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A metabolic disease resulting in deposition of
calcium pyrophosphate dihydrate (CPPD) crystals
within the joint space
characterized by recurrent monoarticular arthritis
commonly affects the elderly
rarely affects younger patients, unless occurring in conjunction with other disease
long term hemodialysis can cause a pyrophosphate like deposition disorder
chondrocalcinosis is present in 7% of patients
Mimics gout except
> 60 years old
acute, onset joint tenderness
warm, erythematous joint
commonly on knee and wrist joints
erythematous, monoarticular arthritis
joints tender to palpation
may observe superficial mineral deposits under the skin at affected joints
may see calcification of fibrocartilage structures (
TFCC in wrist
meniscus in the knee
Joint aspiration crystal analysis
positively birefringent rhomboid-shaped crystals
splints for comfort
intraarticular yttrium-90 injections
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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Qbank (1 Questions)
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?
Deposits of monosodium urate crystals
Deposits of calcium pyrophosphate-dihydrate crystals
Destructive pannus formation
Empty osteocyte lacunae
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PREFERRED RESPONSE ▶
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.
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
Arthroscopy and chondrocalcinosis.
Fisseler-Eckhoff A, Müller KM.
PMID: 1550657 (Link to Abstract)
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Pathology of the meniscus.
Hough AJ Jr, Webber RJ.
Clin Orthop Relat Res. 1990 Mar;(252):32-40.
PMID: 2406071 (Link to Abstract)
Vote for CME
Chris Souder MD
Dave Marcu MD
John Badylak MD
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