Abstract
OBJECTIVE—A Medline electronic search showed a paucity of reports on calcium pyrophosphate dihydrate crystal deposition disease (CPPD-CDD) from the Gulf region. To date only a single case report has been published from this region. Therefore, this study aimed, firstly, at finding out the prevalence of chondrocalcinosis in adult Arabs in Kuwait presenting with knee arthritis and, secondly, at carrying out an observational study of CPPD-CDD among Arabs in Kuwait. METHODS—For the study of the prevalence of chondrocalcinosis 100 consecutive adult patients presenting with knee arthritis were radiologically examined. For the observational study the clinical, laboratory, and radiological findings were analysed in patients with CPPD-CDD seen over a period of five years. RESULTS—This study showed the presence of chondrocalcinosis in two (2%) of the 100 adult Kuwaiti and other Middle-Eastern Arab patients (70 men, 30 women, median age 50 (range 45-80)) who presented to the rheumatology clinic for the evaluation of knee pain. When the younger age of the group (only three patients aged >70) is taken into account the figure was comparable with that reported from Western countries. Over a period of five years a total of 2726 new patients were evaluated at the rheumatology clinic of this institution. A diagnosis of crystal arthritis was made in 85 patients (3%). Fourteen of these 85 (that is, 16.5%, but 0.5% of the total cases) were diagnosed with definite (eight patients) or probable (six patients) CPPD-CDD. Different clinical presentations, including that of acute monarthritis (that is, pseudogout), premature generalised osteoarthritis, and polyarticular rheumatoid-like presentations, were seen in different patients. Overlap with true gout, with the additional presence of monosodium urate crystals in the joint aspirate, was seen in two patients. CONCLUSION—The present report shows that CPPD-CDD may not be uncommon among Arabs in the Gulf region. A high degree of clinical awareness and routine examination of joint aspirates with careful analysis for crystals may make it a more common diagnosis in this part of the world. In this regard it is interesting to note that cases and case series including familial cases have been reported from North Africa, especially Tunisia, indicating that the disease has been well described in Arabs of other geographical regions.
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Figure 1 .
(A) Lumbosacral spine: calcification of the annulus is seen at all the levels with small marginal osteophytes from L2-S1. Note the degenerative changes in the sacroiliac joints. (B) Both knees—weightbearing anteroposterior view: chondrocalcinosis and periarticular calcification are seen bilaterally. Degenerative changes with marked narrowing of the medial and lateral compartments of both knees, and marginal osteophyte formation, are present. (C) Right ankle—lateral view: calcification of the Achilles tendon and plantar fascia is seen. Degenerative changes are present in the talocalcaneal and calcaneocuboid joint. Note the degenerative cyst in the cuboid bone.
Figure 2 .
Radiographs of the wrists and hands: osteoarthritis of the distal interphalangeal, proximal interphalangeal, and metacarpophalangeal joints with calcium pyrophosphate dihydrate deposition disease (CPPD-CDD). The hook-like drooping osteophytes on the radial aspects of the heads of the metacarpal joints and ulnar bones, destructive symmetrical bilateral arthritis of the wrists with scapholunate advanced collapse, radiocarpal joint space narrowing, and subchondral sclerosis are all characteristic features of CPPD-CDD.