Calcium Pyrophosphate Deposition CPPD

Question 1

What is CPPD?

Answer 1

It is an umbrella term used to describe different patterns of disease.

Question 2

What does CPPD include?

Answer 2

• Acute CCP crystal arthritis - Previously known as pseudogout. Like gout it causes an acute monoarthropathy, typically of larger joints in elderly patients. Usually spontaneous and self-limiting
• Chronic CCP - Inflammatory RA-like (symmetrical) polyarthritis and synovitis
• Osteoarthritis withCPPD - chronic polyarticular osteoarthritis with superimposed acute CCP attacks

Question 3

What are the risk factors with CPPD?

Answer 3

• Old age
• hyperparathyroidism
• haeochromatosis
• hyperphosphataemia

Question 4

What tests can be done to distinguish it from other forms of arthritis?

Answer 4

Polarised light microscopy of synovial fluid shows weakly positively bifringent crystals.
It is associated with soft tissue calcium deposition on x-ray

Question 5

How is it managed?

Answer 5

Acute attacks - Cool packs, rest aspiration and intra-articular steroids.
NSAIDs (+PPI) +/- colchicine may prevent acute attacks.

Chronic - methotrexate and hydroxyxholoroquine have a role