Calcium Pyrophosphate Deposition Disease - finished

Question 1

Definition of CPDD

Answer 1

A metabolic arthropathy that is caused by the deposition of calcium pyrophosphate dihydrate in and around joints. The typical sites of deposition are around the articular cartilage and fibrocartilage

Question 2

What are 3 manifestations of calcium pyrophosphate deposition disease/ disease progression?

Answer 2

X-ray evidence of articular cartilage calcification (chondrocalcinosis)

Intermittent attacks of acute crystal induced synovitis (pseudogout)

A degradative arthropathy (chronic pyrophosphate arthropathy)

Question 3

What are the 3 main common locations for chondrocalcinosis?

Answer 3

Knee
Pubic symph
Wrist (triangular fibrocartilage)

Question 4

What is the pathological process of CPDD?

Answer 4

• Generation of pyrophosphate by abnormal cartilage.
• Pyrophosphate combines with calcium within the cartilage matrix resulting in growth of CPDD crystals.
• CPDD crystals for micro tophi-like structures within the cartilage
  This process is called chondrocalcinosis and is most pronounced in fibrocartilage

Occasional shedding of CPDD crystals into the joint causes a gout-like acute inflammatory reaction.

Long standing CPDD crystal deposition results in chronic arthritis and development of OA in joints where OA is not normally seen (elbows, ankles etc)

Question 5

What are the clinical features of pseudogout/ acute synovitis?

Answer 5

• Typically presents in middle aged women
• History of minor illness or trauma
• Manifestations of acute arthritis in a large joint (i.e. acute pain, swelling, tense joint)
• Arthritis lasts a few weeks and then subsides spontaneously

Question 6

What are the clinical features of chronic pyrophosphate arthropathy?

Answer 6

• Typically elderly female
• Observe polyarticular OA affecting the large and unusual joints.
• SSx of chronic arthritis :
  - pain
  - stiffness
  - swelling
  - crepitus
  - decreased ROM

Question 7

What are the radiological manifestations of CPDD?

Answer 7

Calcification:

• Intra and peri-articular
• in knees, shoulders, pub symph, wrists, hips and IVDs
• In articular cartilage observe a thin line of calcification parallel to the joint
• In fibrocartilage observe cloudy irregular opacities

Degenerative changes:

• Similar to OA
• OA occurs in unusual joints
• May have joint destruction

Question 8

Gout VS Pseudogout

• Joints
• Pain
• Inflam
• Aetiology
• Crystal type and description
• Common in

Answer 8

Small joints - > Larger joints
Intense pain - > Moderate pain
Acute inflam - > Moderate swelling
Hyperuricaemia - > Chondrocalcinosis
Uric acid crystals - > Calcium pyrophosphate crystals
Needle shaped - > Polygonal +ve birefringent
-ve birefringent crystals crystal
Men - > Women