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

Abhishek, Abhishek; Tedeschi, Sara K.; 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; McCarthy, Geraldine M.; Ramonda, Roberta; Richette, Pascal; Sivera, Francisca; Andres, Mariano; Cipolletta, Edoardo; Doherty, Michael; Pascual, Eliseo; Perez-Ruiz, Fernando; So, Alexander; Jansen, Tim L.; Kohler, Minna J.; Stamp, Lisa K.; Yinh, Janeth; Adinolfi, Antonella; Arad, Uri; Aung, Thanda; Benillouche, Eva; Bortoluzzi, Alessandra; Dau, Jonathan; Maningding, Ernest; Fang, Meika; Figus, Fabiana; Filippucci, Emilio; Haslett, Janine; Janssen, Matthijs; Kaldas, Marian; Kimoto, Maryann; Leamy, Kelly; Navarro, Geraldine M.; Sarzi-Puttini, Piercarlo; Scirè, Carlo; Silvagni, Ettore; Sirotti, Silvia; Stack, John; Truong, Linh; Xie, Chen; Yokose, Chio; Hendry, Alison; Terkeltaub, Robert; Taylor, William J.; Choi, Hyon K.

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


Authors

Sara K. Tedeschi

Tristan Pascart

Augustin Latourte

Nicola Dalbeth

Tuhina Neogi

AMY FULLER Amy.Fuller@nottingham.ac.uk
Research Fellow

Ann Rosenthal

Fabio Becce

Thomas Bardin

Hang Korng Ea

Georgios Filippou

John Fitzgerald

Annamaria Iagnocco

Frédéric Lioté

Geraldine M. McCarthy

Roberta Ramonda

Pascal Richette

Francisca Sivera

Mariano Andres

Edoardo Cipolletta

Michael Doherty

Eliseo Pascual

Fernando Perez-Ruiz

Alexander So

Tim L. Jansen

Minna J. Kohler

Lisa K. Stamp

Janeth Yinh

Antonella Adinolfi

Uri Arad

Thanda Aung

Eva Benillouche

Alessandra Bortoluzzi

Jonathan Dau

Ernest Maningding

Meika Fang

Fabiana Figus

Emilio Filippucci

Janine Haslett

Matthijs Janssen

Marian Kaldas

Maryann Kimoto

Kelly Leamy

Geraldine M. Navarro

Piercarlo Sarzi-Puttini

Carlo Scirè

Ettore Silvagni

Silvia Sirotti

John Stack

Linh Truong

Chen Xie

Chio Yokose

Alison Hendry

Robert Terkeltaub

William J. Taylor

Hyon K. Choi



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.

Citation

Abhishek, A., Tedeschi, S. K., Pascart, T., Latourte, A., Dalbeth, N., Neogi, T., …Choi, H. K. (2023). The 2023 ACR/EULAR classification criteria for calcium pyrophosphate deposition disease. Annals of the Rheumatic Diseases, 82(10), 1248-1257. https://doi.org/10.1136/ard-2023-224575

Journal Article Type Article
Acceptance Date Jun 14, 2023
Online Publication Date Jul 26, 2023
Publication Date Sep 19, 2023
Deposit Date Jul 26, 2023
Publicly Available Date Jul 26, 2023
Journal Annals of the Rheumatic Diseases
Print ISSN 0003-4967
Electronic ISSN 1468-2060
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 82
Issue 10
Pages 1248-1257
DOI https://doi.org/10.1136/ard-2023-224575
Keywords General Biochemistry, Genetics and Molecular Biology; Immunology; Immunology and Allergy; Rheumatology
Public URL https://nottingham-repository.worktribe.com/output/23479529
Publisher URL https://ard.bmj.com/content/82/10/1248