ArticleClinical rheumatology2026
Serum β-hydroxybutyrate as a diagnostic biomarker distinguishing acute calcium pyrophosphate crystal arthritis from rheumatoid arthritis.
Article in Clinical rheumatology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
INTRODUCTION/
objectivesThis study aimed to identify serum biomarkers that distinguish patients with acute calcium pyrophosphate (CPP) crystal arthritis from those with rheumatoid arthritis (RA).
methodsThis study included patients with acute CPP crystal arthritis and those with RA treated at a single centre. The screening set included 18 patients with acute CPP crystal arthritis and 12 patients with RA. Serum samples were collected from all patients. Additionally, paired samples were obtained from five patients with CPP crystal arthritis after the resolution of their arthritis. The validation set included 11 patients with CPP crystal arthritis and 13 with RA. Serum metabolites were profiled using gas chromatography-mass spectrometry (GC-MS).
resultsOrthogonal partial least squares discriminant analysis revealed good separation between patients with acute CPP crystal arthritis and those with RA and between the acute CPP crystal arthritis phase and the resolution phase in the same patients. A total of 101 metabolites were identified. β-Hydroxybutyrate (BHB) levels were significantly higher in patients with acute CPP crystal arthritis than in those with RA and were higher in the acute CPP crystal arthritis phase than in the resolution phase. In the validation cohort, BHB consistently distinguished acute CPP crystal arthritis from RA, with an area under the receiver operating characteristic curve of 0.748, sensitivity of 90.9%, and specificity of 69.2%.
conclusionsBHB is a potential diagnostic biomarker for distinguishing acute CPP crystal arthritis from RA. These findings highlight the potential of metabolomic analysis as a non-invasive diagnostic approach for CPP crystal deposition disease. Key Points • Serum metabolomic profiling identified distinct metabolic signatures distinguishing acute CPP crystal arthritis from rheumatoid arthritis. • β-Hydroxybutyrate was a potential differential biomarker between acute CPP crystal arthritis and RA. • Alterations in ketone body metabolism may contribute to crystal-induced inflammation.
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