#3-77E. Unraveling BCP Crystals in Musculoskeletal Syndromes (CurrOpinRheumatol, 2018)

Do you ever struggle with managing refractory or multiple calcific periarthritis in your daily clinical practice? Basic calcium phosphate (BCP) crystals are notorious culprits behind conditions ranging from calcific periarthritis to severe destructive arthropathies like Milwaukee Shoulder Syndrome. This review provides a comprehensive update on the clinical presentation of calcific periarthritis in non-shoulder joints, such as the hip, and highlights emerging evidence on how these crystals mediate tissue damage. The most compelling recent finding suggests that BCP crystals actively drive tissue destruction by activating the Syk/PI3K pathway and promoting osteoclastogenesis, while also pointing to pyrophosphate (PPi) analogs as a promising future therapeutic avenue. However, when critically appraising the current management strategies, one must note the significant lack of large-scale, standardized prospective comparative trials; particularly regarding physical modalities like extracorporeal shockwave therapy, variations in techniques make head-to-head treatment comparisons difficult. For clinicians, this paper is highly relevant as it emphasizes the critical importance of screening for underlying metabolic or genetic abnormalities, such as hypophosphatasia, in patients presenting with recurrent calcifications, ultimately enhancing your diagnostic acumen and refining your approach to these challenging musculoskeletal conditions.

Citation: Ann K. Rosenthal. Basic calcium phosphate crystal-associated musculoskeletal syndromes: an update. Current Opinion in Rheumatology. 2018. DOI: 10.1097/BOR.0000000000000477

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