Calcium pyrophosphate deposition disease

Calcium pyrophosphate deposition disease (CPPD) is a medical condition in which crystals of Calcium pyrophosphatedihydrate accumulate in joints. The condition can result in painful inflammation which may be misdiagnosed as gout(a similar condition in which cyrstals of monosodium urateform in joints), this occurs so frequently that it received the term pseudogout. CPPD is more common in women than in men while gout occurs much more often in men than in women.

Definition

Calcium pyrophosphate deposition disease (CPPD) is sometimes incorrectly referred to as pseudogout or chondrocalcinosis, though these entities are not synonymous with CPPD. Pseudogout refers to the clinical syndrome associated with CPPD, which is characterized by red, tender, and swollen joints and mimics gout. Chondrocalcinosis, on the other hand, is the radiologic or pathologic presence of calcifications in articular or fibrocartilage. This is often caused by calcium pyrophosphate dihydrate crystals, but may also be caused by other forms of calcification.

Clinical Aspects

CPPD crystal deposition disease is a polyarticular arthritis, although it can initially present as monoarticular.

CPPD crystals tend to form within articular tissues. Asymptomatic deposits can form in cartilage, joint capsules, intervertebral discs, tendons, and ligaments. Crystal deposition within cartilage (both hyaline and fibrocartilage) is known as chondrocalcinosis. Chondrocalcinosis initially is only visible microscopically, but if there is enough calcification, we can seen it radiographically as well. Common locations of chondrocalcinosis include the knees, wrists, elbows, and hips.

Crystal-induced synovitis is the result of shedding of crystals in the joint space after rupture of a CPPD deposit. Clinically this presents as an acute inflammatory synovitis very similar to that of an attack of gout, and has been referred to as "pseudogout."

• Other conditions associated with chondrocalcinosis:
  • hyperparathyroidism
  • hemochromatosis

Radiologic Findings

Three main manifestations of CPPD deposition:

1. chondrocalcinosis
2. crystal induced synovitis (pseudogout syndrome)
3. pyrophosphate arthropathy

Treatment

Treatment of CPPD is mostly aimed at preventing further crystal formation and reducing symptoms from crystal deposition. CPPD crystal deposition cannot be reversed. If an underlying disease (such as hemochromatosis or hyperparathyroidism) is present, treatment should be aimed specifically at controlling the disease. For symptomatic joints, treatment is similar to treatment of gout. When a single joint is involved, joint aspiration and intra-articular corticosteroid injection is often used, in addition to NSAID's and/or colchicine. When multiple joints are involved, joint injection is often impractical, or limited only to the most severely involved joint, and oral systemic treatment is chosen instead.

References

• Calcium pyrophosphate deposition diseaseby Marla Sammer, M.D. and Rob Gutierrez, M.D., University of Washington Department of Radiology
• Steinbach LS, Resnick D. Calcium pyrophosphate dihydrate crystal deposition disease: imaging perspectives. Curr Probl Diagn Radiol. 2000 Nov-Dec;29(6):209-29.
• Chew FS, Maldijian C, Leffler SG. Musculoskeletal Imaging: A Teaching File, Lippincott Williams & Williams, 1999.sv:Pyrofosfatsynovit

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