subjects lost to follow-up were similar to those completing the study, and (b) loss to follow-up was similar among treatment groups.

A three-year clinical caries evaluation of the effect of a sodium fluoride-silica abrasive dentifrice.

This study was conducted to determine if the anticaries effectiveness of a 0.243% sodium fluoride-silica abrasive dentifrice is superior to a 0.4% stannous fluoride-calcium pyrophosphate dentifrice. A nonfluoride, calcium pyrophosphate abrasive placebo dentifrice was also included at one-third the sample size of the active treatment groups to estimate the level of efficacy of the sodium fluoride dentifrice. A total of 3,093 schoolchildren were randomly assigned at a ratio of 3:3:1 to the sodium fluoride dentifrice, the stannous fluoride dentifrice, or the placebo dentifrice, respectively. Caries examinations were made by the same examiner initially and after one, two, and three years of ad libitum product usage. After three years, the results showed that the group using the sodium fluoride dentifrice had significantly fewer DMF teeth and DMF surfaces increments than the group using the stannous fluoride dentifrice. The percent reductions for DMF teeth and DMF surfaces were 24.2% and 22.6%, respectively. Both groups using fluoride dentifrices also had significantly fewer DMF teeth and DMF surfaces increments than the group using the placebo dentifrice.

A three-year study of the effect of a sodium fluoride-silica abrasive dentifrice on dental caries.

The purpose of this study was to determine if a 0.243% sodium fluoride-silica abrasive dentifrice provides greater anticaries efficacy than a 0.4% stannous fluoride-calcium pyrophosphate abrasive dentifrice. A sample of 1,824 schoolchildren was randomly assigned to either the sodium fluoride dentifrice or the stannous fluoride dentifrice and examined clinically and radiographically for dental caries initially and after one, two, and three years of dentifrice usage. Two examiners independently examined each of the subjects for dental caries. After three years of ad libitum dentifrice usage, the results for both examiners showed that the group brushing with the sodium fluoride dentifrice had significantly lower DMF tooth and DMF surface increments than the group brushing with the stannous fluoride dentifrice. The percent reductions for DMF teeth were 14.8% and 10.5%, and for DMF surfaces 16.4% and 13.1% for the two examiners, respectively.

Effect on dental caries of a stannous fluoride-calcium pyrophosphate dentrifice in an adult population: one-year results.

The first year of a two-year double-blind clinical trial of the anticaries effectiveness of a stannous fluoride-calcium pyrophosphate (SnF2-CPP) dentifrice as compared to a placebo control dentifrice involved 1,337 adult subjects, 18 to 78 years of age. Adult subjects were examined for dental caries at a baseline examination and after one year of ad lib dentifrice usage by an experienced clinical examiner using a visual-tactile examination and a radiographic evaluation. Results of the study after one year indicate a significant (P < 0.05) 33.3% difference in new caries formation with use of the SnF2-CPP dentifrice as compared to the placebo control based on the DMFS score.

The caries-preventive effect of amine fluorides and inorganic fluorides in a mouthrinse or dentifrice after 30 months of use.

The study groups using a dentifrice and mouthrinse both containing fluorides, a dentifrice containing stannous fluoride and a mouthrinse containing sodium fluoride, or a mouthrinse containing sodium fluoride with a placebo dentifrice had a 20.7% to 29.0% lower DMF increment than the control group after 30 months. These differences were significant. The study groups using a dentifrice containing amine fluorides and a placebo mouthrinse, a mouthrinse containing amine fluorides and a placebo dentifrice, or a dentifrice containing stannous fluoride and a placebo mouthrinse had a 13.6% to 22.4% lower DMF increment than the control group. These differences were not statistically significant. There was no significant difference in effectiveness against caries between the use of the organic or inorganic fluoride products.