CPPD Flashcards
- deposition of CPP crystals in articular tissues is most common in the elderly
- occurs in 10-15% of persons age 65-75 years , 30-50% of those >85 years
- Asymptomatic in most cases
- cause is uncertain
CALCIUM PYROPHOSPHATE DEPOSITION (CPPD) DISEASE
Mutations in the ANKH gene
CPPD
CLINICAL MANIFESTATIONS OF CPPD
- may be asymptomatic
- acute/subacute or chronic
- may cause acute synovitis superimposed on chronically involved joints
- association with or enhancement of peculiar forms of osteoarthritis
- induction of severe destructive disease that may radiographically mimic neuropathic arthritis
- intervertebral disk and ligament calcification with restriction of spine mobility, the crowned
dens syndrome, or spinal stenosis (most commonly seen in the elderly) - production of chronic symmetric synovitis that is clinically similar to rheumatoid arthritis
- rarely periarticular tophus-like nodules
Most frequently affected in CPPD
Knee joint
Other sites affected in CPPD
- wrist
- shoulder
- ankle
- elbow
- hands
- temporomandibular joint
Is seen in at least 2/3 of patients
polyarticular
diagnostic likelihood of CPPD
If radiographs or ultrasound reveal punctate and/or linear radiodense deposits within fibrocartilaginous joint menisci or articular hyaline cartilage (chondrocalcinosis)
Definitive diagnosis of CPPD
typical rhomboid or rodlike crystals (generally weakly positively birefringent or
nonbirefringent w/ polarized light) in synovial fluid or articular tissue
is essential to rule out the possibility of infection in dx of CPPD
synovial fluid analysis with microbial cultures
synovial fluid analysis with microbial cultures IN CPPD
Neutrophil
TX of CPPD
- rest, joint aspiration, and NSAIDs or by intraarticular
glucocorticoid injection may result in more rapid return to prior status. - Low doses of colchicine for frequent recurrent attacks
- Severe polyarticular attacks usually require short courses of glucocorticoids or an IL-18 antagonist, anakinra
is the primary mineral of normal bone and teeth
Apatite
Apatite crystals are deposited primarily on
matrix vessels
Apatite aggregates are commonly present in synovial fluid in an extremely destructive chronic arthropathy of the elderly that occurs most often in the ___
shoulders (Milwaukee shoulder)
most common sites of apatite deposition include
- bursae and tendons in and/or around the knees,
- shoulders,
- hips, and
- fingers
Clinical manifestations of CALCIUM APATITE DEPOSITION DISEASE
- asymptomatic radiographic abnormalities,
- acute synovitis,
- bursitis,
- tendinitis,
- chronic destructive arthropathy
synovial fluid leukocyte count in apatite arthritis is ___ despite dramatic symptoms, with predominance of mononuclear cells
usually low (<2000/uL)
Clumps of crystals may appear as 1- to 20-um shiny intra- or extracellular
nonbirefringent globules or aggregates that stain purplish with _____
and bright red with ____.
Tetracycline binding and other investigative techniques are under
consideration as labeling alternatives.
- Wright’s stain
- alizarin red S
is a rare hereditary metabolic disorder
Primary oxalosis
- Hyperoxalemia
- deposition of CaOx crystals in tissues
- nephrocalcinosis and renal failure
- Acute and/or chronic CaOx arthritis, periarthritis, and bone disease may complicate primary oxalosis during later years of illness
CaOx DEPOSITION DISEASE
- more common than the primary disorder
- In chronic renal disease, CaOx deposits have long been recognized in visceral
organs, blood vessels, bones, and cartilage and are now known to be one of the causes of arthritis in chronic renal failure
Secondary oxalosis
CaOx-induced synovial effusions are usually ____ with ___
noninflammatory, with <2000 leukocytes/uL, or mildly inflammatory
most easily recognized forms of CaQOx crystals are ____, have strong birefringence and stain with alizarin red S
bipyramidal
TREATMENT: CaOx DEPOSITION DISEASE
- NSAIDs,
- colchicine,
- intraarticular glucocorticoids,
- and/or an increased frequency of dialysis has produced only slight
improvement.
