Adinolfi, A.

Clavijo Cornejo, D.

D&#8217

Dumitru, A.

Filippou, G.

Gutierrez, M.

Iagnocco, A.

Keen, H.

Pineda, C.

Sarzi-Puttini, P.

Scanu, A.

Scir&#232

Serban, T.

Sirotti, S.

Terslev, L.

English

Florence Research

See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/351894220AB0629 ACCURACY OF SYNOVIAL FLUID ANALYSIS FOR THEIDENTIFICATION OF CALCIUM PYROPHOSPHATE CRYSTALS: AN ANCILLARYSTUDY OF OMERACT CRITERION VALIDITY STUDY FOR ULTRASOUND INCPPDArticle  in  Annals of the Rheumatic Diseases · June 2021DOI: 10.1136/annrheumdis-2021-eular.601CITATION1READS715 authors, including:Some of the authors of this publication are also working on these related projects:Diffuse Large B Cell Lymphoma Male Breast-A rare Case Report View projectUS validation in CPPD View projectAntonella AdinolfiUniversità degli Studi di Siena60 PUBLICATIONS   519 CITATIONS   SEE PROFILEMarwin GutierrezInstituto Nacional de Rehabilitación243 PUBLICATIONS   4,457 CITATIONS   SEE PROFILECarlos PinedaInstituto Nacional de Rehabilitación349 PUBLICATIONS   5,417 CITATIONS   SEE PROFILEDenise Clavijo CornejoInstituto Nacional de Rehabilitación43 PUBLICATIONS   256 CITATIONS   SEE PROFILEAll content following this page was uploaded by Adrian Dumitru on 13 September 2021.The user has requested enhancement of the downloaded file.1348  Scientific Abstractsdiscontinuation was 7 (range: 2-56) and 10 (range: 2-48), respectively. Pre-in-fusion steroids were re-started in 3 patients after a rise in sUA, with 1 regain-ing sUA response (patient 2) and 2 discontinuing therapy (patients 4 and 9). An additional patient had a loss of sUA response (patient 7) and discontinued, 1 patient discontinued due to hospitalization (patient 6), and 1 patient chose to discontinue therapy (patient 8). At the time of data collection, 4 patients remained on therapy (patients 1-3, 5). Eight patients had at least one AE (all deemed unrelated to treatment), including influenza, hypertensive crisis, and toe amputation. No IRs occurred.Conclusion: In this case series, 8 of 9 patients received 6 months or more (≥12 infusion) of pegloticase. These cases suggest that pre-infusion GC discontin-uation may be possible in some patients treated with pegloticase (particularly those over 70 years). Further investigation exploring this concept is warranted, including evaluating the optimal time and conditions to discontinue pre-infusion GCs with pegloticase.REFERENCES: [1] Sundy JS, et al. JAMA. 2011;306(7):711-720.[2] KRYSTEXXA (pegloticase) [prescribing information] Horizon.[3] Saag KG. Bull NYU Hosp Jt Dis 2012;70(Suppl 1):S21-S25.[4] Pillinger MH, et al. Bull NYU Hosp Jt Dis 2010;68:199-203.Disclosure of Interests: Veronica Newsome Speakers bureau: Abbvie, Anthony Amatucci Shareholder of: Horizon Therapeutics plc, Employee of: Horizon Therapeutics plc, Tim Stainbrook: None declared., Brian LaMoreaux Shareholder of: Horizon Therapeutics plc, Employee of: Horizon Therapeu-tics plc.DOI: 10.1136/annrheumdis-2021-eular.70AB0629 ACCURACY OF SYNOVIAL FLUID ANALYSIS FOR THE IDENTIFICATION OF CALCIUM PYROPHOSPHATE CRYSTALS: AN ANCILLARY STUDY OF OMERACT CRITERION VALIDITY STUDY FOR ULTRASOUND IN CPPDA. Adinolfi1, S. Sirotti2, M. Gutierrez3, C. Pineda3, D. Clavijo Cornejo3, T. Serban4, A. Dumitru5, A. Scanu6, M. A. D’agostino7, H. Keen8, L. Terslev9, P. Sarzi-Puttini2, C. A. Scirè10, A. Iagnocco11, G. Filippou2on behalf of Omeract Ultrasound working group, subgroup CPPD. 1ASST Grande Ospedale Metropolitano Niguarda, Rheumatology Unit, Milan, Italy; 2Luigi Sacco University Hospital, Rheumatology Department, Milan, Italy; 3Instituto Nacional de Rehabilitacion, Division of Musculoskeletal and Rheumatic Diseases, Mexico City, Mexico; 4Ospedale La Colletta, ASL3 Genovese, Rheumatology Department, Genoa, Italy; 5Carol Davila University of Medicine and Pharmacy, Department of Pathology, Bucharest r, Romania; 6University of Padova, Department of Medicine-DIMED, Rheumatology Unit, Padova, Italy; 7Università Cattolica del Sacro Cuore, Policlinico Universitario Agostino Gemelli IRCSS, Rheumatology Department, Rome, Italy; 8 The University of Western Australia, Medicine and Pharmacology Department, Murdoch, Perth, Australia; 9Copenhagen University, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; 10Società Italiana di Reumatologia, Epidemiology Research Unit, Milan, Italy; 11Università degli Studi di Torino,  Rheumatology Unit, Department of Clinical and Biological Sciences,  Torino, ItalyBackground: Synovial fluid analysis (SFA) via compensated polarized light microscopy is still considered the gold standard for the identification and diagnosis of Calcium Pyrophosphate Deposition disease (CPPD)-related arthropathies[1], but very few studies have been published about its diagnos-tic accuracy.Objectives: The aim of this study was to evaluate the accuracy of SFA in the identification of calcium pyrophosphate dihydrate (CPP) crystals compared to microscopic analysis of joint tissues as the reference standard.Methods: This is an ancillary study of an international, multicentre cross-sec-tional study performed by the CPPD subgroup of the OMERACT Ultrasound working group[2]. Consecutive patients with knee osteoarthritis (OA) waiting for total knee replacement surgery were enrolled in the study from 2 partic-ipating centres, Mexico and Romania. During surgical procedures synovial fluid (SF), menisci and hyaline cartilage were collected and analysed within 48 hours after surgery under transmitted light microscopy and compensated polarised light microscopy for the presence/absence of CPP crystals. All slides were analysed by expert examiners on site, blinded to other find-ings. A dichotomic score (absence/presence) was used for scoring both SF and tissues. Microscopic analysis of knee tissues was considered the gold standard. Sensitivity, specificity, accuracy, positive and negative predictive values (PPV and NPV) of SFA in the identification of CPP crystals were calculated.Results: 15 patients (53% female, mean age 68yo ± 8.4) with OA of grade 3 or 4 according to Kellgren-Lawrence scoring were enrolled. 12 patients (80%) were positive for CPP crystals at SFA and 14 (93%) at tissues microscopic anal-ysis. Among 12 SFA positive patients, all were positive for CPP crystals in either medial or lateral meniscus, and 11 were positive in both; 10 patients were positive at the hyaline cartilage, and all 10 were also positive for at least one meniscus. Regarding the 3 SFA negative patients, only one had no crystals in the examined tissues, while the other 2 patients had CPP crystals in both menisci and hyaline cartilage. The overall diagnostic accuracy of SFA compared to histology analysis for CPPD was 87%, with a sensitivity of 86% and a specificity of 100%, the PPV was 100% and the NPV was 33% (Table 1).Table 1. sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of synovial fluid analysis compared to the reference standard. CI: Confidential Interval. SF: synovial fluid, in parentheses: numerators and denominators for all percentages provided. Sensitivity Specificity PPV NPV AccuracySF analysis 86% (12/14) 100% (1/1) 100% (12/12) 33% (1/3) 87% (13/15) (0.65-0.99) CI 95%(0.0-0.25) CI 95%(0.65-0.99) CI 95%(0.0-0.25) CI 95% Conclusion: SFA demonstrated to be an accurate test for the identification of CPP crystals in patients with advanced OA. However, is not always feasible and carries some risks for the patient. Considering the availability of validated imag-ing techniques for the detection of CPPD, such as US, SFA could be used in those patients where imaging and clinical data are not definitely confirmatory of the disease.REFERENCES: [1] W. Zhang et al., ‘European League Against Rheumatism recommenda-tions for calcium pyrophosphate deposition. Part I: terminology and diag-nosis’, Ann Rheum Dis, vol. 70, no. 4, pp. 563–570, Apr. 2011, doi: 10.1136/ard.2010.139105.[2] G. Filippou et al., ‘Criterion validity of ultrasound in the identification of calcium pyrophosphate crystal deposits at the knee: an OMERACT ultra-sound study’, Ann Rheum Dis, p. annrheumdis-2020-217998, Sep. 2020, doi: 10.1136/annrheumdis-2020-217998.Disclosure of Interests: None declared.DOI: 10.1136/annrheumdis-2021-eular.601AB0630 PEGLOTICASE/METHOTREXATE CO-THERAPY IMPROVED JOINT AND PATIENT-REPORTED HEALTH ASSESSMENTS IN PATIENTS WITH UNCONTROLLED GOUT: 12-MONTH EXPLORATORY OUTCOMES OF THE MIRROR OPEN-LABEL TRIALJ. Botson1, P. M. Peloso2, K. Obermeyer2, B. Lamoreaux3, L. Zhao2, M. E. Weinblatt4, J. Peterson5. 1Orthopedic Physicians Alaska, Medical,  on September 13, 2021 by guest. Protected by copyright.http://ard.bmj.com/Ann Rheum Dis: first published as 10.1136/annrheumdis-2021-eular.601 on 19 May 2021. Downloaded from View publication stats

AB0629 ACCURACY OF SYNOVIAL FLUID ANALYSIS FOR THE IDENTIFICATION OF CALCIUM PYROPHOSPHATE CRYSTALS: AN ANCILLARY STUDY OF OMERACT CRITERION VALIDITY STUDY FOR ULTRASOUND IN CPPD

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AB0629&#8197;ACCURACY OF SYNOVIAL FLUID ANALYSIS FOR THE IDENTIFICATION OF CALCIUM PYROPHOSPHATE CRYSTALS: AN ANCILLARY STUDY OF OMERACT CRITERION VALIDITY STUDY FOR ULTRASOUND IN CPPD

AB0629 ACCURACY OF SYNOVIAL FLUID ANALYSIS FOR THE IDENTIFICATION OF CALCIUM PYROPHOSPHATE CRYSTALS: AN ANCILLARY STUDY OF OMERACT CRITERION VALIDITY STUDY FOR ULTRASOUND IN CPPD

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AB0629&#8197;ACCURACY OF SYNOVIAL FLUID ANALYSIS FOR THE IDENTIFICATION OF CALCIUM PYROPHOSPHATE CRYSTALS: AN ANCILLARY STUDY OF OMERACT CRITERION VALIDITY STUDY FOR ULTRASOUND IN CPPD

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AB0629 ACCURACY OF SYNOVIAL FLUID ANALYSIS FOR THE IDENTIFICATION OF CALCIUM PYROPHOSPHATE CRYSTALS: AN ANCILLARY STUDY OF OMERACT CRITERION VALIDITY STUDY FOR ULTRASOUND IN CPPD