Calcium pyrophosphate crystal deposition disease: diagnosis and treatment

Abstract

Calcium pyrophosphate dihydrate crystal deposition disease (CPPD) is an inflammatory arthritis produced by the deposition of calcium pyrophosphate (CPP) crystals in the synovium and periarticular soft tissues. It is the third most common inflammatory arthritis. Diagnosis is suspected on the basis of the clinical picture and radiographic/laboratory findings. The reference standard for the diagnosis of CPPD is based on the identification of CPP crystals in synovial fluid by light microscopy, compensated polarized light microscopy, or phase contrast microscopy. Most treatment approaches for CPPD are based upon clinical experience and not upon controlled trials. They range – depending on the subtype and the characteristics of symptoms – from no treatment to interleukin-1 blockade antibodies or specific therapy for an underlying disease. This review summarizes all we know so far about the diagnosis and management of CPPD.

Acute Calcium Pyrophosphate Arthritis after Parathyroidectomy

“…CPP kristalleri, eklem içi ve eklem çevresi yapılarda depolanarak çeşitli klinik tablolara yol açabilir (2). Avrupa Romatizma Birliği tarafından 2011 yılında "CPP depolanması (CPPD)" ismiyle, tek çatı altında farklı klinik durumlar tanımlanmıştır.…”

“…Ultrasonografide de artiküler kıkırdak yüzeyine paralel ince hiperekoik bantlar, fibrokartilaj bölgelerindeki hiperekoik benekli noktalar ve punktat bantlar, serbest kristal agregatlarına benzeyen homojen hiperekoik nodüler ve tendon kalsifikasyonları görülebilir (5). Akut CPP artriti sıklıkla 65 yaş üzerinde, monoartiküler veya oligoartiküler görülmektedir (2). Ancak hiperparatiroidi, hipomagnezemi, hemokromatozis ve hipofosfatazya gibi hastalıklarla birlikte de görülebilir (6).…”

Calcium Pyrophosphate Dihydrate Crystal Deposition Disease Simulating Osteoarthrosis of the Knee: A Case Report

“…15 Joint aspiration and histologic evaluation of crystals in the synovial fluid by light microscopy, compensated polarized light microscopy, or phase contrast light microscopy are considered the criterion standard in the diagnosis of CPPD. 2 Although joint aspiration with crystal identification is the criterion standard, this test is rarely ever performed in a clinical setting because the exact crystal composition is unlikely to alter either the management or the prognosis. A comparison of the characteristics of OA vs CPPD is summarized below (Table 3).…”

“…The parameters for the LLLT therapy were 2 minutes of treatment time at 6 J/cm. 2 In addition, she was given a knee stabilization exercise program. This consisted of quadriceps, hamstring, and gluteal exercises done actively at the patient's home 3 times per week.…”

“…1 CPPD is the third most common inflammatory arthritis, and it tends to affect areas not typically involved by degenerative joint disease. 2 Chondrocalcinosis is depicted as radiopaque calcifications that are linear, punctate, or granular in shape and are seen in the cartilage within affected joint spaces. 3 In the knee, meniscal involvement is seen as coarse granular calcifications, whereas hyaline cartilage involvement appears more as linear densities that parallel the articular surfaces.…”