Kristallarthropathien und andere Gelenkerkrankungen durch Ablagerungen

ZUSAMMENFASSUNG

Durch Kristalle und andere Ablagerungen ausgelöste Arthropathien können sich als Zufallsbefund ohne Symptome, aber auch als akute immobilisierende Arthritis eines oder mehrerer Gelenke manifestieren. Sie treten auch koinzident mit anderen Arthropathien und Arthritiden auf. Typisch sind symptomfreie Intervalle. Aber auch chronisch progrediente Erkrankungsverläufe sind bekannt. Die häufigsten Erkrankungen sind durch CPP- und Urat-Kristalle ausgelöst, andere seltenere Ursachen sind die Hämochromatose, Oxalatarthropathie, Ochronose, Lipid- oder Amyloidoseablagerung. Die durch Ablagerungen ausgelösten Arthropathien können damit auch immer ein Indikator für eine Allgemeinerkrankung sein, welche dann einer ganzheitlichen internistischen Betrachtung bedarf. Die Erkrankungswahrscheinlichkeiten nehmen mit dem Alter zu. Neben der typischen Anamnese und Klinik sind die Bildgebung, hier vor allem Ultraschall und die Dual Energy Computertomografie (DECT), die Labordiagnostik inklusive der Synoviaanalyse essenzielle Bausteine der Diagnostik. Die Therapie ist im akuten Schub symptomatisch, sofern möglich sollte eine gezielte Prophylaxe weiterer Ablagerungen erfolgen.

SUMMARY

Arthropathies triggered by crystals and deposits can manifest themselves as a random finding without symptoms, but also as acute immobilizing arthritis of one or more joints. They also occur co-incidentally with other arthropathies and arthritides. Symptom-free intervals are typical, but chronic progressive disease is also known. The most common causes are CPP and urate crystals, other less frequent causes are hemochromatosis, oxalate arthropathy, ochronosis, lipid or amyloid deposition. The arthropathies triggered by deposits are thus always an indicator of a general disease that requires a holistic internal medicine approach. Prevalence of crystal arthropathies increases with age. In addition to the typical medical history and clinic, imaging, especially ultrasound and dual energy computed tomography, laboratory diagnostics including synovia analysis are essential compounds of the diagnostic work up. The therapy is symptomatic in the acute attacks, if possible a targeted prophylaxis of further deposits should be initiated.

Schlüsselwörter

Kristallarthritis - Chondrokalzinose - CPPD - Gicht - Arthropathie

Keywords

Crystal arthropathy - chondrocalcinosis - CPPD - gout - arthropathy

Publikationsverlauf

Artikel online veröffentlicht:
10. Dezember 2020

• Literatur

• 1 Dalbeth N, Stamp L, Dalbeth N. et al Hyperuricaemia and gout: time for a new staging system?. Ann Rheum Dis 2014; 73 (09) 1598-1600
• 2 Annemans L, Spaepen E, Gaskin M. et al Gout in the UK and Germany: prevalence, comorbidities and management in general practice 2000–2005. Ann Rheum Dis 2008; 67 (07) 960-966
• 3 Schueller-Weidekamm C, Schueller G, Aringer M. et al Impact of sonography in gouty arthritis: comparison with conventional radiography, clinical examination, and laboratory findings. Eur J Radiol 2007; 62 (03) 437-443
• 4 Glazebrook KN, Guimaraes LS, Murthy NS. et al Identification of intraarticular and periarticular uric acid crystals with dual-energy CT: initial evaluation. Radiology 2011; 261: 516-524
• 5 Manger B, Lell M, Wacker J. et al Detection of periarticular urate deposits with dual energy CT in patients with acute gouty arthritis. Ann Rheum Dis 2012; 71 (03) 470-472
• 6 Klauser AS, Halpern EJ, Strobl S. et al Gout of hand and wrist: the value of US as compared with DECT. Eur Radiol 2018; 28 (10) 4174-4181
• 7 The University of Auckland, New Zealand. Im Internet http://goutclassificationcalculator.auckland.ac.nz
• 8 Neogi T, Jansen TL, Dalbeth N. et al 2015 Gout Classification Criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheumatol 2015; 67 (10) 2557-2568
• 9 Alten R, Mischkewitz M. Therapie der Gicht und des akuten Gichtanfalls. arthritis + rheuma 2020: 227-234
• 10 Hollander JL, Jessar RA, McCarty DJ. Synovianalysis: an aid in arthritis diagnosis. Bull Rheum Dis 1961; 12: 263-264
• 11 Salaffi F, De Angelis R, Grassi W. Prevalence of musculoskeletal conditions in an Italian population sample: results of a regional community-based study. I. The MAPPING study. Clin Exp Rheumatol 2005; 23: 819-828
• 12 Zhang W, Doherty M, Bardin T. et al European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis Ann Rheum Dis 2011; 70: 563-570
• 13 McCarty DJ. Calcium pyrophosphate dihydrate crystal deposition disease – 1975. Arthritis Rheum 1976; 19 (Suppl 85)
• 14 de Almeida SF, Carvalho IF, Cardoso CS. et al HFE cross-talks with the MHC class I antigen presentation pathway. Blood 2005; 106: 971-977
• 15 Koopman W, Ryan LM, McCarty DJ. Calcium pyrophosphate crystal deposition disease, pseudogout, and articular chondrocalcinosis. In: Koopman W. ed. Arthritis and Allied Conditions: A textbook of Rheumatology. Baltimore, MD: Williams and Wilkins; 1997: 2103-2126
• 16 Doherty M. Calciumpyrophosphate dihydrate crystal-associated arthropathy. In: Hochberg M, ed. Rheumatology. Edinburgh: Mosby; 2003: 1937-1950
• 17 Fauci AS. ed Harrisons Rheumatology. New York: McGraw-Hill Education; 2017: 248
• 18 Thibaut J, Michelin P, Badr S. et al Conventional radiology in crystal arthritis: gout, calcium pyrophosphate deposition, and basic calcium phosphate crystals. Radio Clin North Am 2017; 55 (05) 967-984
• 19 Reichenbach S, Blank S, Rutjes AW. et al Hylan versus hyaluronic acid for osteoarthritis of the knee: a systematic review and meta-analysis. Arthritis Rheum 2007; 57: 1410-1418
• 20 Doherty M, Dieppe PA. Effect of intra-articular yttrium-90 on chronic pyrophosphate arthropathy of the knee. Lancet 1981; 2: 1243-1246
• 21 Torres R, Macdonald L, Croll SD. et al Hyperalgesia, synovitis and multiple biomarkers of inflammation are suppressed by interleukin 1 inhibition in a novel animal model of gouty arthritis. Ann Rheum Dis 2009; 68: 1602-1608
• 22 Terkeltaub R, Sundy JS, Schumacher HR. et al The interleukin 1 inhibitor rilonacept in treatment of chronic gouty arthritis: results of a placebo-controlled, monosequence crossover, non-randomised, single-blind pilot study. Ann Rheum Dis 2009; 68: 1613-1617
• 23 Cheng PT, Pritzker KP. The effect of calcium and magnesium ions on calcium pyrophosphate crystal formation in aqueous solutions. J Rheumatol 1981; 8: 772-778
• 24 Garancis JC, Cheung HS, Halverson PB. et al “Milwaukee shoulder” – association of microspheroids containing hydroxyapatite crystals, active collagenase, ad neutral protease with rotator cuff defects. III. Morphologic and biochemical studies of an excised synovium showing chondromatosis. Arthritis Rheum 1981; 24 (03) 484-491
• 25 McCarthy GM, Dunne A. Calcium crystal deposition diseases – beyond gout. Nat Rev Rheumatol 2018; 14 (10) 592-602
• 26 Maldonado I, Prasad V, Reginato AJ. Oxalate crystal deposition desease. Curr Rheumatol Rep 2002; 4 (03) 257-264
• 27 Horta-Baas G, Vargas-Gutiérrez C, Barille-Fabris L. Large joint destructive arthropathy and tumoral calcinosis associated to primary oxlosis: case report and literature review. Rheumatol Clin 2013; 9 (03) 181-185
• 28 Hoppe B. An update on primary hyperoxluria. Nat Rev Nephrol 2012; 8 (08) 467-475
• 29 Hylander E, Jarnum S, Jensen HJ, Thale M. Enteric hyperoxaluria: dependence on small intestinal resection, colectomy, and steatorrhoea in chronic inflammatory bowel desease. Scand J Gastroenterol 1978; 13 (05) 577-588
• 30 Lange U Reuss-Borst M, Dischereit G. Kasuistik einer Oxalose-Arthropathie und aktueller Überblick. Akt Rheumatol 2018; 43: 224-227
• 31 Hoppe B, Beck BB, Milliner DS. The primary hyperoxalurias. Kidney international 2009; 75 (12) 1264-1271
• 32 Terkelaub R. Gout and Other Crystal Arthropathies. Philadelphia: Elsevier Saunders; 2012: 282-292
• 33 Cochat P, Hulton SA, Acquaviva C. et al Primary hyperoxaluria Type 1: indications for screening and guidance for diagnosis an treatment. Nephrol Dial Transplant 2012; 27 (05) 1729-1736
• 34 Somach SC, Davis BR, Paras FA. et al Fatal Cutaneous Necrosis Mimicking Calciphylaxis in a Patient With Type 1 Primary Hyperoxaluria. Arch Dermatol. 1995; 131 (07) 821-823
• 35 Blackmon JA, Jeffy BG, Malone JC. et al Oxalosis Involving the Skin: Case Report and Literature Review. Arch Dermatol 2011; 147 (11) 1302-1305
• 36 Lorenz EC, Michet CJ, Milliner DS. et al Update on Oxalate Crystal Desease. Curr Rheumatol Rep 2013; 15 (07) 340
• 37 Vilboux T, Kayser M, Introne W. et al Alkaptonuria: Mutation spectrum of homogentisic acid oxidase (HGD) in alkaptonuria. Hum Mutat 2009; 30: 1611-1619
• 38 Fitzpatrick DL, Anderson PD, Huizing M. et al Natural history of alkaptonuria. N Engl J Med 2002; 347: 2121
• 39 Mistry JB, Bukhari M, Taylor AM. Alkaptonuria. Rare Dis 2013; 1: e27475
• 40 Taylor AM, Hsueh M-F, Ranganath LR. et al Cartilage biomarkers in the osteoarthropathy of alkaptonuria reveal low turnover and accelerated ageing. Rheumatology 2017; 56 (01) 156-164
• 41 Reyes A, Hashemi L. Incidentally discovered Ochronosis explaining decades of chronic pain. Fed Pract 2020; 37: 48-52
• 42 Thapa M, Bhatia M, Maurya VK. Alkaptonuria. Med J Armed Forces India 2018; 74 (04) 394-396
• 43 Coggins C, Hayes C. Ochronosis. In: Pope TL, Bloem HL, Beltran J, eds. Imaging of the Muskuloskeletal System. Philadelphia, PA: Saunders; 2008: 1183-1188
• 44 Phornphutkul C, Introne WJ, Perry MB. et al Natural History of Alkaptonuria. N Engl J Med 2002; 347 (26) 2111-2121
• 45 Perry MB, Suwannarat P, Furst GP. et al Muskuloskeletal findings and disability in alkaptonuria. J Rhaumatol 2006; 33: 2280-2285
• 46 Braconi D, Millucci L, Bernardini G. et al Oxidative stress and mechanisms of ochronosis in alkaptonuria. Free radical biology & medicine 2015; 88: 70-80
• 47 Giannini G, Nast CC. An organ system-based approach to differential diagnosis of amyloid type in surgical pathology. Arch Pathol Lab Med. 2020: 144
• 48 Röcken C, Shakespeare A. Pathology, diagnosis und pathogenesis of AA Amyloidosis. Virchows Arch 2002; 440 (02) 111-122
• 49 Khoo HW, Ding CSL, Tandon AA. Polyarticular amyloid arthropathy in multiple myeloma. Am J Case Rep 2018; 19: 1398-1404
• 50 Prokaeva T, Spencer B, Kaut M. et al Soft tissue, joint an bone manifestations of AL amyloidosis: Clinical presentation, molecular features an survival. Arthritis Rheum 2007; 56: 3858-3868
• 51 Fautrel B, Fermand JP, Sibilia J. et al Amyloid Arthropathy in the course of multiple myeloma. J Rheumatol 2002; 29: 1473
• 52 Fujishima M, Komatsuda A, Imai H. et al Amyloid arthropathy resembling seronegative rheumatoid arthritis in a patient with IgD-multiple myeloma. Intern Med 2003; 42: 121-124
• 53 M’bappé P, Grateau G. Osteo-articular manifestations of amyloidosis. Best Pract Res Clin Rheumatol 2012; 26 (04) 459-475
• 54 Saito A, Gejyo F. Current clinical aspects of dialysis-related amyloidosis in chronic dialysis patients. Ther Apher Dial 2006; 10 (04) 316-320
• 55 Terzi S, Calabrò T, Brodano GB. et al Systemic Amyloidosis with Predominant Spine Involvement: A Case Report. Orthop Muscular Syst 2015; 5: 1
• 56 Dagistan E, Canan A, Kizildag B. et al Multiple tendon xanthomas in patient with heterozygous familial hypercholesterolaemia: sonographic and MRI findings. BMJ Case Rep 2013
• 57 Kedar E, Gardner GC. Lipid-associated rheumatologic syndromes. Rheum Dis Clin North Am 2013; 39 (02) 481-493