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Calcium pyrophosphate deposition (CPPD) (Risk factors (Age,…
Calcium pyrophosphate
deposition (CPPD)
Definition
Crystal arthropathy caused
by Ca pyrophosphate crystals
Epidemiology
Elderly women
Risk factors
Age
Hyperparathyroidism
Haemachromatosis
Hyperphosphatemia
Wilson's disease
Pathophysiology
Crystal formation
Ca deposition in articular cartilage and soft tissue
Shedding of crystals into joint causes inflammation
Natural history
Acute CCP
Pseudogout, acute flair in one large joint
Triggered spontaneously by e.g. illness, surgery, trauma
Often self limiting
Chronic CCP
Longstanding, inflammatory, multiple joint involvement
OA with CCP
Chronic OA with superimposed CCP
Clinical
features
Joint pain
Character
Painful
Radiation
Nil
Onset
Acute
Associated symptoms
Swelling, erythema, heat, tender
Site
Large joint e.g. knee
Timing
Self limiting
Diagnosis
Examination
Joint examination
Large joint, swelling, erythema, tenderness,
may have signs of OA, no tophii
Investigations
Bloods
FBC, ESR/CRP (exclude infection, autoimmune),
uric acid (exclude gout), U+Es, bone profile (phos, Ca, ALP etc.)
Imaging
Joint X-ray: chondrocalcinosis (linear
calcifications parallel to articular surfaces)
Bedside
Obs (exclude sepsis)
Joint aspiration
Exclude septic arthritis
Microscopy: short, brick shaped crystals,
weakly +ve biorefringence
History
SH
Occupation, smoking, alcohol, diet
FH
Gout, arthritis, CPPD
DH
Current meds, allergies
PMH
OA, Haemachromatosis/Wilson's,
hyperparathyroidism, hyperphosphatemia
PC/HPC
Joint pain (SOCRATES), nil red flags
recent illness/surgery/trauma
Management
Conservative
Information, advice, support
Rest and ice packs
Medical
Anti-inflammatories
Indication: acute attack
E.g. NSAIDs, colchine
Steroids
Indication: acute attack
E.g. IA/PO methylprednisolone
Immunosuppressants
Indication: chronic CPPD
E.g. methotrexate, hydroxychloroquine