Prevalence of chondrocalcinosis in a Mexican tertiary care institution of musculoskeletal disorders.

INTRODUCTION/OBJECTIVES: The prevalence of chondrocalcinosis (CC) was reported as variable according to the geographic populations. However, there are no data regarding its prevalence in Mexico. Thus, we decided to investigate the Mexican prevalence of CC in a cohort of patients from a tertiary health care institution. METHODS: A retrospective analysis of radiographs of knees and wrists from our institution was performed. Inclusion criteria included patients > 50 years old having radiographs of knees and wrists. Radiographic presence of CC was classified according to a dichotomous evaluation assayed by two rheumatologists experts on the area. RESULTS: A total of 3.350 radiographs from 1.602 patients were evaluated. Forty-seven patients showed calcifications in at least one knee or wrist for an overall prevalence of 3%, of which 23.4% were men and 76.6% women. The knee was more commonly affected than the wrist (85.1% and 14.9% respectively). The prevalence according to gender was 2.9% in women, whereas, it was 3.2% in men. Only two patients (4.3%) showed a contemporaneous presence of CC in both hands and both knees. At knee level, the prevalence was 2.7%, whereas at the wrist, we reported a prevalence of 4.9%. CONCLUSIONS: The prevalence of CC for Mexican population had not been reported so far. This a starting point to break the silence and encourage the knowledge of how this disease is associated with possible risk factors in Mexican population. Key Points •The prevalence of chondrocalcinosis in Mexico was 3%. •The prevalence of knee chondrocalcinosis increases according to the age in women's. •The nixtamalized meals could be a protective factor for CC in Mexican population.

[Choroidal calcification associated to chondrocalcinosis]. / Calcificación coroidea asociada a condrocalcinosis.

Introduction: Chondrocalcinosis is a common joint condition in people over 50, characterized by the deposition of calcium pyrophosphate crystals that causes calcification in cartilage structures. Although its prevalence in the general population is 5%, sclerochoroidal calcifications are a rare finding in this pathology. Objective: Describe the case of a 60-year-old man with choroidal calcification in the left eye, associated with radiological findings of chondrocalcinosis, whose metabolic report showed parameters compatible with hyperparathyroidism. Clinical case: Male patient from Mexico City, smoker for 45 years, with medical history of calcium pyrophosphate deposition disease at age 16, attended routine eye examination. A left eye funduscopy revealed an irregularly shaped white-yellowish subretinal lesion with well-defined edges inside the upper temporal arch. Ophthalmological paraclinical studies were performed, and a choroidal hyperreflectic paramacular plate image, which did not involve the retina layers, was corroborated with five-line optical coherence tomography. Conclusions: Although the lesions are asymptomatic and do not require treatment, it is of great importance to make a differential diagnosis with choroidal metastases, choroidal melanoma, choroidal osteoma and lymphoma, since these pathologies do require more aggressive treatment.

Introducción: la condrocalcinosis es una afección articular común en personas mayores de 50 años, caracterizada por el depósito de cristales de pirofosfato de calcio que produce calcificación en estructuras cartilaginosas. Aunque su prevalencia en población general es del 5%, las calcificaciones esclerocoroideas son un hallazgo poco frecuente en esta patología. Objetivo: describir el caso de un hombre de 60 años de edad con calcificación coroidea en el ojo izquierdo, asociada a hallazgos radiológicos de condrocalcinosis, cuyo reporte metabólico evidenció parámetros compatibles con hiperparatiroidismo. Caso clínico: paciente de la Ciudad de México con antecedentes de enfermedad por depósito de pirofosfato de calcio hace 16 años y tabaquismo desde hace 45 años, acudió a revisión oftalmológica de rutina. A la fundoscopia de ojo izquierdo se observó por dentro de arcada temporal superior, una lesión subretiniana blanco-amarillenta de forma irregular con bordes bien definidos. Se le realizaron estudios paraclínicos oftalmológicos y se corrobora con tomografía de coherencia óptica de cinco líneas, imagen en placa paramacular hiperrefléctica coroidea, que no involucra las capas de la retina. Conclusiones: aunque las lesiones son asintomáticas y no requieren tratamiento es de gran importancia hacer un diagnóstico diferencial con metástasis coroideas, melanoma coroideo, osteoma coroideo y linfoma, ya que estas patologías sí implican un tratamiento más agresivo.

Condrocalcinosis axial: reporte de un caso / Axial chondrocalcinosis: a case report

La artropatía por pirofosfato de calcio (CPPD) se caracteriza por la acumulación de cristales de pirofosfato de calcio en el tejido articular y periarticular. La localización más frecuente son rodillas, muñecas y pelvis. Sin embargo, también existen reportes aislados de compromiso de columna. Se presenta el caso de un paciente varón de 52 años, con antecedentes de doble prótesis de caderas por coxartrosis diagnosticada a los 20 años de edad. Es evaluado en reumatología en febrero de 2017, por cuadro de poliartralgias de grandes articula-ciones, asociada a dolor de columna cervical, dorsal y lumbar. Se realizan exámenes imagenológicos que demuestran la presencia de calcificaciones interdiscales con sobrecrecimiento óseo, secundario a artrosis severa y discreta este-nosis raquídea solo en segmentos lumbares bajos.

The Calcium pyrophosphate dihydrate (CPPD) deposition disease is characterised by the deposition of crystals of CPPD in the articular as well as in periarticular structures. The most frequent location are knees, wrist and pelvis. However, also there are iso-lated cases involving the spine. It presents the case of a 52 years male patient, with history of bone arthrosis dou-ble hips prosthesis by bone arthrosis diagnosed 30 years ago. He is evaluated in feb-ruary 2017 by pain of large joints associated cervical spine pain dorsal and lumbar. Imagenological tests are prerfomed and confirms the presence of intervertebral discs calcifications and bone overgrowth secundary to severe osteoarthrosis and spinal ste-nosis in lower lumbar segments.

Knee effusion: ultrasound as a useful tool for the detection of calcium pyrophosphate crystals.

The objective of this study was to evaluate the sensitivity and specificity of ultrasound (US) and conventional radiography (CR) for the detection of calcium pyrophosphate (CPP) crystals in patients with knee effusion. Consecutive patients ≥50 years old with knee effusion were included. All patients underwent arthrocentesis with aspiration of synovial fluid (SF) and subsequent analysis of CPP crystals using plain light and polarizing light microscopy. US and CR of the involved knee were performed immediately after arthrocentesis. CR results were read by an experienced rheumatologist, searching for chondrocalcinosis. US examinations were carried out by an experienced rheumatologist blinded to all clinical and imaging data. The following US abnormal findings were considered indicative of CPP crystals deposition (CPPD): (1) hyperechoic bands within the femoral hyaline cartilage layer, and (2) hyperechoic sparkling spots in meniscal fibrocartilage. A total of 75 knees were evaluated in the same number of patients. Analysis of SF revealed CPP crystals in 15 out of 75 (20 %) knees: all (10) patients with previous diagnosis of CPPD, 3 patients with previous diagnosis of primary knee osteoarthritis (OA) and 2 patients without previous definitive diagnosis of a rheumatic condition. Using SF analysis as reference method, sensitivity and specificity for US findings was 60 and 96.7 %, respectively, while CR showed a sensitivity of 40 % and a specificity of 83.3 %. US results showed high specificity with acceptable sensitivity to detect CPP crystals in patients with knee effusion. Compared with CR, US results had better specificity and sensitivity. US may be used in daily rheumatologic practice when CPPD is suspected.

Artropatía por depósito de cristales de dihidrato de pirofosfato de calcio / Calcium pyrophosfate dihydrate crystal deposition disease: review

Los autores estudiaron las características radiológicas en 67 pacientes con artropatía por depósito de cristales de dihidrato de pirofosfato de calcio encontrados en un total de 2.565 pacientes con articulaciones dolorosas no traumáticas; 2 por ciento de los casos presentaron artropatía por pirofosfato. La radiología convencional fue generalmente diagnóstica en todos los casos cuando se analizaron signos específicos para diferenciar la artropatía por pitofosfato de otras artropatías como la osteoartritis, considerando: a) condocalcinosis (94 por ciento), b) articulación no afectada usualmente en la osteoartritis primaria (22 por ciento) y c) compartimientos no comúnmente comprometidos en la osteoartritis (29 por ciento). Todos los pacientes presentaron además signos de artropatía degenerativa (AU)

Hereditary chondrocalcinosis in a Mexican-American family.

In a study of 45 adults in a family of Mexican-Indian ancestry, it was found that 22 (49%) had joint symptoms resembling those of degenerative joint disease. Eleven family members had radiographic evidence of chondrocalcinosis, and 1 adult and 3 adolescents had clinical histories and examinations consistent with the familial arthropathy, but no radiographic evidence of disease. The cause of the arthritis in the affected family members is calcium pyrophosphate crystal deposition. The mode of inheritance appears to be autosomal dominant with a high degree of penetrance. The disease is characterized by onset in the second to fifth decades of either episodes of acute inflammatory arthritis or degenerative joint disease. A unique finding of this study was a "halo" surrounding chondrocytes in 1 patient's cartilage, demonstrating loss of the proteoglycans.