Hamdan Omar, Alajlouni Yazeed, Mussa Qais, Alsawalmeh Ahmad, Sabbah Qutaiba, Al-Zou'bi Muna, Abuhamdan Asem, Alnaimat Fatima
School of Medicine, The University of Jordan, Amman, 11942, Jordan.
School of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
Rheumatol Int. 2025 Apr 25;45(5):124. doi: 10.1007/s00296-025-05884-6.
Crowned Dens Syndrome (CDS) is an acute inflammatory neck pain linked to Calcium Pyrophosphate crystal deposition surrounding the odontoid process. This systematic review and meta-analysis aim to illuminate the Features and Diagnostic Challenges of CDS. PubMed, Web of Sciences, and Scopus databases were searched in July 2024 to include all studies on CDS without publication year or language restrictions. Demographic, clinical, laboratory, and radiological data, in addition to treatment regimens and outcomes, were extracted and analyzed. PROSPERO registration number is CRD42024575491. We analyzed 153 reports, including 196 CDS patients, with a mean age of 73.13 ± 12.95 years and an almost equal female-to-male ratio. Neck pain was the most common symptom (96.8%). CRP and ESR were elevated in 91.4% and 80.7% of cases, respectively. CT scans had the highest detection rate for abnormalities (97.3%), compared to MRI (68.4%) and plain radiographs (79.4%). NSAIDs were the most frequently used treatment (62.5%), with improvement observed in 96.6% of cases. Meningitis was the most common misdiagnosis (21.4%), leading to a higher likelihood of plain radiographs and lumbar punctures. In contrast, patients with neck tenderness and restricted range of motion had a lower risk of misdiagnosis. Patients who were initially misdiagnosed were more likely to undergo LP (13.1% Vs. 34.8%; P-value < 0.001). CDS is an elderly disease that usually presents as acute neck pain with elevated inflammatory markers and is frequently misdiagnosed as meningitis. Recognizing key clinical features may improve diagnosis and management.
齿状突冠综合征（CDS）是一种与齿状突周围焦磷酸钙晶体沉积相关的急性炎症性颈部疼痛。本系统评价和荟萃分析旨在阐明CDS的特征和诊断挑战。2024年7月检索了PubMed、科学网和Scopus数据库，纳入所有关于CDS的研究，无出版年份或语言限制。提取并分析了人口统计学、临床、实验室和放射学数据，以及治疗方案和结果。PROSPERO注册号为CRD42024575491。我们分析了153份报告，包括196例CDS患者，平均年龄为73.13±12.95岁，男女比例几乎相等。颈部疼痛是最常见的症状（96.8%）。91.4%和80.7%的病例中CRP和ESR升高。与MRI（68.4%）和平片（79.4%）相比，CT扫描对异常的检出率最高（97.3%）。非甾体抗炎药是最常用的治疗方法（62.5%），96.6%的病例有改善。脑膜炎是最常见的误诊（21.4%），导致平片和腰椎穿刺的可能性更高。相比之下，颈部压痛和活动范围受限的患者误诊风险较低。最初被误诊的患者更有可能接受腰椎穿刺（13.1%对34.8%；P值<0.001）。CDS是一种老年疾病，通常表现为急性颈部疼痛伴炎症标志物升高，常被误诊为脑膜炎。认识关键临床特征可能改善诊断和管理。
