Case report
Adalimumab treatment of resistant chondrocalcinosis
Tratamiento con adalimumab de la condrocalcinosis resistente
Ege University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Izmir, Turkey
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Although CPPD can stay mostly asymptomatic, it can present as acute or chronic arthritis.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> Intra-articular corticosteroids injection, non-steroidal anti-inflammatory drugs, colchicine, methotrexate and hydroxychloroquine can be used for CPPD. In resistant cases, biological treatments can also be used. IL-1 inhibitor anakinra is the most widely used biological agent for chondrocalcinosis.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3–5</span></a> Since TNF is also involved in the pathophysiology, anti-TNF drugs are also considered to be used in treatment.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case presentation</span><p id="par0010" class="elsevierStylePara elsevierViewall">Forty-six years old male patient presented with history of hip and joint pain for 2 years. His pains were resistant to analgesics. He does not have any comorbidities. He does not have any family history of CPPD or CPPD like symptoms. On laboratory examination C-reactive protein was 2.35<span class="elsevierStyleHsp" style=""></span>mg/L (0–5), serum calcium was 9.2<span class="elsevierStyleHsp" style=""></span>mg/dL (8.6–10.2), magnesium was 1.81<span class="elsevierStyleHsp" style=""></span>mg/dL (1.5–2.6), uric acid was 4.1<span class="elsevierStyleHsp" style=""></span>mg/dL (3.5–7.2), ferritin was 23.5<span class="elsevierStyleHsp" style=""></span>μg/L (30–400), erythrocyte sedimentation rate was 2<span class="elsevierStyleHsp" style=""></span>mm/h (<15), parathormone was 56.82<span class="elsevierStyleHsp" style=""></span>ng/L (15–65), thyroid releasing hormone was: 0.953<span class="elsevierStyleHsp" style=""></span>mU/L (0.27–4.2) and vitamin D was 48<span class="elsevierStyleHsp" style=""></span>ng/mL (20–50). Rheumatoid factor and antinuclear antibodies were negative. HLA-B27, HLA B-51, HLA B52 were negative. There was no history of inflammatory bowel disease and psoriasis. X-rays revealed chondrocalcinosis of the glenohumoral joints, intervertebral disks, acetabular joints, iliac crests, femoral trochanters, iliopubic tuberosities, symphisis pubis, meniscuses, knee joint cartilages, ankles, tarsal joints and heels (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). In his magnetic resonance imagining chondrocalcinosis and early coxarthrosis was seen in bilateral hip joints. There was not any sign of sacroiliac inflammation. He was refractory to multiple NSAIDs, colchicine, sulfasalazine, methotrexate and low-middle dose corticosteroid. Subcutaneous adalimumab 40<span class="elsevierStyleHsp" style=""></span>mg was started each 2 weeks. Methotrexate and 2<span class="elsevierStyleHsp" style=""></span>mg dexamethasone treatments continued. A major reduction of pain was observed in his 3 months follow-up. No side effects of adalimumab were observed. The patient's follow-up continues stably under anti-TNF therapy.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">In the literature, successfully treated cases with IL-1R antagonist anakinra are published.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4–6</span></a> One of the cases treated with anakinra was resistant to adalimumab treatment.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Patients that successfully managed with the IL-6 receptor inhibitor tocilizumab that resistant to anakinra was also reported.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7,8</span></a> In a report infliximab was used for treatment of two resistant chondrocalcinosis and results has been shown to be effective.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Although several reports exist of monosodium urate crystals deposition being successfully treated with anti-TNFα drugs, published cases of CPPD successfully treated with these agents are lacking.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Due to various roles of TNF in inflammatory processes we decided to use anti-TNF blocking agent adalimumab in therapy of resistant chondrocalcinosis patient. In the follow-up periods the patient had really good answer to our therapy and there were no major side effects. To our knowledge, this is the first report using adalimumab successfully in severe CPDD.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Funding</span><p id="par0020" class="elsevierStylePara elsevierViewall">This research received no financial support from any funding agency in the public, commercial, or not-for-profit sectors.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Informed consent</span><p id="par0025" class="elsevierStylePara elsevierViewall">Informed consent was taken from patient.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflict of interests</span><p id="par0030" class="elsevierStylePara elsevierViewall">All other authors declare no competing interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres2269788" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1892471" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2269787" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1892470" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case presentation" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Funding" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Informed consent" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2024-05-02" "fechaAceptado" => "2024-06-21" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1892471" "palabras" => array:4 [ 0 => "Calcium pyrophosphate" 1 => "Chondrocalcinosis" 2 => "Tumor necrosis factor-alpha" 3 => "Adalimumab" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1892470" "palabras" => array:4 [ 0 => "Pirofosfato cálcico" 1 => "Condrocalcinosis" 2 => "Factor de necrosis tumoral alfa" 3 => "Adalimumab" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">In this article, we present a case of resistant chondrocalcinosis who had a good response with 40<span class="elsevierStyleHsp" style=""></span>mg subcutaneous adalimumab. To our knowledge, this is the first report using adalimumab successfully in severe CPDD. Anti-TNF therapy can be a good therapeutic option for second line therapy in CPPD.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">En este artículo, presentamos un caso de condrocalcinosis resistente que tuvo una buena respuesta con 40<span class="elsevierStyleHsp" style=""></span>mg de adalimumab subcutáneo. Hasta donde sabemos, este es el primer informe en el que se utiliza adalimumab con éxito en la enfermedad por depósitos de cristales de pirofosfato de calcio dihidratado (CPPD) grave. El tratamiento anti-TNF puede ser una buena opción terapéutica de segunda línea en la CPPD.</p></span>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 948 "Ancho" => 975 "Tamanyo" => 53824 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">CPPD on the patient's direct radiograph.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cartilage diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Y. Krishnan" 1 => "A.J. Grodzinsky" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.matbio.2018.05.005" "Revista" => array:5 [ "tituloSerie" => "Matrix Biol" "fecha" => "2018" "volumen" => "71–72" "paginaInicial" => "51" "paginaFinal" => "69" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Calcium pyrophosphate deposition disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.K. Rosenthal" 1 => "L.M. Ryan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMra1511117" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2016" "volumen" => "374" "paginaInicial" => "2575" "paginaFinal" => "2584" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27355536" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Zhang W, Doherty M, Bardin T, Barskova V, Guerne PA, Jansen TL, et al. European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann Rheum Dis. 2011;70:563-70, https://doi.org/10.1136/ard.2010.139105 [Epub 7.01.2011; PMID: 21216817]." ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Biologics in the treatment of calcium pyrophosphate deposition disease: a systematic literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E. Cipolletta" 1 => "A. DI Matteo" 2 => "A. Scanu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Exp Rheumatol" "fecha" => "2020" "volumen" => "38" "paginaInicial" => "1001" "paginaFinal" => "1007" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32359034" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Calcium pyrophosphate deposition (CPPD) disease – treatment options" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Stack" 1 => "G. Mccarthy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.berh.2021.101720" "Revista" => array:5 [ "tituloSerie" => "Best Pract Res Clin Rheumatol" "fecha" => "2021" "volumen" => "35" "paginaInicial" => "101720" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34756508" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy and tolerance of anakinra in acute calcium pyrophosphate crystal arthritis: a retrospective study of 33 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Thomas" 1 => "M. Forien" 2 => "E. Palazzo" 3 => "P. Dieudé" 4 => "S. Ottaviani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10067-018-4272-2" "Revista" => array:5 [ "tituloSerie" => "Clin Rheumatol" "fecha" => "2019" "volumen" => "38" "paginaInicial" => "425" "paginaFinal" => "430" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interleukin-6 pathway blockade as an option for managing refractory cases of crystal arthritis: two cases report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N. Quilis" 1 => "M. Andrés" 2 => "P. Vela" 3 => "E. Pascual" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jbspin.2017.04.008" "Revista" => array:5 [ "tituloSerie" => "Joint Bone Spine" "fecha" => "2018" "volumen" => "85" "paginaInicial" => "377" "paginaFinal" => "378" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tocilizumab in symptomatic calcium pyrophosphate deposition disease: a pilot study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Latourte" 1 => "H.K. EA" 2 => "A. Frazier" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2020-217188" "Revista" => array:5 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2020" "volumen" => "79" "paginaInicial" => "1126" "paginaFinal" => "1128" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effectiveness and safety of infliximab in two cases of severe chondrocalcinosis: nine years of follow-up" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Bruges-Armas" 1 => "B.F. Bettencourt" 2 => "A.R. Couto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2014/536856" "Revista" => array:4 [ "tituloSerie" => "Case Rep Rheumatol" "fecha" => "2014" "volumen" => "2014" "paginaInicial" => "536856" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The emerging role of biotechnological drugs in the treatment of gout" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Cavagna" 1 => "W.J. 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