Recognize the different types of CPPD disease, which include:
Acute CPP crystal arthritis, which is self-limited (“pseudogout”)
Chronic CPP crystal inflammatory arthritis
Asymptomatic CPP, which may be incidentally identified on imaging studies
Osteoarthritis with CPP
For acute CPP crystal arthritis, look for tenderness, warmth, and swelling of a single knee, shoulder, wrist, metatarsophalangeal and interphalangeal joints, or several of these joints.
For chronic CPP crystal arthritis, look for tenderness, swelling, effusions, or chronic deformities, generally asymmetrical, of the shoulders, wrists, metacarpophalangeal joints, or knees.
For the syndrome of osteoarthritis with CPP, look for tenderness with slight synovial thickening and swelling of metacarpophalangeal, proximal, and distal interphalangeal joints in the setting of Heberden's and Bouchard's nodes of the hands.
Use synovial fluid analysis to confirm the diagnosis of CPPD disease, looking for intracellular crystals with positive birefringence.
Consider checking radiographs or ultrasound if synovial analysis cannot be performed or if the diagnosis remains unclear.