Features associated with different inflammatory phenotypes of calcium pyrophosphate deposition (CPPD) disease: study using data from the international ACR/EULAR CPPD classification criteria cohort

Objective: To examine the disease, demographic, and imaging features associated with different inflammatory phenotypes of calcium pyrophosphate deposition (CPPD) disease i.e., recurrent acute CPP crystal arthritis, chronic CPP crystal inflammatory arthritis, and crowned dens syndrome (CDS). Methods: Data from an international cohort assembled from 25 sites in 7 countries for the development and validation of the 2023 ACR/EULAR CPPD classification criteria, that met the criteria were included. Three cross-sectional studies were conducted to determine the phenotypic characteristics of recurrent acute CPP crystal arthritis, chronic CPP crystal inflammatory arthritis, and CDS. Multivariable logistic regression analysis was used to calculate the adjusted odds ratios (aOR) and 95% confidence intervals (CIs) to examine the association between potential risk factors and the inflammatory phenotype. Results: Among the 618 people included ((56% female), mean age (standard deviation (S.D.)) 74.0 (11.9) years), 602 (97.4%) had experienced acute CPP crystal arthritis, 332 (53.7%) had recurrent acute arthritis, 158 (25.6%) had persistent inflammatory arthritis, and 45 (7.3%), had had CDS. Recurrent acute CPP crystal arthritis associated with longer disease duration (aOR 2.88 (95%CI 2.00;4.14)). Chronic CPP crystal inflammatory arthritis was associated with ). acute wrist arthritis (aOR(95%CI) 2.92(1.81-4.73)), metacarpophalangeal (aOR(95% CI) 1.87(1.17-2.97)) and scapho-trapezio-trapezoid (STT) joint osteoarthritis (aOR(95% CI) 1.83(1.15-2.91)), and negatively associated with either metabolic or familial risk for CPPD (aOR(95% CI) 0.60(0.37-0.96). CDS was associated with male sex (aOR(95% CI) 2.35(1.21-4.59)), STT joint osteoarthritis (aOR(95% CI) 2.71(1.22-6.05)), and more joints affected with chondrocalcinosis (aOR(95% CI) 1.46(1.15-1.85)). Conclusions: CPPD disease encompasses acute and chronic inflammatory phenotypes, each with specific clinical and imaging features which need to be considered in the diagnostic workup.