Age-related features of calcium pyrophosphate deposition disease

Calcium pyrophosphate deposition disease (CPPD) is more common at an old age. The age-related features of the disease have not been studied.

Objective: to study age-related features of CPPD.

Subjects and methods. A total of 113 patients (54 men and 59 women) who had received inpatient or outpatient treatment at the V.A. Nasonova Research Institute of Rheumatology were retrospectively analyzed. The inclusion criteria were age older than 18 years, crystal-verified diagnosis of CPPD, and a signed informed consent.

The patients were divided into two groups: 1) older than 55 years (n=38) and younger than 55 years (n=75). The investigators compared the frequency of clinical symptoms, including phenotypes in accordance with the EULAR recommendations, the intensity of pain with a visual analogue scale (VAS), the need for symptomatic therapy, detection rates for chondrocalcinosis (CC) in the knee and wrist joints by radiography, anthropometric and laboratory (the serum levels of C-reactive protein (CRP), creatinine, uric acid, parathyroid hormone, magnesium, phosphorus, and total calcium) features, the presence of CPPD-associated factors (a history of joint injuries, family CC cases, hypomagnesemia, hyperparathyroidism (HPT), hemochromatosis, hypomagnesemia, rheumatoid arthritis (RA), gout, chronic kidney disease (CKD) Stage >3, and use of diuretics).

Results and discussion. Thirty-eight (33.6%) of the 113 examined patients with CPPD were aged less than 55 years. The most common clinical form of CPPD was chronic arthritis (n=54; 47.8%), the less common forms were osteoarthritis (OA) with calcium pyrophosphate (CPP) crystals (n=35; 31%) and acute arthritis (n=24; 21.2 %); their rates did not differ in the formed groups.

In patients older than 55 years, the pain intensity according to VAS was higher than that at a younger age (50 [40; 70] mm and 40 [25; 54] mm, respectively; p<0.001); they had more frequently to take nonsteroidal anti-inflammatory drugs (NSAIDs) and/or colchicine (94.7 and 76.3%, respectively; p=0.0039) and had a higher serum CRP level (4.1 [1.9; 10.3] and 2.1 [1.9; 10.3] mg/L, respectively; p=0.0034); however, the number of patients with a CRP concentration of >5 mg/dL was comparable for both groups. Family CPPD cases were recorded in two patients less than 55 years of age. Knee joint radiography significantly more frequently revealed CC in 65 (57.5%) patients aged older than 55 years than that at a younger age (68 and 36.8%, respectively; p=0.001). Hand radiography detected CC in 21 (18.6%) patients, it was also more common in those aged older than 55 years (25.3 and 5.3%, respectively; p=0.001).

The CPPD-associated factors include OA, gout, HPT, RA, and CKD >3 Stage; these diseases detected in this study were seen in 91 (80.5%), 28 (24.8%), 14 (12.4%), 5 (4.4%), and 12 (11%) cases, respectively. There were no significant differences in the detection rates for these diseases in patients younger and older than 55 years of age. Also, one patient had hypomagnesemia and one patient had hemochromatosis; both were younger than 55 years old.

Conclusion. The prevalence of CPPD at a young age can be underestimated: 33.6% of the patients with CPPD confirmed by the detection of CPP crystals in synovial fluid were aged less than 55 years. Moreover, the frequency of individual phenotypes and main CPPD-associated factors is identical in different age groups. At the age of older than 55 years, CPPD is characterized by the more frequent detection of radiographic signs of CC, a greater need for NSAIDs and colchicine, and a high level of CRP.

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