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Questions and Answers
What is the primary method for conducting synovial fluid analysis for crystal identification?
What is the primary method for conducting synovial fluid analysis for crystal identification?
In the classification criteria system, what was the chosen threshold score to maximize specificity and sensitivity?
In the classification criteria system, what was the chosen threshold score to maximize specificity and sensitivity?
Which method is required for imaging a symptomatic peripheral joint when criteria are not met?
Which method is required for imaging a symptomatic peripheral joint when criteria are not met?
What is the percent agreement range of Steering Committee members for classifying patients for a research study?
What is the percent agreement range of Steering Committee members for classifying patients for a research study?
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In the derivation and validation cohorts, what was the sensitivity and specificity of the threshold score of >56?
In the derivation and validation cohorts, what was the sensitivity and specificity of the threshold score of >56?
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What is a typical episode of persistent inflammatory arthritis characterized by?
What is a typical episode of persistent inflammatory arthritis characterized by?
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Which condition should be considered in the diagnosis of CPPD disease?
Which condition should be considered in the diagnosis of CPPD disease?
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What method is required for imaging a symptomatic peripheral joint for consideration in CPPD disease?
What method is required for imaging a symptomatic peripheral joint for consideration in CPPD disease?
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What is the threshold score chosen to maximize specificity and sensitivity in the classification criteria for CPPD disease?
What is the threshold score chosen to maximize specificity and sensitivity in the classification criteria for CPPD disease?
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What is the classification framework for CPPD disease based on?
What is the classification framework for CPPD disease based on?
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Study Notes
- Persistent inflammatory arthritis is defined by joint swelling, pain, and/or warmth in one or more joints that persists.
- A typical episode is defined as an acute onset or worsening of joint pain and swelling/warmth that resolves, regardless of treatment.
- Conditions like hereditary hemochromatosis, primary hyperparathyroidism, hypomagnesemia, Gitelman syndrome, hypophosphatasia, and familial history of CPPD disease should be considered.
- Synovial fluid analysis should be conducted by an expert using compensated polarized light microscopy for crystal identification.
- Imaging of a symptomatic peripheral joint (CR, US, CT, or DECT) is required if criteria are not met.
- Imaging evidence includes calcification of fibrocartilage or hyaline cartilage, not the synovial membrane, joint capsule, or tendon.
- Classification criteria and weights are presented in Table 2.
- The CEC agreed that imaging of a symptomatic peripheral joint is necessary when sufficient criteria are not met.
- A web-based calculator is available at https://bblinks.live/acrclassification-criteria-for-cppd-disease.
- The percent agreement of Steering Committee members for classifying patients for a research study ranged from 53% to 57% (Figure 3).
- Among 190 definite cases in the derivation cohort, 130 met sufficient criteria and 60 remained for scoring.
- These 60 cases had an area under the curve (AUC) of 0.95 (95% CI 0.93-0.98).
- A threshold score of >56 was chosen to maximize specificity and sensitivity.
- When the entire classification criteria system was applied, the threshold score had a sensitivity of 97.8% and specificity of 87.9%.
- Examples of borderline cases included a single episode of acute inflammatory arthritis in the wrist and a single episode in the knee with other conditions present.
- Among 251 definite cases in the validation cohort, 186 met sufficient criteria and 65 remained for scoring.
- The threshold score of >56 had a sensitivity and specificity of 96.5% and 92.5%, respectively, in this subgroup.
- Classification criteria performance in the derivation and validation cohorts demonstrated high sensitivity (99.2%) and specificity (92.5%).
- The percentage of patient profiles classified as CPPD disease increased with the submitting clinician's rating of CPPD.
§ Persistent inflammatory arthritis is defined by ongoing joint swelling with pain and/or warmth in one or more joints, with a typical episode being an acute worsening of joint pain and swelling that resolves regardless of treatment.
§ Certain conditions like hereditary hemochromatosis, primary hyperparathyroidism, hypomagnesemia, Gitelman syndrome, hypophosphatasia, and familial history of CPPD disease should be considered in the diagnosis.
§ Synovial fluid analysis should be done by an expert to identify crystals using compensated polarized light microscopy.
§ Imaging of at least one symptomatic peripheral joint is required for consideration. Imaging evidence includes calcification of fibrocartilage or hyaline cartilage.
§ The American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) classification criteria for CPPD disease include entry, exclusion, sufficient, and scored criteria.
§ A threshold score of >56 was chosen, as it maximizes specificity at 87.9% while retaining a high sensitivity of 92.2%.
§ The classification criteria have good performance, with sensitivity and specificity of 96.5% and 92.5%, respectively, in a subgroup of the validation cohort.
§ The classification framework, including entry, exclusion, sufficient criteria, and the threshold score of >56, had a sensitivity of 99.2% and specificity of 92.5% among all definite cases and definite mimickers in the validation cohort.
§ The percentage of cases classified as CPPD disease increases with the submitting clinician’s rating of CPPD.
§ The study, published in Annals of the Rheumatic Diseases, aimed to develop evidence-based classification criteria for CPPD disease using a multidisciplinary approach.
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Description
Learn about the sequential phases involved in the development of classification criteria, overseen by a Steering Committee and contributions from a Combined Expert Committee (CEC). The process includes a literature review, input from patient research partners, and previous methodology.
