Objective: Calcium pyrophosphate deposition (CPPD) disease is prevalent and has diverse presentations, but there are no validated classification criteria for this symptomatic arthritis. The American College of Rheumatology (ACR) and EULAR have developed the first-ever validated classification criteria for symptomatic CPPD disease. Methods: Supported by the ACR and EULAR, a multinational group of investigators followed established methodology to develop these disease classification criteria. The group generated lists of candidate items and refined their definitions, collected de-identified patient profiles, evaluated strengths of associations between candidate items and CPPD disease, developed a classification criteria framework, and used multi-criterion decision analysis to define criteria weights and a classification threshold score. The criteria were validated in an independent cohort. Results: Among patients with joint pain, swelling, or tenderness (entry criterion) whose symptoms are not fully explained by an alternative disease (exclusion criterion), the presence of crowned dens syndrome or calcium pyrophosphate crystals in synovial fluid are sufficient to classify a patient as having CPPD disease. In the absence of these findings, a score>56 points using weighted criteria, comprising clinical features, associated metabolic disorders, and results of laboratory and imaging investigations, can be used to classify as CPPD disease. These criteria had a sensitivity of 92.2% and specificity of 87.9% in the derivation cohort (190 CPPD cases, 148 mimickers), whereas sensitivity was 99.2% and specificity was 92.5% in the validation cohort (251 CPPD cases, 162 mimickers). Conclusion: The 2023 ACR/EULAR CPPD disease classification criteria have excellent performance characteristics and will facilitate research in this field.

The 2023 ACR/EULAR classification criteria for calcium pyrophosphate deposition disease

Alessandra Bortoluzzi;Ettore Silvagni;
2023

Abstract

Objective: Calcium pyrophosphate deposition (CPPD) disease is prevalent and has diverse presentations, but there are no validated classification criteria for this symptomatic arthritis. The American College of Rheumatology (ACR) and EULAR have developed the first-ever validated classification criteria for symptomatic CPPD disease. Methods: Supported by the ACR and EULAR, a multinational group of investigators followed established methodology to develop these disease classification criteria. The group generated lists of candidate items and refined their definitions, collected de-identified patient profiles, evaluated strengths of associations between candidate items and CPPD disease, developed a classification criteria framework, and used multi-criterion decision analysis to define criteria weights and a classification threshold score. The criteria were validated in an independent cohort. Results: Among patients with joint pain, swelling, or tenderness (entry criterion) whose symptoms are not fully explained by an alternative disease (exclusion criterion), the presence of crowned dens syndrome or calcium pyrophosphate crystals in synovial fluid are sufficient to classify a patient as having CPPD disease. In the absence of these findings, a score>56 points using weighted criteria, comprising clinical features, associated metabolic disorders, and results of laboratory and imaging investigations, can be used to classify as CPPD disease. These criteria had a sensitivity of 92.2% and specificity of 87.9% in the derivation cohort (190 CPPD cases, 148 mimickers), whereas sensitivity was 99.2% and specificity was 92.5% in the validation cohort (251 CPPD cases, 162 mimickers). Conclusion: The 2023 ACR/EULAR CPPD disease classification criteria have excellent performance characteristics and will facilitate research in this field.
2023
Abhishek, Abhishek; K Tedeschi, Sara; Pascart, Tristan; Latourte, Augustin; Dalbeth, Nicola; Neogi, Tuhina; Fuller, Amy; Rosenthal, Ann; Becce, Fabio; Bardin, Thomas; Ea, Hang-Korng; Filippou, Georgios; Fitzgerald, John; Iagnocco, Annamaria; Lioté, Frédéric; M McCarthy, Geraldine; Ramonda, Roberta; Richette, Pascal; Sivera, Francisca; Andrés, Mariano; Cipolletta, Edoardo; Doherty, Michael; Pascual, Eliseo; Perez-Ruiz, Fernando; So, Alexander; L Jansen, Tim; J Kohler, Minna; K Stamp, Lisa; Yinh, Janeth; Adinolfi, Antonella; Arad, Uri; Aung, Thanda; Benillouche, Eva; Bortoluzzi, Alessandra; Dau, Jonathan; Maningding, Ernest; A Fang, Meika; A Figus, Fabiana; Filippucci, Emilio; Haslett, Janine; Janssen, Matthijs; Kaldas, Marian; Kimoto, Maryann; Leamy, Kelly; M Navarro, Geraldine; Sarzi-Puttini, Piercarlo; Scirè, Carlo; Silvagni, Ettore; Sirotti, Silvia; R Stack, John; Truong, Linh; Xie, Chen; Yokose, Chio; M Hendry, Alison; Terkeltaub, Robert; J Taylor, William; K Choi, Hyon
File in questo prodotto:
File Dimensione Formato  
CPPD_classification_criteria_manuscript-2023-May-17_clean_submittedtoUoNrepository.pdf

accesso aperto

Descrizione: Pre-print
Tipologia: Pre-print
Licenza: PUBBLICO - Pubblico con Copyright
Dimensione 1.03 MB
Formato Adobe PDF
1.03 MB Adobe PDF Visualizza/Apri
1248.full.pdf

solo gestori archivio

Descrizione: Full text editoriale
Tipologia: Full text (versione editoriale)
Licenza: NON PUBBLICO - Accesso privato/ristretto
Dimensione 2.12 MB
Formato Adobe PDF
2.12 MB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11392/2520371
Citazioni
  • ???jsp.display-item.citation.pmc??? 2
  • Scopus 8
  • ???jsp.display-item.citation.isi??? 5
social impact