FRI0313 Spinal Symptomatic Calcium Pyrophosphate Deposition in a Series of 152 Calcium Pyrophosphate Deposition Disease (CPPD) Patients Consecutively Admitted in a Single Rheumatology Center
Authors: A. Moshrif, J.-D. Laredo, H. Bassiouni, T. Bardin
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Few systematic studies of spinal CPPD have been published <h3>Objectives</h3> To further characterise spinal involvement of CPPD by a systematic study of CPPD patients hospitalized in a rheumatology department. <h3>Methods</h3> We retrospectively reviewed all the files of patients consecutively admitted for CPPD in the rheumatology department of the Lariboisière hospital in Paris, France from May 2006 to May 2011, using a standardized protocol. Imaging studies (that had been indicated for symptomatic involvement) were reviewed. <h3>Results</h3> During the 5 year-period, a diagnosis of CPPD was made because of peripheral chondrocalcinosis (n=87) and/or synovial fluid demonstration of CPP crystals (n=65) in 101 women and 51 men (mean age 78 yrs). Spinal CPPD was diagnosed in 37 (24.3%) patients who did not differ from the whole series by age, sex, CPPD etiology, peripheral joint involvement distribution and pattern. The cervical spine was affected in 21 patients. Peri-odontoid calcifications were identified at CT-scan in 19/21 patients (8/21 by conventional radiography (CR), who suffered from acute (n=12) or chronic (n=4) neck pain radiating to the occiput in 6. Dens erosion was observed at CT-scan in 13 patients, and associated with a dens cyst in 5 and C1-C2 dislocation in 6. CT-scan and MRI disclosed destructive C1-C2 arthropathy, massive calcification and panus-like hypertrophy behind the dens in 3 patients with neurological impigement. A grade 2 dens fracture was evidenced in another one. Multiple C2-T1 intervertebral disc calcifications (IVDC) in the peripheral nucleus and/or vertebral cartilagenous endplates were observed at CT-scan and CR in 13/18 and 8/21 patients respectively. OA features were common. 7 patients had vacuum phenomenon of at least one disc. Spondylolisthesis of the uper (C2-C4 segment) and lower cervical spine was seen in 3 and 7 patients respectively, associated with mechanical cervical or cervicobrachial pain. Thoracic IVDCs were found at CT-scan in 4 symptomatic patients. Among 19 patients with lumbar involvement, IVDCs were seen at CT-scan in 17 patients (multiple in 15), with annular, nuclear and global pattern in 9, 1 and 7 patients respectively. A vacuum phenomenon was seen in 7. CT-scan showed calcifications in the ligamenta flava, interspinal ligament and interapophyseal hyaline cartilage in 6, 3 and 1 patients respectively. A degenerative spondyloslisthesis was seen at standing CR in 8 patients, with dislocation of the upper lumbar spine in 2. Symptomatic lumbar canal stenosis was documented in 12 patients. Disc inflammation was observed at MRI. One patient had 3 Mobic type1 lesions with no erosion; 6 had clinical and imaging features compatible with disc infection (2 cervical, 2 thoracic, 4 lumbar). Percutaneous disc biopy was sterile in 5 patients and disclosed tuberculosis infection in one. Sacro-iliac calcifications were seen in 5 patients, associated with a destructive sterile sacroiliitis and fusion in one patient each. <h3>Conclusions</h3> Symptomatic involvement of the spine was observed in 24% of this series of hospitalized CPPD patients. CT-scan was more sensitive than CR for the diagnosis of calcification. 6 patients underwent percutaneous disc biopsy leading to the diagnosis of tiuberculosis in one <h3>Disclosure of Interest</h3> None declared