{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:49:38Z","timestamp":1785408578966,"version":"3.56.0"},"reference-count":20,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2023,4,3]],"date-time":"2023-04-03T00:00:00Z","timestamp":1680480000000},"content-version":"unspecified","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2023,2,13]]},"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:p>Chondrocalcinosis (CC) is the one of the most common crystal pyrophosphate disease associated arthritis in the elderly. It has been shown to coexist with seronegative and seropositive rheumatoid arthritis (RA), yet mostly with seronegative RA. Among the localisation of CC, the deposition in the ligaments surrounding the odontoid process may remain asymptomatic for years or may lead to and acute severe symptomatology, which may mimic several clinical illnesses among which meningitis (fever, severe pain, acute phase reactants). This is called the \u2018crowned dens syndrome (CDS)\u2019, which has been reported to represent an important percentage of acute neck pain needing hospital admission in neurosurgery units. In this case, the rapid demonstration of \u2018crowned dens\u2019 through CT scan may allow to avoid lumbar puncture and cerebrospinal fluid examination. The coexistence of RA and CDS is very rare, and rarely reported in the literature, yet it may represent a clinical challenge. We describe here one case that while on therapy with methotrexate (MTX) and naproxen (NPX) had an acute neck pain, and peripheral arthritis flare, that responded well to colchicine given along with MTX and NPX.<\/jats:p>","DOI":"10.1136\/rmdopen-2023-003017","type":"journal-article","created":{"date-parts":[[2023,4,3]],"date-time":"2023-04-03T13:21:58Z","timestamp":1680528118000},"page":"e003017","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Case report: crowned dens syndrome in a patient with seronegative rheumatoid arthritis"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6884-4301","authenticated-orcid":false,"given":"Gianfranco","family":"Ferraccioli","sequence":"first","affiliation":[{"name":"IRCCS - Fondazione Policlinico Universitario A. Gemelli - Catholic University of the Sacred Heart, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romeo","family":"Zanardi","sequence":"additional","affiliation":[{"name":"Radiology and Neuroradiology, Ospedale Santa Maria della Misericordia, Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Gremese","sequence":"additional","affiliation":[{"name":"Aging, Orthopedics and Rheumatological Sciences, Universit\u00e0 Cattolica del Sacro Cuore Facolt\u00e0 di Medicina e Chirurgia, Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,4,3]]},"reference":[{"key":"2025090313141386000_9.2.e003017.1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.42.3.280"},{"key":"2025090313141386000_9.2.e003017.2","doi-asserted-by":"crossref","DOI":"10.1136\/rmdopen-2022-002383","article-title":"High prevalence of chondrocalcinosis and frequent comorbidity with calcium pyrophosphate deposition disease in patients with seronegative rheumatoid arthritis","volume":"8","author":"Krekeler","year":"2022","journal-title":"RMD Open"},{"key":"2025090313141386000_9.2.e003017.3","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2010.139105"},{"key":"2025090313141386000_9.2.e003017.4","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1007\/s10067-016-3193-1","article-title":"The prevalence of chondrocalcinosis of the symphysis pubis on CT scan and correlation with calcium pyrophosphate dihydrate crystal deposition disease","volume":"35","author":"Patel","year":"2016","journal-title":"Clin Rheumatol"},{"key":"2025090313141386000_9.2.e003017.5","doi-asserted-by":"crossref","first-page":"2575","DOI":"10.1056\/NEJMra1511117","article-title":"Calcium pyrophosphate deposition disease","volume":"374","author":"Rosenthal","year":"2016","journal-title":"N Engl J Med"},{"key":"2025090313141386000_9.2.e003017.6","doi-asserted-by":"crossref","first-page":"3997","DOI":"10.1093\/rheumatology\/keac063","article-title":"Ultrasound findings of calcium pyrophosphate deposition disease at metacarpophalangeal joints","volume":"61","author":"Cipolletta","year":"2022","journal-title":"Rheumatology (Oxford)"},{"key":"2025090313141386000_9.2.e003017.7","doi-asserted-by":"crossref","first-page":"1629","DOI":"10.1002\/acr.20573","article-title":"Atlantoepistrophic magnetic resonance imaging involvement in early rheumatoid arthritis: an aggressive tight control therapy not fully arresting the disease","volume":"63","author":"Zoli","year":"2011","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2025090313141386000_9.2.e003017.8","first-page":"1040","article-title":"The crowned dens syndrome as a cause of neck pain: clinical and computed tomography study in patients with calcium pyrophosphate dihydrate deposition disease","volume":"26","author":"Salaffi","year":"2008","journal-title":"Clin Exp Rheumatol"},{"key":"2025090313141386000_9.2.e003017.9","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780281215"},{"key":"2025090313141386000_9.2.e003017.10","first-page":"583","article-title":"Acute neck pain and fever as the first manifestation of chondrocalcinosis with calcification of the transverse ligament of the atlas. Five case-reports with a literature review","volume":"65","author":"Constantin","year":"1998","journal-title":"Rev Rhum Engl Ed"},{"key":"2025090313141386000_9.2.e003017.11","doi-asserted-by":"crossref","first-page":"15","DOI":"10.14245\/kjs.2014.11.1.15","article-title":"Crowned dens syndrome: a case report and review of the literature","volume":"11","author":"Lee","year":"2014","journal-title":"Korean J Spine"},{"key":"2025090313141386000_9.2.e003017.12","doi-asserted-by":"crossref","first-page":"2405","DOI":"10.2169\/internalmedicine.54.4571","article-title":"Crowned dens syndrome as an initial manifestation of crystalline deposition disease","volume":"54","author":"Koda","year":"2015","journal-title":"Intern Med"},{"key":"2025090313141386000_9.2.e003017.13","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1016\/j.semarthrit.2018.10.009","article-title":"Spinal involvement with calcium pyrophosphate deposition disease in an academic rheumatology center: a series of 37 patients","volume":"48","author":"Moshrif","year":"2019","journal-title":"Semin Arthritis Rheum"},{"key":"2025090313141386000_9.2.e003017.14","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2012-202748"},{"key":"2025090313141386000_9.2.e003017.15","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1186\/s13075-014-0458-4","article-title":"Methotrexate in chronic-recurrent calcium pyrophosphate deposition disease: no significant effect in a randomized crossover trial","volume":"16","author":"Finckh","year":"2014","journal-title":"Arthritis Res Ther"},{"key":"2025090313141386000_9.2.e003017.16","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.F.01322"},{"key":"2025090313141386000_9.2.e003017.17","unstructured":"Reginato AJ , Reginato AM . Disease associated with depositon of calcium pyrophosphate or hydroxyapatie. In: Rubby S , Harris EDJ , Sledge CB , eds. Kelly\u2019s Textbook of Rheumatology, 1. 6 ed. Philadelphia: W.B.Saunders, 2001: 1377\u201390."},{"key":"2025090313141386000_9.2.e003017.18","doi-asserted-by":"crossref","DOI":"10.3389\/fmed.2021.528663","article-title":"Crowned dens syndrome: a case report and literature review","volume":"8","author":"Huang","year":"2021","journal-title":"Front Med (Lausanne)"},{"key":"2025090313141386000_9.2.e003017.19","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2017-001793"},{"key":"2025090313141386000_9.2.e003017.20","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1080\/14397595.2017.1316461","article-title":"The prevalence of calcification around odontoid process and the incidence of crowned dens syndrome in the neurosurgical ward: a single institution\u2019s analysis","volume":"28","author":"Sano","year":"2018","journal-title":"Mod Rheumatol"}],"container-title":["RMD Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rmdopen-2023-003017","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T20:14:24Z","timestamp":1756930464000},"score":1,"resource":{"primary":{"URL":"https:\/\/rmdopen.bmj.com\/lookup\/doi\/10.1136\/rmdopen-2023-003017"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4]]},"references-count":20,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,4,3]]},"published-print":{"date-parts":[[2023,4]]}},"alternative-id":["10.1136\/rmdopen-2023-003017"],"URL":"https:\/\/doi.org\/10.1136\/rmdopen-2023-003017","relation":{},"ISSN":["2056-5933"],"issn-type":[{"value":"2056-5933","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4]]}}}