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Calcium pyrophosphate arthritis

Calcium pyrophosphate dihydrate deposition disease; CPPD disease; Acute CPPD arthritis; Pseudogout; Pyrophosphate arthropathy; Chondrocalcinosis

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Calcium pyrophosphate dihydrate (CPPD) arthritis is a joint disease that can cause attacks of arthritis. Like gout, crystals form in the joints. But in this arthritis, the crystals are not formed from uric acid.

Causes

Deposition of calcium pyrophosphate dihydrate (CPPD) causes this form of arthritis. The buildup of this chemical forms crystals in the joints. This leads to attacks of joint swelling and pain in the knees, wrists, ankles, and other joints.

Among older adults, CPPD is a common cause of sudden (acute) arthritis in one joint. The attack is caused due to:

  • Injury to the joint
  • Hyaluronate injection in the joint
  • Medical illness

CPPD arthritis mainly affects the elderly because joint degeneration and osteoarthritis increases with age. Such joint damage increases the tendency of CPPD deposition. However, CPPD arthritis can sometimes affect younger people who have conditions such as:

Symptoms

In most cases, CPPD arthritis does not show any symptoms.

Some people with chronic CPPD deposition in large joints may have the following symptoms:

  • Pain
  • Swelling
  • Warmth
  • Redness

Attacks of joint pain can last for months. There may be no symptoms between attacks.

Because the symptoms are similar, CPPD arthritis can be confused with:

Exams and Tests

Most arthritic conditions show similar symptoms. Carefully testing the joint fluid for crystals can help the doctor detect the condition.

You may undergo the following tests:

  • Joint fluid exam to detect white blood cells and calcium pyrophosphate crystals
  • Joint x-rays to look for joint damage and calcium deposits in joint spaces
  • Other joint imaging tests such as CT scan, MRI or ultrasound, if required
  • Blood tests to screen for conditions that are linked to calcium pyrophosphate arthritis

Treatment

Treatment may involve removing fluid to relieve pressure in the joint. A needle is placed into the joint and fluid is aspirated. Some common treatment options are:

  • Steroid injections: to treat severely swollen joints
  • Oral steroids: to treat multiple swollen joints
  • Nonsteroidal anti-inflammatory medications (NSAIDS): to ease the pain
  • Colchicine: to treat attacks of CPPD arthritis

Outlook (Prognosis)

Most people do well with treatment to reduce the acute joint pain. A medicine such as colchicine may help prevent repeat attacks. There is no treatment to remove the CPPD crystals.

Possible Complications

Permanent joint damage can occur without treatment.

When to Contact a Medical Professional

Call your health care provider if you have attacks of joint swelling and joint pain.

Prevention

There is no known way to prevent this disorder. However, treating other problems that may cause CPPD arthritis may make the condition less severe.

Regular follow-up visits may help prevent permanent damage of the affected joints.

References

Edwards NL. Crystal deposition diseases. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 273.

Rosenthal AK, Ryan LM. Calcium pyrophosphate deposition disease. N Engl J Med. 2016; 374(26):2575-2584. PMID: 27355536 www.ncbi.nlm.nih.gov/pubmed/27355536.

Terkeltaub R. Calcium crystal disease: calcium pyrophosphate dihydrate and basic calcium phosphate. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, eds. Kelley and Firestein's Textbook of Rheumatology. 10th ed. Philadelphia, PA: Elsevier; 2017:chap 96.

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    A Closer Look

     
     

    Review Date: 1/29/2018

    Reviewed By: Gordon A. Starkebaum, MD, ABIM Board Certified in Rheumatology, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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