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
QUESTIONS 1 of 2 1 2 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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: A 1 Deposits of monosodium urate crystals 5% (90/1824) 2 Deposits of calcium pyrophosphate-dihydrate crystals 90% (1636/1824) 3 Destructive pannus formation 2% (29/1824) 4 Empty osteocyte lacunae 2% (41/1824) 5 Recurrent hemarthroses 1% (16/1824) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 2