POS1141 ASSESSING RELEVANT JOINTS FOR MONITORING CPPD DISEASE: A SYSTEMATIC LITERATURE REVIEW OF IMAGING TECHNIQUES BY THE OMERACT ULTRASOUND – CPPD SUBGROUP
Authors: A. Adinolfi, S. Sirotti, G. Sakellariou, E. Cipolletta, E. Filippucci, F. Porta, P. Sarzi-Puttini, C. A. Scirè, H. Keen, P. Mandl, G. Mouterde, C. Pineda, L. Terslev, M. A. D’agostino, A. Iagnocco, G. Filippou
Journal: Annals of the Rheumatic Diseases (2021)

Background: Imaging has been extensively used for the Calcium Pyrophosphate Deposition Disease (CPPD) diagnosis but the prevalence of joint calcifications at imaging in CPPD patients has not been thoroughly assessed. Objectives: This systematic literature review (SLR) is aimed to estimate the prevalence of calcium crystal deposition in peripheral joints by imaging in suspected or definite CPPD patients to establish relevant joints for CPPD monitoring Methods: After defining PICOs, Pubmed and Embase were searched from inception to October 2020 for identifying studies that evaluated the use of Conventional Radiography (CR), Ultrasound (US), Computed Tomography (CT) and Dual Energy Computed Tomography (DECT) in detecting calcifications at peripheral joints in patients with defined or probable CPPD. Search strategies based on MeSH terms and free text were applied. Six reviewers independently screened titles and abstracts, eligible article full texts were evaluated for inclusion and data extraction. Results: The SLR identified 1149 manuscripts. 524 papers entered in the full text evaluation and 181 articles were finally included. Considering excluded abstracts and full texts, 23 and 17 were excluded as duplicate, 156 and 9 for language, 171 and 48 for population, 171 and 20 for intervention, 57 and 117 for outcome, 47 and 70 for study type and 76 for full text unavailability. Among included, 41 papers considered patients with definite CPPD with a total population of 1239 patients, 908 cases and 331 controls and 140 papers referred to patients with suspected CPPD with a total population of 26785 patients, 2896 affected by CPPD and 23889 controls. The results about all joints are summarized in the Table 1. In patients with definite diagnosis, knee and wrist are the joints with the highest prevalence of calcifications at all imaging types, followed by hip and acromion-clavicular joint while in patients with suspected CPPD, the knee is the most prevalent followed by the wrist, hip and ankle (only sites with more than 50 patients assessed considered). The hand joints are characterized by CPPD lowest prevalence at imaging. Bilateral imaging findings varies depending on the technique used, the site and the patient’s type. Table 1. Definite CPPD Diagnosis KNEE WRIST HAND ELBOW SHOULDER AC HIP ANKLE FOOT TM XR Imaging positive cases/all cases 330/584 57% 214/409 52% 43/158 27% 54/212 25% 65/249 26% 37/84 44% 140/293 48% 30/255 12% 15/59 25% 0 Cases positive bilaterally 99/146 68% 30/79 38% 0/10 4/12 33% 2/2 100% 9/17 53% 7/10 70% 7/10 70% 0 0 US Imaging positive cases/all cases 155/252 62% 86/118 75% 4/42 9% 2/2 100% 0/30 4/30 13% 47/80 59% 30/255 12% 15/59 25% 0 Cases positive bilaterally 83/96 86% 33/47 70% 1/ 4 25% 0 0 3/ 4 75% 29/47 62% 7/10 70% 0 0 CT Imaging positive cases/all cases 41/50 82% 22/28 78% 0 0 0 0 0 0 0 0 Cases positive bilaterally 27/30 90% 0 0 0 0 0 0 0 0 0 DECT Imaging positive cases/all cases 8/10 80% 9/10 90% 1/1 100% 0 0 0 0 0 0 0 Cases positive bilaterally 0 0 1/1 100% 0 0 0 0 0 0 0 Suspected CPPD diagnosis KNEE WRIST HAND ELBOW SHOULDER AC HIP ANKLE FOOT TM XR Imaging positive cases/all cases 1989/2442 81% 549/1024 54% 98/602 16% 29/72 40% 75/185 41% 27/31 87% 322/887 36% 56/116 48% 24/42 57% 0 Cases positive bilaterally 611/1068 57% 209/334 63% 64/85 75% 22/23 96% 41/46 89% 0/2 94/196 48% 44/53 83% 18/19 95% 0 US Imaging positive cases/all cases 241/261 93% 125/185 68% 2/39 5% 1/1 100% 4/12 33% 0 2/2 100% 27/78 35% 8/37 22% 0 Cases positive bilaterally 4/9 44% 74/93 80% 0 0 0 0 0 0 0 0 CT Imaging positive cases/all cases 0 19/23 83% 0 0 2/2 100% 0 2/2 100% 0 0 1/1 100% Cases positive bilaterally 0 0 0 0 0 0 0 0 0 1/1 100% DECT Imaging positive cases/all cases 1/1 100% 2/2 100% 0 0 0 0 0 0 0 0 Cases positive bilaterally 1/1 100% 0 0 0 0 0 0 0 0 0 Table 1 For each joint, are summarized the ratio between positive joints and overall evaluated joints and the ratio between the joints positive bilaterally and overall joints evaluated bilaterally. AC Acromion Clavicular, TM temporo mandibular Conclusion: According to the results of this SLR, knees and wrists could be the sentinel joints for CPPD detection by imaging. Disclosure of Interests: None declared.