Tristan Pascart

• MD, PhD
• Lille Catholic University

Gout is the most common form of inflammatory arthritis in adults worldwide. There has been a steady increase in prevalence, which varies across different geographic areas and is high in the Indigenous (First Nations) peoples of the Pacific region. Palaeo-archaeological studies demonstrate that gout was present in the Pacific region prior to Europea...

Gout and calcium pyrophosphate deposition (CPPD) disease are the most common causes of crystal arthritis. Identifying the pathogenic crystal deposition is the cornerstone of the diagnosis, but also prognosis and monitoring of the diseases. Conventional radiography has been for decades the only imaging technique used, with its very restricted sensit...

Objectives The Gout, Hyperuricaemia and Crystal-Associated Disease Network (G-CAN) has developed a calcium pyrophosphate deposition (CPPD) nomenclature project. This systematic literature review constituted its first step and aimed to provide a state-of-the-art analysis of the medical literature of the last 20 years. Methods A systematic literatur...

Objective The objective of this study was to explore the ability of dual-energy computed tomography (DECT) to detect monosodium urate (MSU) crystal deposits in the kidneys and renal artery walls, and uric acid urolithiasis, in patients with gout and chronic kidney disease (CKD). Methods Patients with gout and with stage 2–4 CKD were prospectively...

Objective To develop and validate a patient-reported definition of acute calcium pyrophosphate (CPP) crystal arthritis in people with crystal-proven CPP deposition (CPPD) disease. Methods Consecutive patients with crystal-proven CPPD disease from seven centres across four countries were enrolled in a cross-sectional study. In each centre, patient-...

Introduction The central biochemical cause of gout is hyperuricemia (elevated serum urate levels). Ultrasound features of monosodium urate (MSU) crystal deposition are common in people with asymptomatic hyperuricemia. However, it is unclear whether this is a precondition for the development of gout. This study aims to determine whether ultrasound i...

Gout is a chronic disease that is caused by an innate immune response to deposited monosodium urate crystals in the setting of hyperuricemia. Here, we provide insights into the molecular mechanism of the poorly understood inflammatory component of gout from a genome-wide association study (GWAS) of 2.6 million people, including 120,295 people with...

Objective The genetic basis of calcium pyrophosphate deposition (CPPD) disease is largely unknown. This limits the development of therapeutic strategies. We aimed to analyze a genome-wide association study (GWAS) on a large administrative database to identify new candidate causal genes for CPPD disease. Methods We used publicly available GWAS summa...

15th Anniversary this year: the ECN workshop is set up in Paris, down town. Every year ECN workshop offers a unique opportunity for clinicians and researchers interested in crystals, inflammation, crystal-induced diseases including gout, to present their latest results and discuss novel concepts. Twenty nine out of 52 accepted abstracts are reporte...

Sharing genetic and other study results with the communities who participate in research falls under benefit-sharing and capacity-building initiatives that underpin a more equitable biomedical research relationship.Yet, which results to return and how remain fundamental challenges that persist in the absence of practicalguidance and institutional p...

Objective The study objective was to examine the disease, demographic, and imaging features associated with different inflammatory phenotypes of calcium pyrophosphate deposition (CPPD) disease, ie, recurrent acute calcium pyrophosphate (CPP) crystal arthritis, chronic CPP crystal inflammatory arthritis, and crowned dens syndrome (CDS). Methods Dat...

La goutte est une maladie associée au syndrome métabolique dont la prévalence en Polynésie française est la plus élevée au monde. Comme partout, sa prise en charge n’y est pourtant pas optimale. Outre la prise en charge médicamenteuse, l’éducation thérapeutique du patient (ETP) est primordiale, raison pour laquelle nous avons créé un programme d’ET...

Purpose of the review Although calcium pyrophosphate deposition (CPPD) has been known since the 1960s, our understanding of its pathogenesis remains rudimentary. This review aims to illustrate the known mechanisms underlying calcium pyrophosphate (CPP) crystal formation and deposition and explore future directions in research. By examining various...

Background Clinical variables known to influence the urate-lowering response to allopurinol include body mass index, renal function and pre-treatment urate levels. As the renal handling of oxypurinol, the active metabolite of allopurinol, is similar to that of uric acid, we hypothesise that the fractional excretion of uric acid (FEUA) may also be a...

Objective Intra‐articular (IA) mineralization may contribute to osteoarthritis (OA) structural progression. We studied the association of IA mineralization on knee computed tomography (CT) with cartilage damage worsening on knee magnetic resonance imaging (MRI), with a focus on location‐ and tissue‐specific effects. Methods Participants from the M...

Gout is the most common form of inflammatory arthritis worldwide and is characterized by painful recurrent flares of inflammatory arthritis that are associated with a transiently increased risk of adverse cardiovascular events. Furthermore, gout is associated with multiple cardiometabolic-renal comorbidities such as type 2 diabetes, chronic kidney...

The 14th annual international European Crystal Network was held in Paris on 2 and 3 March 2023. This in-person meeting was attended by 93 participants. Over 40 research abstract submissions were received from investigators, ranging from early career investigators to senior researchers, for plenary oral and poster presentations. Here, we present the...

Objectives: To determine the clinical associations and predictive value of two thresholds of negative dual-energy CT (DECT) for MSU crystal deposition in gout patients initiating urate lowering therapy (ULT), and identify which threshold is more clinically relevant. Methods: Patients from the CRYSTALILLE cohort with a diagnosis of gout naive to...

Objective To formulate evidence-based recommendations and overarching principles on the use of imaging in the clinical management of crystal-induced arthropathies (CiAs). Methods An international task force of 25 rheumatologists, radiologists, methodologists, healthcare professionals and patient research partners from 11 countries was formed accor...

Objective Cartilage pathologic calcification is a hallmark of osteoarthritis (OA). Here, we aimed to describe a new ex vivo human model to study the progression of cartilage calcification. Method Cartilage explants (n = 11), as well as primary chondrocytes (n = 3), were obtained from OA patients undergoing knee replacement. Explants and chondrocyt...

Objective To examine factors influencing the kinetics of monosodium urate (MSU) crystal dissolution measured with dual-energy computed tomography (DECT) during follow-up of patients with gout. Methods Patients with a diagnosis of gout with baseline knees and feet DECT scans exhibiting MSU crystal volumes ≥0.1 cm ³ and at least one follow-up DECT w...

Objectives To assess whether the extent of monosodium urate (MSU) crystal deposition estimated by ultrasound could predict renal and cardiometabolic events during urate‐lowering therapy (ULT). Methods A prospective study on gout patients from two referral centers initiating ULT who underwent baseline ultrasound and were followed for 1 year. Ultras...

Cardiovascular disease in gout is a central issue, but the underlying mechanisms linking the two are unclear. The existence of monosodium (MSU) crystal deposition directly inflaming vessel walls has been recurrently suggested and challenged since the 1950s and is again a matter of active debate since recent studies using dual-energy computed tomogr...

Objective Calcium pyrophosphate deposition (CPPD) disease is prevalent and has diverse presentations, but there are no validated classification criteria for this symptomatic arthritis. The American College of Rheumatology (ACR) and EULAR have developed the first‐ever validated classification criteria for symptomatic CPPD disease. Methods Supported...

Objective Calcium pyrophosphate deposition (CPPD) disease is prevalent and has diverse presentations, but there are no validated classification criteria for this symptomatic arthritis. The American College of Rheumatology (ACR) and EULAR have developed the first-ever validated classification criteria for symptomatic CPPD disease. Methods Supported...

Objective To characterize dual-energy computed tomography (DECT) changes depicting hyaline cartilage changes in gout patients with and without osteoarthritis (OA) and in comparators without gout. Design Patients with suspected crystal-associated arthropathy were enrolled and underwent bilateral DECT scans of the knees. Standardized regions of inte...

Community Approved Genetic Research with Benefit Sharing in Ma'ohi Nui/French Polynesia

Background The multifaceted clinical presentation in crystal-induced arthropathies (CiA) poses challenges to imaging. Objectives To formulate evidence-based recommendations on the use of imaging in the diagnosis and management of CiA. Methods Following EULAR standard operating procedures a task force of 25 stakeholders from 11 countries was creat...

Background Acute calcium pyrophosphate (CPP) crystal arthritis is a common clinical presentation of CPP deposition (CPPD) disease, and recurrent episodes occur in 25% of patients with CPPD disease [1] . Although recent studies have evaluated the short-term efficacy of different drugs in acute CPP crystal arthritis [2-4] , future studies would focus...

Background Despite prior attempts at standardising terminology of calcium pyrophosphate deposition (CPPD) disease (including the 2011 EULAR recommendations for CPPD terminology), many different terms are still used interchangeably to describe the disease, its elements, and its states (Tedeschi SK, Curr Rheumatol Rep 2019). This confusing nomenclatu...

Background The concept of difficult-to-treat rheumatoid arthritis (D2T RA) has recently emerged. It is defined by the persistence of disease activity and the failure of at least 2 b/tsDMARDs of 2 different mechanisms of action (MoA) [1]. In this definition, the period during which the treatments have failed is not included. The D2T concept has not...

Objectives Very little is known on the efficacy and safety of drugs for the management of chronic calcium pyrophosphate (CPP) crystal inflammatory arthritis. To describe the drugs used in the management of chronic CPP crystal inflammatory arthritis in expert European centres, and to examine treatment retention. Methods This was a retrospective coh...

Objective To assess the reliability and diagnostic accuracy of new radiographic imaging definitions developed by an international multidisciplinary working group for identification of calcium pyrophosphate deposition (CPPD). Methods Patients with knee osteoarthritis scheduled for knee replacement were enrolled. Two radiologists and 2 rheumatologis...

Background: Baricitinib (BARI) or Tofacitinib (TOFA) were the first Janus Kinase Inhibitors (JAKi) to be marketed in rheumatoid arthritis (RA). Concerns regarding venous thromboembolism (VTE) risk have emerged during the past years. The aim of the study was to compare the baseline characteristics of patients initiating BARI or TOFA in RA before ve...

Gout is a chronic disease of monosodium urate crystal deposition in the setting of hyperuricemia that typically presents with recurrent flares of acute inflammatory arthritis that occur due to innate immune response to deposited crystals. The molecular mechanism of the progression from hyperuricemia to clinical gout is poorly understood. Here we pr...

Gout and crystal deposition-associated disorders are among the leading causes of inflammation and arthritis throughout the world [...]

Objective To develop definitions for imaging features being considered as potential classification criteria for calcium pyrophosphate deposition (CPPD) disease, additional to clinical and laboratory criteria, and to compile example images of CPPD on different imaging modalities. Methods The American College of Rheumatology and European Alliance of...

Background: In a context of therapeutic inertia, the French Society of Rheumatology (SFR) published its first recommendations on gout in 2020, which were deliberately simple and concise. The objectives of the study were to determine the profile of patients referred to French gout-expert centres, and to examine the results of their management and t...

Background Recent studies have shown a lack of implementation of gout recommendations in primary care. In this context of therapeutic inertia, the French Society of Rheumatology (SFR) published its first recommendations on gout in 2020, which were deliberately simple and concise. Objectives The objectives were to determine the profile of patients r...

Résumé La place de l’imagerie dans le diagnostic et la prise en charge des rhumatismes microcristallins est grandissante avec l’application de moyens d’imagerie que sont l’échographie, et plus récemment le scanner double-énergie (DECT). L’objectif de cette revue est d’identifier la place actuelle de ces imageries appliquées à la goutte, au rhumatis...

Objective Classification criteria for calcium pyrophosphate deposition (CPPD) disease will facilitate clinical research on this common crystalline arthritis. Our objective was to report on the first 2 phases of a 4‐phase process for developing CPPD classification criteria. Methods CPPD classification criteria development is overseen by a 12‐member...

Background Recent studies have shown a lack of implementation of gout recommendations in primary care. In this context of therapeutic inertia, the French Society of Rheumatology (SFR) published its first recommendations on gout (RECO) in 2020 [1,2], which were deliberately simple and concise. Objectives To determine the profile of patients referre...

(257 words) Objective To determine changes of subchondral bone composition, micro-structure, bone marrow adiposity and micro-vascular perfusion in end-stage osteonecrosis of the femoral head (ONFH) compared to osteoarthritis (OA) using a combined in vivo and ex vivo approach. Design Male patients up to 70 years old referred for total hip replacem...

Objectives: To develop definitions for imaging features being considered as potential classification criteria for calcium pyrophosphate deposition (CPPD) disease, additional to clinical and laboratory criteria, and to compile example images of CPPD on different imaging modalities. Methods: The ACR/EULAR CPPD classification criteria Imaging Advisory...

Purpose of review: To give an overview of what can reasonably be considered as known about dual-energy computed tomography (DECT) in crystal-related arthropathies, and what still needs to be explored. Recent findings: Recent studies suggest an overall superiority of DECT over ultrasound in gout in terms of sensitivity (89 vs. 84%) and specificit...

Introduction De récentes études ont montré un défaut d’application des recommandations sur la goutte en soins primaires. Ainsi, la Société française de rhumatologie (SFR) a publié en 2020 ses premières recommandations sur la goutte (RECO) [1], [2], volontairement simples et concises. L’objectif principal de notre étude était d’évaluer les résultats...

Introduction Les biomédicaments anti-TNFα (TNFi) et le sécukinumab (SEC) ciblant l’interleukine 17 sont indiqués chez les patients atteints de spondyloarthrite axiale (AxSpA) et dont la maladie reste active malgré plusieurs traitements anti-inflammatoires non stéroïdiens. Peu d’études comparent la persistance de ces traitements chez ces patients et...

Introduction La goutte est la cause la plus fréquente d’arthrites, tout particulièrement dans certaines populations asiatiques et du Pacifique où la maladie approche une prévalence de 10 %. En Polynésie française, bien qu’une forte fréquence de la maladie y soit suspectée, aucune donnée épidémiologique n’était disponible sur la goutte et ses comorb...

Introduction Le Tofacitinib (TOFA) et le Baricitinib (BARI) ont été les premiers JAK inhibiteurs (JAKi) indiqués dans la polyarthrite rhumatoïde (PR). Ces molécules ont fait l’objet d’alertes concernant un potentiel surrisque thromboembolique veineux (VTE). En mai 2019, l’Agence européenne du médicament (EMA) a alerté la communauté médicale afin de...

Objectives To describe new-onset inflammatory bowel diseases (new IBD) in patients treated with interleukin 17 inhibitors (IL-17i), to assess their incidence and to identify their risk factors in real life. Methods A French national registry (MISSIL) aimed to report all cases of new IBD in patients treated with IL-17i from January 2016 to December...

Background In 2017, TOCILIZUMAB (TCZ) obtained marketing authorization for treatment of giant cell arteritis (GCA); however, this doesn’t extend to polymyalgia rheumatica (PMR) therapy. Based on efficacy data for TCZ in GCA, TCZ is sometimes used as a glucocorticoid (GC) sparing agent when PMR is GC dependent or when a rapid steroid withdraw is nee...

Background Classification criteria for calcium pyrophosphate deposition disease (CPPD) will facilitate clinical research on this common crystalline arthritis. ACR/EULAR are jointly sponsoring development of CPPD classification criteria using a multi-phase process. Objectives To report preliminary results from the first two phases of a four-phase p...

Background Dual energy computed tomography (DECT) is highly accurate for the diagnosis of gout. However, many artifacts have been described (1,2) such as nail bed, skin, beam hardening, sub-millimeter and vascular artifacts). Their presence can lead to a risk of over-diagnosis (false positives). Objectives Main objective of this case-control study...

Introduction Although calcium pyrophosphate deposition (CPPD) is common, there are no published outcome domains or validated measurement instruments for CPPD studies. In this paper, we describe the framework for development of the Outcome Measures in Rheumatology (OMERACT) CPPD Core Domain Sets. Methods The OMERACT CPPD working group performed a s...

Objective To characterize peripheral vascular plaques color-coded as monosodium urate (MSU) deposition by dual-energy computed tomography (DECT) and assess their association with the overall soft-tissue MSU crystal burden. Methods Patients with suspected crystal arthropathies were prospectively included in the CRYSTALILLE inception cohort to under...

Objective : To explore the lived experience of people with calcium pyrophosphate deposition (CPPD) disease and the impact of this condition on their daily lives. Methods : Patients with CPPD and their caregivers were invited to take part in a one-to-one (patient only) or paired (patient and caregiver) semi-structured interview. Interviews covered...

Objective To assess the ability of dual‐energy computed tomography (DECT) in identifying early calcium crystal deposition in menisci and articular cartilage of the knee, depending on the presence/absence of chondrocalcinosis seen on conventional CT. Methods One hundred thirty‐two knee DECT scans from patients with suspected crystal‐associated arth...

Objective: To examine the accuracy of dual-energy computed tomography (DECT) versus ultrasound or their combination for the diagnosis of gout. Methods: Using prospectively collected data from an outpatient rheumatology clinic at a tertiary-care hospital, we examined the diagnostic accuracy of either modality alone or their combination, by anatomica...

Objectives To determine whether the volume of monosodium urate (MSU) crystal deposition measured with dual-energy computed tomography (DECT) is predictive of short-term mortality and development of cardiovascular comorbidities and diabetes mellitus. Methods Patients with a diagnosis of gout having had baseline DECT scans of their knees and feet to...

Objective To examine the accuracy of dual-energy computed tomography (DECT) vs ultrasound or their combination for the diagnosis of gout. Methods Using prospectively collected data from an outpatient rheumatology clinic at a tertiary-care hospital, we examined the diagnostic accuracy of either modality alone or their combination, by anatomical sit...

Introduction Although calcium pyrophosphate deposition (CPPD) disease is common, there are no validated outcome measures for clinical research in this condition. The aim of this study was to generate a list of outcome domains as reported by patients, their caregivers, healthcare professionals (HCPs) and stakeholders to inform the development of an...

Background: In gout, several types of dual-energy computed tomography (DECT) artifacts have been described (nail bed, skin, beam hardening, submillimeter and vascular artifacts), which can lead to overdiagnosis. The objective of this study was to determine the optimal DECT settings for post processing in order to reduce the frequency of some commo...