Updated: 4/10/2017

Pseudogout (CPPD)

Topic
Review Topic
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Questions
2
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Evidence
3
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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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Questions (2)
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(SBQ07SM.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

QID: 1398
FIGURES:
1

Deposits of monosodium urate crystals

5%

(91/1837)

2

Deposits of calcium pyrophosphate-dihydrate crystals

90%

(1648/1837)

3

Destructive pannus formation

2%

(29/1837)

4

Empty osteocyte lacunae

2%

(41/1837)

5

Recurrent hemarthroses

1%

(16/1837)

ML 1

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