CC BY
16mediterranean journal
of RHEUMATOLOGY
eaahnikh peymatqaoria
26 1
2015
KAINIKO nPOBAHMA CLiNiCAL PROBLEM
To MUöTiKÖ eivai öinv aKiivoYpaQia tuv äKpuv xeipwv
EuaYYeAia rewpyiou, MD, EAevr|-Ne0eAr| KoAokotoci, A9aväöioq KouTpoupnaq, MD, PhD, AäZapoq I. ZaKKäq, MD, DM, PhD (UK)
navenioTrpaKri PeuMaToAoYiKn KAiviKri, naveniorrpaKÖ reviKÖ NoookomgIo Aäpioaq, laipiKÖ TpHMa, ZxoAri EniöTriMwv YYeiaq, naveniörrpo OeooaAlaq, Aäpioa
The clue is in the radiography of hands
Evangelia Georgiou, MD, Eleni-Nefeli Kolokotsa, Athanasios Koutroumpas, MD, PhD, Lazaros I. Sakkas, MD, DM, PhD
Department of Rheumatology, Faculty of Medicine, School of Health Sciences, University of Thessaly and University General Hospital of Larissa, Larissa
To npoPAnMa. Tuvaka nAiKiaQ 69 etwv je xpovia ap9piTiSa Kai uno 9epaneia je prednisolone oe Soon 4-16 mg/njepa ano 10 eTiaQ, Kai npoo0aTn evap^n azathioprine npooepxeTai oto peujaToAoYiKo iaTpeio. H a/a onovSuAiK|Q orqAnQ (££) eSei^e noAAanAa Ka-TaYjaTa 9wpaKiK|Q (0M2) Kai oo0uiKHQ (OM2) joi-paQ TnQ H a/a aKpwv xeipwv 0aiveTai oTnv EiKova. To eupnja nou Kavei Tn SiaYvwon TnQ ap9piTiSaQ eivai n aoPeoTwon tou TpiYwvou xovSpou oTnv wAevio-Kap-niKn ap9pwon: voooQ evano9eonQ nupo0wo<t>opiKou aoPeoTiou (calcium pyrophosphate deposition disease, CPPD, ^eu6o-oupiKii ap9piTiSa[pseudogout], xovSpa-oPeoTwon [chondrocalcinosis]). Ta na9oAoYiKa Ka-TaYjaTa anoSo9nKav oTa KopTiKooTepoeiSil a0ou o eAeYXoQ Yia aAAn aiTia na9oAoYiKwv KaTaYjaTwv Sev eSei^e KaTi. Eivai owot| n avTijeTwnion;
Ynsu8uvoq aXXr|Xoypa0iac;
Ka8nvnTnQ AäZapoQ I ZaKKäq PeupaxoAoyiKn KAIVIKH, laTpiKÖ TpHMa, ZxoAq Emarr||jwv YyeiaQ, naveniCTTHMio QeccaAiaq BiöhoAiq 41110, Aäpica TnA +241350 2813, Fax: +2413501016, email:lsakkas@med.uth.gr Corresponding author: Prof. Lazaros I. Sakkas Department of Rheumatology Faculty of Medicine, School of Health Sciences, University of Thessaly and University General Hospital of Larissa
Biopolis 41110, Larissa Tel:+241350 2813, Fax:+241350 1016, email:lsakkas@med.uth.gr
H andvrnon. H CPPD eM0aviZeTai uq o^eia ap-9piTi6a, uq oöTeoap9pi-TiSa, r uq xpövia 0Acy-MovwSnq noAuap9piTi6a. To eneiöÖSio Tnq o^eiaq ap9piTi6aq SiapKei AiYeq nMepeq euq eßSoMäSeq. KaTä 09ivouoa oeipä ouxvÖTnTaq npooßäAAo-viai Ta YÖvaia (>50%), oi noSoKvnMiKeq, oi äKpoi nÖSeq, oi wmoi, oi aYKÜveq, oi Kapnoi Kai oi äKpeq xeipeq. H ap-
9piTiSa avanTüööeTai uq anoTeAeöMa ouoowpeuonq KpuöTäAAuv nupo0uo0opiKou aoßeöTiou öTiq ap9pw-oeiq, Kai eivai auio0AeYMovwSnq vÖooq. napäYovieq KivSüvou Yia Tnv eKSnAuon Tnq nepiAaMßävouv MeYäAn nAiKia, oiKoYevrq npoSiä9eon, TpaÜMa, MeTaßoAiKeq Kai evSoKpiviKeq SiaTapaxeq, Önuq aiMoxpuMäTuon, unep-napa9upeoeiSiöMÖq, uno0uo0aiaiMia, unoMaYvnoiai-Mia, uno9upoeiSiöMÖq, Kai oupiKr ap9piTiSa 1 . H avTiMeTwnion Tnq CPPD e^apTäTai anÖ Tnv unoKei-Mevn aiTia (onÖTe avTiMeiuniZeiai auT| 9epaneuTiKä), Kai anÖ tov Tüno Tnq ap9piTiSaq. ria napäSeiYMa, oe unoMaYvnoiaiMia, n xopiYnon MaYvnoiou ßon9äei. Aev unäpxouv enapKeiq TuxaionoinMeveq MeAeTeq Yia Tn 9epaneia Tnq CPPD. napoAa auTä, exouv SnMo-öieu9ei ouöTäöeiq (recommendations) Tnq EULAR Yia Tnv avTiMeTünionq Tnq CPPD2. H 9epaneia Tnq o^eiaq ap9piTiSaq, nepiAaMßävei Mn 0apMaKeuTiKn avTiMeTÜ-nion (napaKevinon Tnq näoxouoaq äp9puonq, avä-nauon, ToniKr Kpuo9epaneia (näYoq, naYoKüöTn), Kai 0äpMaKa: Mn öTepoeiSn avTi0AeYMovwSn, KoAxiKivn, n oe nepinTuon avievSei^nq öTa avuiepu, koptikootc-poeiSn oe evSap9piKr eveon, evSoMuiKä (1-2 eveoeiq triamcinolone acetonide 60 mg), n ACTH evSoMuiKä, evSo^Aeßia n unoSÖpia 2,3
H xpovia CPPD, ÖTav eivai aouMnTUMaTiKn, Önuq oum-ßaivei ouv|9uq oe äToMa MeYäAnq nAiKiaq, Sev xpeiäZe-Tai 0äpMaKa. Ze ouMnTUMaTiKn vÖoo, Ta 0äpMaKa nou xpnoiMonoioüvTai nepiAaMßävouv hydroxychloroquine, colchicine, xaMnAI SÖon Mn öTepoeiSwv avTi0AeYMo-vuSwv 0apMäKuv (eäv Sev unäpxei avrevSei^n). Ze av9eKTiKeq nepinTüoeiq n methotrexate (7.5-15 mg/ eßSoMäSa) Mnopei va ßon9noei. Autö 0ävnKe oe Mia
mediterranean journal
of RHEUMATOLOGY
eaahnikh peymatoaofia
26 1
2015
MiKpn oeipa aoöevwv 4, poÄovÖTi pia piKpn Tuxaionoin-pevn M£^£Tn öev eöei^e onpavTiKn eniöpaon 5. Paöio-u-peveKTOMn Me yttrium-90 ¿xei enionQ xPnoiMonoinöei 2. To Anakinra (Kineret) eivai anoTeÄeopaTiKÖ oe noAAouq aoöeveiq 6. Ze 2 nepioTaTiKa, infliximab (Remicade) eni 9 ¿Tn eöei^e anoTeXeopaTiKÖTnTa 7
BIBAIOrPAQIA
1. Zhang W, Doherty M, Bardin T, Barskova V, Guerne PA, Jansen TL et al. EULAR recommendations for calcium pyrophosphate crystal associated arthritis. Part I: Terminology and diagnosis. Ann Rheum Dis 2011;70:563-70
2. Zhang W, Doherty M, Pascual E, Barskova V, Guerne PA, Jansen TL et al. EULAR Standing Committee for International Clinical Studies Including Therapeutics. EULAR evidence based recommendations for gout. Part II: Management. Ann Rheum Dis 2011;70:571-5.
3. Daoussis D, Andonopoulos I, Andonopoulos A. ACTH as a treatment for acute crystal-induced arthritis;update on clinical evidence and mechanism of action. Semin Arthritis Rheum 2014;43:648-53
4. Chollet-Janin A, Finckh A, Dudler J, guerne PA. methotrexate as an alternative therapy for chronic calcium pyrophosphate deposition disease:an exploratory analysis. Arthritis Rheum 2007;56:688-72
5. Finckh A, McCarthy GM, Madigan A, van Linthoudt D, weber M, neto d et al. methotrexate in chronic-recurrent calcium pyrophosphate deposition disease;no significant effect in a randomized crossover trial. Arthritis Res Ther 2014;16:458
6. Ottaviani S, Brunier L, Sibilia J, Maurier F, Ardizzone M, Wending D, et al. Efficacy of anakinra in calcium pyrophosphate crystal-induced arthritis: a report of 16 cases and review of the literature. Joint Bone spine 2013;80:178-82.
7. Bruges-Armas J, Bettencourt BF, Couto AR, Lima M, Rodrigues AM, Vastesaeger n et al. effectiveness and safety of infliximab in two cases of severe chondrocalcinosis;nine years of follow up. Case Rep Rheumatol 2014;2014;536856
EiKÖva. AnXq aKiivoYpa^ia äKpwv x£ip^v ödxvei aaßeaiwari tou ipiY^vou xövöpou Giqv wXevio-Kapniaia apOpwaq (xovöpaaßeaiwan).
