Calcium pyrophosphate deposition (CPPD) disease is the most prevalent crystal related arthropathy in the older-aged population. The clinical spectrum of CPPD arthropathy can include asymptomatic, acute, and chronic inflammatory disease that primarily results in irreversible structural joint damage. The manifestations and impact of structural damage that result from other inflammatory non-degenerative features of chronic CPP crystal inflammatory arthritis are often underrecognized and may lead to an inaccurate perception of disease severity. This pictorial essay sought to display the disease burden and various presentations of chronic inflammatory CPP crystal arthritis. Sonographic imaging of cases with chronic CPP arthritis was presented for diagnostic considerations and to demonstrate the extent of irreversible articular and peri-articular damage occurring at a structural level. Evolving understanding of the imaging characteristics of CPPD disease will provide a better appreciation of disease morbidity caused by this condition and stress the need to expand efforts to find effective treatments to dissolve crystal deposition and targeted therapies that will contain the inflammatory response to crystals. Recognizing the anatomic consequences of tissue damage that arise from CPPD disease should also help reflect on potential surgical alternatives to mitigate the progression of structural complications until effective disease modifying agents for this condition emerge.

The temporomandibular joint (TMJ) involvement is an underestimated feature of juvenile idiopathic arthritis (JIA) since it is usually asymptomatic at presentation for an undeterminable time. Late diagnosis of TMJ arthritis in JIA patients leads to delayed treatment, long-term orofacial disturbances, and impaired health-related quality of life (HRQOL). Therefore, the detection of TMJ involvement is fundamental and represents a challenge. This perspective presents state-of-the-art current initiatives and available tools for early diagnosis of TMJ arthritis in children with JIA. Standardized protocols and multidisciplinary efforts for improving clinical skills in the assessment of TMJ in JIA are presented and commented on. An overview of imaging efforts for early detection of TMJ involvement in JIA is also provided, with a critical review of the advantages and limitations of different techniques, imaging protocols, and scoring systems. The perspective offers insights into the correct use and improvement of available and potential tools for early identification of TMJ arthritis in JIA subjects who deserve timely multidisciplinary treatment, avoiding both underestimation and over-diagnosis of TMJ arthritis in routine clinical practice.

Musculoskeletal ultrasound has become a valuable imaging tool in the diagnosis and management of rheumatologic disorders. Expertise in recognizing sonographic findings of pathology is the basis for its successful application in clinical use. This article will provide descriptions and a pictorial essay of ultrasound findings in common musculoskeletal manifestations of rheumatologic disorders.