Background/Purpose: Calcium pyrophosphate deposition disease (CPPD) is a common cause of arthropathy over the age of 60. It can also manifest as a chronic polyarticular disease and may be mistaken for seronegative rheumatoid arthritis (RA). While previous retrospective cohort studies [1, 2] have explored the relationship between CPPD and RA, the potential role of specific hand joint space narrowing in the diagnosis or treatment response of CPPD has not been addressed.We aimed to explore whether, in a cohort of patients with early non erosive RA, the presence of specific hand and wrist joint narrowing suggestive of CPPD is associated with distinct baseline features and whether it influences clinical outcomes over the first 60 months.

Methods: A retrospective analysis was conducted on RA patients from the Early Undifferentiated Polyarthritis (EUPA) cohort (1998–2023) [3]. EUPA inclusion criteria required a baseline SJC66 ≥3 and a symptom duration of one to twelve months. Patients with confirmed crystal-induced arthritis, connective tissue disease or vasculitis were excluded. For this analysis, only patients fulfilling the 1987 and/or 2010 RA classification criteria were included, while those with ≥1 erosions on hand or foot radiographs, as determined by the Sharp-van der Heijde score, were excluded. Radiographs of hands and wrists were reviewed by two independent evaluators for the presence of at least one narrowing suggestive of CPPD such as bilateral radiocarpal, second or third metacarpophalangeal (MCP), scaphotrapeziotrapezoid (STT) joints without first carpometacarpal (CMC) involvement. Patient characteristics were compared using descriptive statistics. Time-dependent outcomes were evaluated using generalized estimating equations (GEE) with repeated measures. Multivariable models were adjusted for baseline variables, including age, sex, BMI, smoking status, and seropositivity.

Results: Among 966 EUPA patients, 388 met inclusion criteria, of which 70 (18%) exhibited at least one radiologic sign suggestive of CPPD. At baseline, CPPD+ patients were older, had higher comorbidity scores and slightly higher ESR (Table 1). The prevalence of CPPD was numerically higher among seronegative patients (20%) compared to seropositive patients (15%) (p=0.16). Over 60 months of follow-up, CPPD+ patients were more likely to have a joint narrowing score ≥5 and a Rheumatic Disease Comorbidity Index (RDCI) ≥1 (Figure 1). They were also more likely to remain on conventional disease-modifying drug (DMARD) therapy and were more intensely treated with biologics combined with and without prednisone (Table 2). No significant differences were found in SDAI, CDAI, erosions, SJC66, TJC68, pain, or fatigue. Stratification by seropositivity yielded similar results.

Conclusion: Radiological signs of CPPD do not appear to influence RA disease trajectory, regardless of their seropositivity status. However, CPPD+ RA patients may require more intensive treatment, including biologics and prednisone. These changes in RA likely reflect a concomitant or preexisting condition rather than a distinct RA subtype. Further research is needed to enhance our understanding of this topic and its clinical implications.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-impact-of-signs-of-calcium-pyrophosphate-deposition-disease-cppd-on-radiographs-of-hands-and-wrists-in-a-real-world-cohort-of-patients-with-early-rheumatoid-arthritis/