POS0167 CRYSTAL ARTHROPATIES IN WOMEN: A COMPLEX PRESENTATION AND A DIFFICULT DIAGNOSTIC JOURNEY
Authors: L. Scagnellato, S. Farah, G. Cozzi, M. Lorenzin, E. Cipolletta, B. Raffeiner, C. Montecucco, S. Grignaschi, F. Oliviero, F. Salaffi, R. Ramonda
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Crystal arthropaties, including gout and calcium pyrophosphate deposition disease (CPPD), are prevalent and burdensome conditions, significantly impacting the quality of life. The prevalence of these conditions in males and females are different, implying a differential approach to the diagnosis of acute oligoarthritis. <h3>Objectives:</h3> Our primary aim was to characterise the clinical presentation of crystal arthropaties in female patients and define the diagnostic approach to these conditions in a multicentre Italian population. <h3>Methods:</h3> Adult patients presenting with acute mono-oligoarthritis attributed to gout, calcium pyrophosphate deposition (CPPD), or unspecified crystal arthropathy were systematically enrolled in five Italian rheumatologic centres. Clinical, demographic, and imaging data, encompassing conventional radiography and ultrasound findings were gathered through a cross-sectional online survey conducted between January 1, 2023, and November 15, 2023. Individuals with a pre-existing diagnosis of any other inflammatory arthropathy were excluded from the analysis. Consequently, a comparative analysis between female and male patients was conducted. Statistical evaluations were executed using GraphPad, employing the Mann-Whitney test to compare variables while maintaining a significance level of 0.05. A multiple logistic regression was applied to ascertain predictors for each diagnostic test. <h3>Results:</h3> A total of 399 patients presenting with mono-oligoarthritis and diagnosed with crystal arthropathy were enrolled. Among them, 136 (34%) were females, and 263 were males. Female patients were found to be significantly older (mean age 67.1 vs. 63.8 years, p=0.008), had a lower BMI (mean BMI 24.3 vs. 27.4, p&lt;0.001), and exhibited a higher prevalence of comorbidities (60.3% vs. 17.2%, p&lt;0.001). Differences in dietary habits, smoking habits, and alcohol consumption were observed between the two groups. At presentation, women more frequently exhibited involvement of the knee (36.7%) and hand (21.3%), while men more often presented with involvement of the foot (55.6%) and knee (22.6%). Female patients reported significantly worse levels of pain and global health status. Women were also more likely to undergo synovial fluid examination (36.8% vs. 18.4%, p=0.001) and conventional radiography (43.4% vs. 28.7% p=0.004) to obtain a definite diagnosis. However, in 37.5% of cases, female patients did not receive a definitive diagnosis, whereas the proportion was significantly lower in males. The predominant diagnosis in female patients was CPPD (45.5%), while in males, the diagnosis was acute or chronic gout (20.3% and 50.2%, respectively). Predictors of synovial fluid examination, ultrasound, and conventional radiography examinations were comorbidities and pain, regardless of sex. <h3>Conclusion:</h3> In this multicentre cohort, female patients with crystal arthropathy are frequently complex elderly individuals with comorbidities and a low quality of life. Despite undergoing various examinations including synovial fluid analysis, ultrasound scans and radiography, nearly 40% of cases do not receive a definite diagnosis. <h3>REFERENCES:</h3> [1] Lorenzin M, et al; SIR Study Group ATTACk. Predictors of disease activity in gout: a 12-month analysis of the ATTACk (Achieving improvement in the management of crystal-induced arthritis) multicentre cohort study. Clin Exp Rheumatol. 2023 Mar;41(3):628-633. [2] Ramonda R, et al. Reumatismo. 2014 Jun 6;66(1):48-56. [3] Lorenzin M, et al; SIR Study Group ATTACk. Impact of disease duration and gender on the sensitivity and specificity of 2015 ACR/EULAR classification criteria for gout. Cross-sectional results from an Italian multicentric study on the management of crystal-induced arthritis (ATTACk). Clin Exp Rheumatol. 2022 Jul;40(7):1368-1377. <h3>Acknowledgements:</h3> Prof. Annamaria Iagnocco, Prof. Marcello Govoni, Dr. Enrico Selvi. <h3>Disclosure of Interests:</h3> <b>None declared.</b>