Calcium pyrophosphate dihydrate and hydroxyapatite crystals in a patient with rheumatoid arthritis: Acase report

• Main Author: Shereen R Kamel
• Format: Article
• Language: English
• Published: SpringerOpen 2017-01-01
• Series: Egyptian Rheumatology and Rehabilitation
• Subjects: calcium pyrophosphate dihydrate deposition; hydroxyapatite deposition; rheumatoid arthritis
• Online Access: http://www.err.eg.net/article.asp?issn=1110-161X;year=2017;volume=44;issue=2;spage=91;epage=94;aulast=Kamel

The association between rheumatoid arthritis (RA) and calcium pyrophosphate dihydrate (CPPD) crystal deposits can now be easily identified by MSUS, which is a noninvasive technique that can be applied to patients with painful joints and enthesis that are unexplained by rheumatoid activity. In this paper, we report an Egyptian case of a 51-year-old man who had rheumatoid arthritis since 7 years and developed bilateral knee and heel pain of 1.5 months’ duration with gradual onset and progressive course. Radiography revealed features of RA in both hands, as well as features of severe osteoarthritis in both knees with no signs of chondrocalcinosis. Ultrasonography of the joints, Achilles tendon, and plantar fascia detected knee, Achilles tendon, and plantar fascia calcifications, which are characteristic of CPPD, and supraspinatus calcification, which is characteristic of hydroxyapatite (HA) deposition. Further investigations revealed no evidence of metabolic disorders. CPPD and HA crystals were identified in his synovial fluid. Subclinical affection with CPPD and HA crystals in RA can be easily detected by ultrasonography, which allows early management to prevent future attacks in RA patients that could lead to exacerbation of joint symptoms that may be missed as rheumatoid disease activity. Diet control and colchicine treatment may be more effective if started early before exacerbation.