• A metabolic disease resulting in deposition of calcium pyrophosphate dihydrate (CPPD) crystals within the joint space
    • characterized by recurrent monoarticular arthritis
  • Epidemiology
    • commonly affects the elderly
    • rarely affects younger patients, unless occurring in conjunction with other disease
  • Associated conditions
    • hemochromatosis
    • hyperparathyroidism
    • SLE
    • gout
    • RA
    • Wilson's disease
    • hemophilia
    • long term hemodialysis can cause a pyrophosphate like deposition disorder
    • chondrocalcinosis is present in 7% of patients
  • Mimics gout except
    • affects older patients > 60 years old
    • affects more proximal joints
    • positively-birefringent crystal
  • Symptoms
    • acute, onset joint tenderness
    • warm, erythematous joint
    • commonly on knee and wrist joints
  • Physical exam
    • erythematous, monoarticular arthritis
    • joints tender to palpation
    • may observe superficial mineral deposits under the skin at affected joints
  • Radiographs
    • may see calcification of fibrocartilage structures (chondrocalcinosis)
      • TFCC in wrist
      • meniscus in the knee  
  • Joint aspiration crystal analysis
    • weakly positively birefringent rhomboid-shaped crystals
  • Acute gout
    • nonoperative
      • NSAID
      • splints for comfort
  • Chronic gout
    • nonoperative
      • intraarticular yttrium-90 injections
      • colchicine ( 0.6 mg PO bid for recurrent cases)
        • prophylactic colchine can help to prevent recurrence
  • Can result in permanent damage to the joints and renal disease

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Questions (1)

(SBQ07.13) A 53-year-old male laborer presents to his primary care physician with complaints of acute onset of left knee pain. He has had mild episodes of knee pain in the past and is two years status post a left partial medial meniscectomy. He has had mild relief with the use of anti-inflammatories. His past medical history is significant only for hyperparathyroidism and mild hypertension. He denies any fevers or chills. His exam reveals a moderate knee effusion and diffuse pain and tenderness with palpation and range of motion. Weightbearing radiographs are shown below. The most likely etiology of the patient's knee pain is characterized by which finding? Review Topic


Deposits of monosodium urate crystals




Deposits of calcium pyrophosphate-dihydrate crystals




Destructive pannus formation




Empty osteocyte lacunae




Recurrent hemarthroses



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The patient has chondrocalcinosis, or pseudogout. This disease is characterized by radiographs that show deposits of calcium pyrophosphate-dihydrate crystals in the articular cartilage and menisci. Aspiration typically yields a moderate WBC count (<50,000) and weakly positive birefringent rhomboid-shaped crystals as shown in Illustration A.

Fisseler-Eckhoff and Muller examined over 3,000 menisci from arthroscopic retrieval for evidence of chondrocalcinosis followed by acquisition of clinical data to evaluate for a possible association with prior surgery or trauma. Their results revealed a positive correlation between prior surgery or traumatic knee injuries and the presence of chondrocalcinosis in 68.6% of patients.

Hough and Webber discussed multiple pathologies affecting the menisci, including chondrocalcinosis. They report on the high association of chondrocalcinosis with the presence of OA within the knee, but conclude that the exact relationship of these two pathologies has yet to be fully elucidated.

Incorrect Answers:
Answer 1: Refers to gout which can display punched out periarticular erosions on radiographs and strongly negative birefringent needle-shaped crystals, as shown in Illustration B.
Answer 3: Characteristic of rheumatoid arthritis, which is associated with symmetric joint space narrowing, osteopenia and periarticular erosions
Answer 4: Consistent with osteonecrosis, which is not apparent on the radiograph
Answer 5: Suggests hemophilia. Typical presentation includes a history of bleeding events and radiographs that show a widened intercondylar notch and enlarged femoral condyles


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