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Last Updated: 5/28/2014  

Calcium Pyrophosphate Deposition Disease

Diagnosis:
  • 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.

Therapy
  • Encourage patients with acute CPP crystal arthritis to use ice and to rest the joint.

  • Use NSAIDs to treat acute and chronic CPP crystal arthritis.

  • Use oral colchicine as option for patients with acute CPP crystal arthritis, to prevent episodes of acute CPPD crystal arthritis, or to treat patients with chronic CPP crystal arthritis.

  • Use intra-articular steroid injection or oral glucocorticoids as a treatment option in patients with acute CPPD crystal arthritis disease, particularly those in whom NSAIDs and colchicine cannot be used.

  • Consider second-line anti-inflammatory drugs in patients with refractory CPP crystal arthritis.

  • Encourage patients with chronic CPP disease with or without osteoarthritis of the hip or knee to exercise.

DOI: 10.7326/d357
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Authors and Disclosures:
Kenneth Kalunian, MD has nothing to disclose. Bruce Rothschild, MD has nothing to disclose.

The following editors of ACP Smart Medicine have nothing to disclose: Deborah Korenstein, MD, FACP, Editor in Chief; Richard B. Lynn, MD, FACP, Editor; and Davoren Chick, MD, FACP, Editor.

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