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Updated: Jun 17 2021

Pseudogout (CPPD)

Images knee_moved.jpg
  • summary
    • Pseudogout is a common form of inflammatory arthritis caused by intra-articular calcium pyrophosphate dihydrate crystal deposition and presents with attacks of joint pain, joint stiffness and swelling.
    • Diagnosis is made by joint aspiration and crystal analysis showing weakly positively birefringent rhomboid-shaped crystals
    • Treatment is usually medical management with NSAIDs.
  • Epidemiology
    • Demographics
      • commonly affects the elderly
      • rarely affects younger patients, unless occurring in conjunction with other disease
  • Etiology
    • 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 (most common) and wrist joints (2nd most common)
    • 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
  • 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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