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Arthritis und Rheuma 2020; 40(06): 408-419
DOI: 10.1055/a-1213-0965
Schwerpunkt

Kristallarthropathien und andere Gelenkerkrankungen durch Ablagerungen

Crystal arthropathy and other deposition induced arthropathies
Inna Frohne∗
1   Poliklinik und Funktionsbereich für Rheumatologie, Heinrich-Heine-Universität Düsseldorf
,
Claudia Dechant∗
2   Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik IV, LMU Klinikum, München
,
Oliver Sander∗
1   Poliklinik und Funktionsbereich für Rheumatologie, Heinrich-Heine-Universität Düsseldorf
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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


Publication History

Article published online:
10 December 2020

© 2020. Thieme. All rights reserved.

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  • 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 DOI: doi:10.1136/annrheumdis-2014-205304. Epub 2014 Apr 9. Ann Rheum Dis. 2014. PMID: 24718961.
    CrossrefGoogle Scholar
  • 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 DOI: doi:10.1136/ard.2007.076232.
    CrossrefPubMedGoogle Scholar
  • 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 DOI: doi:10.1016/j.ejrad.2006.12.005.
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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 DOI: doi:10.1136/ard.2011.154054.
    CrossrefPubMedGoogle Scholar
  • 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 DOI: doi:10.1007/s00330-018-5363-9.
    CrossrefPubMedGoogle Scholar
  • 7 The University of Auckland, New Zealand. Im Internet http://goutclassificationcalculator.auckland.ac.nz DOI: Stand: 09.11.2020
  • 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 DOI: doi:10.1002/art.39254.
    CrossrefPubMedGoogle Scholar
  • 9 Alten R, Mischkewitz M. Therapie der Gicht und des akuten Gichtanfalls. arthritis + rheuma 2020: 227-234
    Google Scholar
  • 10 Hollander JL, Jessar RA, McCarty DJ. Synovianalysis: an aid in arthritis diagnosis. Bull Rheum Dis 1961; 12: 263-264
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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 DOI: doi:10.1136/ard.2010.139105.
    Google Scholar
  • 13 McCarty DJ. Calcium pyrophosphate dihydrate crystal deposition disease – 1975. Arthritis Rheum 1976; 19 (Suppl 85)
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 16 Doherty M. Calciumpyrophosphate dihydrate crystal-associated arthropathy. In: Hochberg M, ed. Rheumatology. Edinburgh: Mosby; 2003: 1937-1950
    Google Scholar
  • 17 Fauci AS. ed Harrisons Rheumatology. New York: McGraw-Hill Education; 2017: 248
    Google Scholar
  • 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
    CrossrefGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 20 Doherty M, Dieppe PA. Effect of intra-articular yttrium-90 on chronic pyrophosphate arthropathy of the knee. Lancet 1981; 2: 1243-1246
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 25 McCarthy GM, Dunne A. Calcium crystal deposition diseases – beyond gout. Nat Rev Rheumatol 2018; 14 (10) 592-602
    CrossrefPubMedGoogle Scholar
  • 26 Maldonado I, Prasad V, Reginato AJ. Oxalate crystal deposition desease. Curr Rheumatol Rep 2002; 4 (03) 257-264
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 28 Hoppe B. An update on primary hyperoxluria. Nat Rev Nephrol 2012; 8 (08) 467-475
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 30 Lange U Reuss-Borst M, Dischereit G. Kasuistik einer Oxalose-Arthropathie und aktueller Überblick. Akt Rheumatol 2018; 43: 224-227
    Article in Thieme ConnectGoogle Scholar
  • 31 Hoppe B, Beck BB, Milliner DS. The primary hyperoxalurias. Kidney international 2009; 75 (12) 1264-1271
    CrossrefPubMedGoogle Scholar
  • 32 Terkelaub R. Gout and Other Crystal Arthropathies. Philadelphia: Elsevier Saunders; 2012: 282-292
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 36 Lorenz EC, Michet CJ, Milliner DS. et al Update on Oxalate Crystal Desease. Curr Rheumatol Rep 2013; 15 (07) 340
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 38 Fitzpatrick DL, Anderson PD, Huizing M. et al Natural history of alkaptonuria. N Engl J Med 2002; 347: 2121
    Google Scholar
  • 39 Mistry JB, Bukhari M, Taylor AM. Alkaptonuria. Rare Dis 2013; 1: e27475
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 41 Reyes A, Hashemi L. Incidentally discovered Ochronosis explaining decades of chronic pain. Fed Pract 2020; 37: 48-52
    PubMedGoogle Scholar
  • 42 Thapa M, Bhatia M, Maurya VK. Alkaptonuria. Med J Armed Forces India 2018; 74 (04) 394-396
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 44 Phornphutkul C, Introne WJ, Perry MB. et al Natural History of Alkaptonuria. N Engl J Med 2002; 347 (26) 2111-2121
    CrossrefPubMedGoogle Scholar
  • 45 Perry MB, Suwannarat P, Furst GP. et al Muskuloskeletal findings and disability in alkaptonuria. J Rhaumatol 2006; 33: 2280-2285
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 48 Röcken C, Shakespeare A. Pathology, diagnosis und pathogenesis of AA Amyloidosis. Virchows Arch 2002; 440 (02) 111-122
    CrossrefPubMedGoogle Scholar
  • 49 Khoo HW, Ding CSL, Tandon AA. Polyarticular amyloid arthropathy in multiple myeloma. Am J Case Rep 2018; 19: 1398-1404
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 51 Fautrel B, Fermand JP, Sibilia J. et al Amyloid Arthropathy in the course of multiple myeloma. J Rheumatol 2002; 29: 1473
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 53 M’bappé P, Grateau G. Osteo-articular manifestations of amyloidosis. Best Pract Res Clin Rheumatol 2012; 26 (04) 459-475
    CrossrefPubMedGoogle Scholar
  • 54 Saito A, Gejyo F. Current clinical aspects of dialysis-related amyloidosis in chronic dialysis patients. Ther Apher Dial 2006; 10 (04) 316-320
    CrossrefPubMedGoogle Scholar
  • 55 Terzi S, Calabrò T, Brodano GB. et al Systemic Amyloidosis with Predominant Spine Involvement: A Case Report. Orthop Muscular Syst 2015; 5: 1
    Google Scholar
  • 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 DOI: 2013:bcr2013200755. Published 2013 Nov 19. doi:10.1136/bcr-2013-200755
    Google Scholar
  • 57 Kedar E, Gardner GC. Lipid-associated rheumatologic syndromes. Rheum Dis Clin North Am 2013; 39 (02) 481-493
    CrossrefPubMedGoogle Scholar