Destruierende multilokuläre Arthropathie bei Chondrokalzinose

Zusammenfassung

Die Chondrokalzinose ist charakterisiert durch intra- und extraartikuläre Ablagerungen von Kalzium-Pyrophosphat. In seltenen Fällen wird bei diesem Krankheitsbild eine progressiv verlaufende destruierende Arthropathie beobachtet. Wir berichten über einen Fall von destruierender polyartikulärer Arthropathie bei Chondrokalzinose und gleichzeitigem Nachweis von Urat und Hydroxylapatit. Das klinische Bild sowie differenzialdiagnostische und therapeutische Aspekte der Chondrokalzinose werden anhand der vorliegenden Kasuistik dargestellt und diskutiert.

Abstract

Calcium pyrophosphate dihydrate (CPPD) deposition disease is characterised by the presence of intra- or extraarticular CPPD crystal deposits. Amongst this entity, destructive arthropathy is a rare but severe complication. We report on a case of multiarticular destructive arthropathy in a 64-year old patient associated with chondrocalcinosis and the presence of monosodium urate and basic calcium phosphate (BCP). In addition, we outline the diagnostic and therapeutic implications related to CPPD crystal deposition disease.

Literatur

• 1 Aeberli D, Stanga Z, Gerber N J. Fever of unknown origin as a sign of calcium pyrophosphate deposition disease.  Schweiz Med Wochenschr. 2000;  130 505-509
• 2 Cheung H S. Calcium crystal effects on the cell of the joint: implications for pathogenesis of disease.  Curr Opin Rheumatol. 2000;  12 223-227
• 3 Cohen P R, Schmidt W A, Rapini R P. Chronic tophaceous gout with severely deforming arthritis: a case report with emphasis on histopathologic considerations.  Cutis. 1991;  48 445-451
• 4 Concoff A L, Kalunian K C. What is the relation between crystals and osteoarthritis?.  Curr Opin Rheumatol. 1999;  11 436-440
• 5 Dieppe P, Alexander G J, Jones H E, Dothery M, Scott D G, Manhire A, Watt I. Pyrophosphate arthropathy: a clinical and radiological study of 105 cases.  Ann Rheum Dis. 1982;  41 371-376
• 6 Dieppe P, Pascual E, Swan A. The identification of crystals in synovial fluids; the EULAR quality control initiative.  Rheumatol Eur. 1997;  26 74-75
• 7 Dihlmann W. Persönliche Mitteilung. 2001
• 8 Freyschmidt J. Skeletterkrankungen. Berlin; Springer-Verlag 1993
• 9 Garcia-Porrura C, Gonzalez-Gay M A, Vasquez-Caruncho M. Tophaceous gout mimicking tumoral growth.  J Rheumatol. 1999;  26 508-509
• 10 Greenspan A. Skelettradiologie. Weinheim; Chapmann & Hall GmbH 1990
• 11 Halverson P B, McCarthy D J. Patterns of radiographic abnormalities associated with basic calcium phosphate and calcium pyrophosphate dihydrate crystal deposition disease in the knee.  Ann Rheum Dis. 1986;  47 603-605
• 12 Ho A M, Johnson M D, Kingsley D M. Role of the mouse ank gene in control of tissue calcification and arthritis.  Science. 2000;  289 265-270
• 13 Honig S, Gorevic P, Hoffstein S, Weissman G. Crystal deposition disease. Diagnosis by electron microscopy.  Am J Med. 1977;  63 161-164
• 14 Jaccard Y B, Gerster J C, Calame L. Mixed monosodium urate and calcium pyrophosphate crystal-induced arthropathy. A review of seventeen cases.  Rev Rhum Engl Ed. 1996;  63 331-335
• 15 Kini S, Mittal G, Balakrishna C, Mangat G, Hedge A V, Joshi V R. An unusual systemic presentation of gout.  J Assoc Physicians India. 2000;  48 354-355
• 16 McCarthy G M, Mitchell P G, Cheung H S. The mitogenic response to stimulation with basic calcium phosphate crystals is accompanied by induction and secretion of collagenase in human fibroblasts.  Arthritis Rheum. 1991;  34 1021-1030
• 17 McCarthy G M, Augustine J A, Baldwin A S, Christophersen P A, Cheung H S, Westfall P R, Scheinman R I. Molecular mechanism of basic calcium phosphate crystal-induced activation of human fibroblasts. Role of nuclear factor Kappa b, activator protein 1, and protein kinase C.  J Biol Chem. 1998;  273 35 161-35 169
• 18 Pascual E. Management of crystal arthritis.  Rheumatology. 1999;  38 912-916
• 19 Paul H, Reginato A J, Schumacher H R. Alizarin red staining as a screening test to detect calcium compounds in synovial fluid.  Arthritis Rheum. 1983;  26 191-200
• 20 Reginato A J, Falasca G F, Usmani Q. Do we really need to pay attention to the less common crystals?.  Curr Opin Rheumatol. 1999;  11 446-452
• 21 Resnick D, Niwayama G, Goergen T G, Utsinger P D, Shapiro R F, Haselwood D H, Wiesner K B. Clinical, radiographic and pathologic abnormalities in calcium pyrophosphate dihydrate deposition disease (CPPD).  Radiology. 1997;  122 1-15
• 22 Rosenthal A K, Ryan L M. Treatment of refractory crystal-associated arthritis.  Rheum Dis Clin North Am. 1995;  21 151-161
• 23 Rothschild B, Yabakov L E. Prospective 6-month double-blind trial of hydroxychloroquine treatment of CPDD.  Compr Ther. 1997;  23 327-332
• 24 Sissons H A, Steiner G C, Bonar F, May M, Rosenberg Z S, Samuels H, Present D. Tumoral calcium pyrophosphate deposition disease.  Skeletal Radiol. 1989;  18 79-87
• 25 Swan A, Chapman B, Heap P, Seward H, Dieppe P. Submicroscopic crystals in osteoarthritic synovial fluids.  Ann Rheum Dis. 1994;  53 467-470
• 26 Werlen D, Gabay C, Vischer T L. Corticoid therapy for the treatment of acute attacks of crystal-induced arthritis: an effective alternative to nonsteroidal antiinflammatory drugs.  Rev Rhum Engl Ed. 1996;  63 248-254