European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis
European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis
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DOI：
10.1136/ard.2010.139105
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发表时间：
2011-04-01
影响因子：
27.4
通讯作者：
Pascual, E.
中科院分区：
文献类型：
--
作者：
Zhang, W.;Doherty, M.;Pascual, E.
目的同意术语，并制定建议的诊断焦磷酸钙沉积（CPPD）。方法欧洲反风湿联盟（EULAR）CPPD工作组，包括15名专家来自10个国家，同意的条款和建议的诊断CPPD使用德尔菲共识的方法。对证据进行了系统性审查，并在敏感性、特异性和阳性似然比（LR）方面提供证据，以支持诊断; OR用于关联。结果“CPPD”应作为包括急性焦磷酸钙（CPP）结晶性关节炎、骨关节炎（OA）伴CPPD和慢性CPP结晶性炎性关节炎的总称。软骨钙质沉着症（CC）定义为软骨钙化，最常见的是由于CPPD，并通过成像或组织学检查检测。共产生了11项关于临床特征、滑液（SF）检查、影像学、合并症和风险因素的关键建议。CPPD的诊断依赖于SF CPP晶体的鉴定。急性CPP结晶性关节炎的快速发作的炎症症状和体征是提示性的，但不是决定性的。放射学CC不是高度敏感或特异性的，而超声检查似乎更有用（LR=24.2，95%CI 3.51至168.01）外周关节。公认的CPPD风险因素包括衰老、OA和代谢性疾病，如原发性甲状旁腺功能亢进、血色病和低镁血症;家族性CPPD很少见。SORs从53到99不等（最多100）。结论CPPD的新术语已达成一致，并利用研究证据和专家共识制定了11项诊断CPPD的关键建议。
Objectives To agree terminology and to develop recommendations for the diagnosis of calcium pyrophosphate deposition (CPPD).Methods The European League Against Rheumatism (EULAR) CPPD Task Force, comprising 15 experts from 10 countries, agreed the terms and recommendations for diagnosis of CPPD using a Delphi consensus approach. Evidence was systematically reviewed and presented in terms of sensitivity, specificity and positive likelihood ratio (LR) to support diagnosis; ORs were used for association. Strength of recommendation (SOR) was assessed by the EULAR visual analogue scale.Results It was agreed that 'CPPD' should be the umbrella term that includes acute calcium pyrophosphate (CPP) crystal arthritis, osteoarthritis (OA) with CPPD and chronic CPP crystal inflammatory arthritis. Chondrocalcinosis (CC) defines cartilage calcification, most commonly due to CPPD and detected by imaging or histological examination. A total of 11 key recommendations were generated on the topics of clinical features, synovial fluid (SF) examination, imaging, comorbidities and risk factors. Definitive diagnosis of CPPD relies on identification of SF CPP crystals. Rapid onset inflammatory symptoms and signs are suggestive but not definitive for acute CPP crystal arthritis. Radiographic CC is not highly sensitive or specific, whereas ultrasonography appears more useful (LR=24.2, 95% CI 3.51 to 168.01) for peripheral joints. Recognised risk factors for CPPD include ageing, OA and metabolic conditions such as primary hyperparathyroidism, haemochromatosis and hypomagnesaemia; familial forms are rare. SORs varied from 53 to 99 (maximum 100).Conclusion New terms for CPPD were agreed and 11 key recommendations for diagnosis of CPPD were developed using research evidence and expert consensus.