Crowned dens syndrome not uncommon in elderly patients with calcium pyrophosphate disease

Elderly patients with neck pain associated with calcium pyrophosphate disease (CPD) are also prone to crowned dens syndrome, an often under-recognized condition, according to a recent study.

A total of 191 patients with CPD were included in the analysis, of whom 57 had cervical computed tomography (CT) scans. Of those with CT scans, 34 (59.64 percent) had periodontoid calcifications. Twelve of the 34 patients were diagnosed by rheumatologists with crowned dens syndrome, while the rest were either not seen by a specialist or were not diagnosed with the condition.

Median age of those with periodontoid calcifications was 78.5 years, majority of which were aged >70 years (73.52 percent) and female (70.58 percent). Half of the patients (17/34; 50 percent) were symptomatic, 28 (82.35 percent) had additional sites of chondrocalcinosis on available radiographs, and eight (28.57 percent) had at least three sites of chondrocalcinosis in typical calcium pyrophosphate disease locations. Six patients had no radiographs.

“Our data demonstrated a high percentage (about 60 percent) of patients with calcium pyrophosphate disease who had cervical computed tomography findings consistent with crowned dens syndrome,” the authors said. “This underscores the importance of performing cervical computed tomography when evaluating patients with neck pain and calcium pyrophosphate disease.”

This retrospective chart review was conducted at the University of Kansas Medical Center from 1 November 2005 to 1 November 2017, identifying 191 patients with calcium pyrophosphate disease. A musculoskeletal radiologist analysed the available cervical CT scans for the presence of periodontoid calcifications and erosions.