Calcium Pyrophosphate Deposition Disease (CPPD)

Working group OMERACT > CPPD

MENTOR:

H KEEN  

Convenors: G Filippou, N Damjanov

Website responsible: G Filippou

Fellow: Silvia Sirotti

Target domain:

Imaging/structural damage (waiting for definitive core domain definition by the CPPD Working Group)

The objective of the subgroup work: 

The subtask force was founded in 2014 with the objective to validate US for use in Calcium Pyrophosphate deposition Disease (CPPD) for diagnosis, assessment of inflammation, assessment of structural damage and extent of CPP deposition in tissues.

Description of the possible contribution of the subgroup work for OMERACT :

The OMERACT CPPD working group is actually concentrating it’s efforts on the definition of the domains of the disease. The chairs of the two groups are in contact and collaborating in these first steps of the working group. The US subgroup will contribute to the future steps of the process, accordingly with the needs of the CPPD working group.  

Short description of the previous work (including publications)

The group created the novel OMERACT definitions for US identification of CPPD that demonstrated to be reliable at the level of wrists and knees. The definitions have been used also by external researchers that confirmed the OMERACT group data regarding the reliability. A criterion validity study has been also carried out and published, demonstrating that US is an accurate tool for discriminating CPPD. Finally, a novel scoring system for assessment of the extent of CPPD has been created and validated.

In detail:

Steps completed:

- Creation of definitions for US CPPD identification,

- Investigation of reliability

- Investigation of validity

- ancillary study on the diagnostic accuracy of synovial fluid analysis

- ancillary study on the diagnostic accuracy of conventional radiology for CPPD identification

- SLR on the prevalence of involvement of peripheral joints in CPPD

- Creation of a scoring system for the extent of deposition

 -Investigation of the reliability of the scoring system for the extension of CPPD

Work in progress

-        CLAIM study: Development of an algorithm for Automatic Identification of crystal deposition and crystal burden in joints by ultrasound, in patients affected by Calcium Pyrophosphate Deposition Disease and Gout: the CrystaL Artificial Intelligence Monitoring (CLAIM) study

-        Assessment of the extent of CPPD and correlation with the clinical phenotypes

Relative publications:

1.      Filippou G, Adinolfi A, Iagnocco A, et al. Ultrasound in the diagnosis of calcium pyrophosphate dihydrate deposition disease. A systematic literature review and a meta-analysis. Osteoarthritis Cartilage. 2016;24(6):973‐981. doi: 10.1016/j.joca.2016.01.136

2.      Filippou G, Scirè CA, Damjanov N, et al. Definition and Reliability Assessment of Elementary Ultrasonographic Findings in Calcium Pyrophosphate Deposition Disease: A Study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound Subtask Force. J Rheumatol. 2017;44(11):1744‐1749. doi:10.3899/jrheum.1610572.

3.      Filippou G, Scirè CA, Adinolfi A, et al. Identification of calcium pyrophosphate deposition disease (CPPD) by ultrasound: reliability of the OMERACT definitions in an extended set of joints-an international multiobserver study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound Subtask Force. Ann Rheum Dis. 2018;77(8):1194‐1199. doi:10.1136/annrheumdis-2017-212542

4.     Filippou G, Scanu A, Adinolfi A, Toscano C, Gambera D, Largo R, Naredo E, Calvo E, Herrero-Beaumont G, Zufferey P, Bonjour CM, MacCarter DK, Makman S, Weber Z, Figus F, Möller I, Gutierrez M, Pineda C, Clavijo Cornejo D, Garcia H, Ilizaliturri V, Mendoza Torres J, Pichardo R, Rodriguez Delgado LC, Filippucci E, Cipolletta E, Serban T, Cirstoiu C, Vreju FA, Grecu D, Mouterde G, Govoni M, Punzi L, Damjanov NS, Keen HI, Bruyn GA, Terslev L, D'Agostino MA, Scirè CA, Iagnocco A. Criterion validity of ultrasound in the identification of calcium pyrophosphate crystal deposits at the knee: an OMERACT ultrasound study. Ann Rheum Dis. 2020 Sep 28:annrheumdis-2020-217998. doi: 10.1136/annrheumdis-2020-217998. Epub ahead of print. PMID: 32988839.

5.      Sirotti S, Gutierrez M, Pineda C, Clavijo-Cornejo D, Serban T, Dumitru A, Scanu A, Adinolfi A, Scirè CA, Sarzi Puttini P, D'Agostino MA, Keen HI, Terslev L, Iagnocco A, Filippou G. Accuracy of synovial fluid analysis compared to histology for the identification of calcium pyrophosphate crystals: an ancillary study of the OMERACT US Working Group - CPPD subgroup. Reumatismo. 2021 Aug 3;73(2):106-110. doi: 10.4081/reumatismo.2021.1403. PMID: 34342211.

6.      Sirotti S, Becce F, Sconfienza LM, Terslev L, Naredo E, Zufferey P, Pineda C, Gutierrez M, Adinolfi A, Serban T, MacCarter D, Mouterde G, Zanetti A, Scanu A, Möller I, Novo-Rivas U, Largo R, Sarzi-Puttini P, Abhishek A, Choi HK, Dalbeth N, Pascart T, Tedeschi SK, D'Agostino MA, Iagnocco A, Keen HI, Scirè CA, Filippou G. Reliability and Diagnostic Accuracy of Radiography for the Diagnosis of Calcium Pyrophosphate Deposition: Performance of the Novel Definitions Developed by an International Multidisciplinary Working Group. Arthritis Rheumatol. 2023 Apr;75(4):630-638. doi: 10.1002/art.42368. Epub 2023 Jan 19. PMID: 36122187.

7.      Adinolfi A, Sirotti S, Sakellariou G, Cipolletta E, Filippucci E, Porta F, Zanetti A, Ughi N, Sarzi-Puttini P, Scirè CA, Keen H, Pineda C, Terslev L, D'Agostino MA, Filippou G. Which are the most frequently involved peripheral joints in calcium pyrophosphate crystal deposition at imaging? A systematic literature review and meta-analysis by the OMERACT ultrasound - CPPD subgroup. Front Med (Lausanne). 2023 Mar 9;10:1131362. doi: 10.3389/fmed.2023.1131362. PMID: 36968827; PMCID: PMC10034772.

8.      Development and Validation of an OMERACT Ultrasound Scoring System for the Extent of Calcium Pyrophosphate Crystal Deposition at Joint and Patient Level. In press, The Lancet Rheumatology

Contributions in EULAR congress:

·       Adinolfi A, Sirotti S, Sakellariou G on behalf of Omeract Ultrasound working group, subgroup CPPD, et al POS1141 ASSESSING RELEVANT JOINTS FOR MONITORING CPPD DISEASE: A SYSTEMATIC LITERATURE REVIEW OF IMAGING TECHNIQUES BY THE OMERACT ULTRASOUND – CPPD SUBGROUPAnnals of the Rheumatic Diseases 2021;80:850

·       Sirotti S, Becce F, Sconfienza LM on behalf of OMERACT US in CPPD working group, et al. POS0276 TRADITION VS INNOVATION! CONVENTIONAL RADIOGRAPHY AND ULTRASOUND IN THE DIAGNOSIS OF CPPD: INSTRUCTIONS FOR USE. Annals of the Rheumatic Diseases 2022;81:381-382.

·       Sirotti S, Adinolfi A, Damiani A on behalf of OMERACT US in CPPD working group, et al OP0168 DEVELOPMENT OF AN ULTRASOUND SCORING SYSTEM FOR CPPD EXTENT: RESULTS FROM A DELPHI PROCESS AND WEB-RELIABILITY EXERCISE BY THE OMERACT US WORKING GROUP Annals of the Rheumatic Diseases 2022;81:110-111.

Reporting back on work done since the previous F2F meeting (ACR, EULAR or OMERACT)

Since the last meeting at the ACR, the protocol for the CLAIM study has been developed, submitted and approved by Copenhagen EC. The licence agreement for participation in the study is under evaluation by the legal office of the Galeazzi Hospital (Milan) which will perform the analysis of the images.

 Next steps and discussion points

In the next steps, the licence agreement will be sent to all participating centres and the collection of images will start immediately after.