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Introduction
  • 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
Presentation
  • 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
Imaging
  • Radiographs
    • may see calcification of fibrocartilage structures (chondrocalcinosis)
      • TFCC in wrist  
      • meniscus in the knee  
Evaluation
  • Joint aspiration crystal analysis
    • weakly positively birefringent rhomboid-shaped crystals
Treatment
  • Acute pseudogout
    • nonoperative
      • NSAIDS
      • splint
      • intra-articular steroids
      • splints for comfort
  • Chronic pseudogout
    • nonoperative
      • intraarticular yttrium-90 injections
      • colchicine ( 0.6 mg PO bid for recurrent cases)
        • prophylactic colchine can help to prevent recurrence
Complications
  • Can result in permanent damage to the joints and renal disease
 

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