CPPD & HADD

Question 1

What does CPPD stand for?

Answer 1

Calcium Pyrophosphate Dihydrate

Question 2

What is another name for CPPD crystal deposition disease?

Answer 2

pseudogout

Question 3

What age demographic is affected by CPPD deposition disease?

Answer 3

• onset after 30 yrs of age, peak at age 60
• experienced by 1/2 of those >85 yrs

Question 4

What are the potential causes of CPPD deposition disease?

Answer 4

• idiopathic
• hereditary (rare)
• trauma
• metabolic disorders

Question 5

What other pathologies may CPPD deposition disease simulate?

Answer 5

• gout (crystalline deposits in soft tiss.)
• RA (can be bilat. & symmetric)
• DJD (dull/achy pain)
• NA (slower destruction than CPPD)
• septic arthritis

Question 6

Describe the pathogenesis of CPPD deposition disease.

Answer 6

• accumulation of CPPD crystals around joint tissue
• phagocytosis of CPPD crystals by synovial fluid & PMNs –> release of inflam. mediators

Question 7

Where may CPPD crystals accumulate?

Answer 7

• articular cartilage (hyaline & fibrocartilage)
• synovial membranes
• tendons & ligaments

Question 8

What is the term for the radiographic finding of crystalline deposits in articular cartilage?

Answer 8

chondrocalcinosis

Question 9

What is the prognosis of acute CPPD attacks?

Answer 9

may be self-limiting (1 day to several days)

Question 10

What is the prognosis of severe CPPD attacks involving peripheral and axial joints?

Answer 10

resolve slowly over weeks

Question 11

What are the clinical manifestations of CPPD deposition disease?

Answer 11

• many cases asymptomatic (early stage)
• chronic progressive jt pain
• reduced ROM
• crepitus
• can be BL symmetric
• favors LE (knee) & peripheral jts (wrists, hands)

Question 12

What types of cartilage does CPPD deposit into?

Answer 12

• hyaline
• fibrocartilage

Question 13

What are the radiographic characteristics of CPPD?

Answer 13

• chondrocalcinosis
• calcification of periarticular soft tissues (synovium, fat, tendons, ligaments)

Question 14

What is the most common pathology to involve chondrocalcinosis?

Answer 14

joint degeneration
(on boards, MC= CPPD)

Question 15

What pathologies may involve chondrocalcinosis?

Answer 15

• DJD
• CPPD
• HPT (^Ca)
• Hemochromatosis
• Wilson’s Dz

Question 16

What type of cartilage are menisci composed of?

Answer 16

fibrocartilage

Question 17

Hyaline cartilage is composed of a _____ matrix which has what property related to water?

Answer 17

proteoglycans; hydrophilic

Question 18

How does CPPD affect hyaline cartilage?

Answer 18

shreds cartilage and accelerates degenerative process

Question 19

A patient who has deposits of calcium pyrophosphate dihydrate crystals in the meniscus of the knee, and synovial membrane will develop what condition?

Answer 19

pyrophosphate arthropathy
(long-standing degeneration in CPPD)

Question 20

CPPD responds to what treatments?

Answer 20

• rest
• joint protection
• NSAIDs
• colchicine (for acute attacks)
• corticosteroids (only during exacerbations)

Question 21

What treatment that is used for RA and psoriatic arthritis does NOT work for CPPD?

Answer 21

DMARDs

Question 22

What is the average radiographic latent period for CPPD?

Answer 22

within 2 years

Question 23

What does HADD stand for?

Answer 23

(calcium) hydroxyapatite deposition disease

Question 24

What are other names for HADD?

Answer 24

• calcific tendinosis
• calcific bursitis

Question 25

What tissues can HADD deposit into?

Answer 25

• bursa
• ligaments
• tendons
  (“hadd a BLT”)

Question 26

What is the most commonly involved tissue in HADD?

Answer 26

tendons
(calcific tendinosis)

Question 27

How can you differentiate between CPPD and HADD radiographically?

Answer 27

CPPD involves cartilage, HADD does not

Question 28

Describe the pathogenesis of HADD

Answer 28

• breakdown of bursa/lig./tendons as a result of over-use or trauma
• hydroxyapatite deposits in leukocytes & mononuclear cells and migrate into area
• hydroxyapatite precipitates out and calcifies tissue

Question 29

What is the most common location in the body to find HADD?

Answer 29

shoulder (rotator cuff)

Question 30

How does HADD in the shoulder present clinically?

Answer 30

as supraspinatus tendinosis
(should get x-rays)

Question 31

What tissue in the c-spine is HADD commonly found?

Answer 31

longus coli tendon

Question 32

How does HADD in the c-spine present clinically?

Answer 32

as torticollis (in longus coli tendon)
- pain & limited ROM
- some rotation & lat. flexion (neck tilted to side)
- calcification behind C1 ant. tubercle on x-ray
- natural Hx of 2 weeks

Question 33

What age group is commonly affected by HADD?

Answer 33

40+

Question 34

What are the general clinical manifestations of HADD?

Answer 34

• may be asymptomatic at first
• painful attacks can last days to months
• reduced ROM

Question 35

HADD responds to what treatments?

Answer 35

ultrasound or shockwave (breaks up Ca2+)

Question 36

How is HADD in the c-spine treated?

Answer 36

leave it alone
(naturally Hx of ~2wks)

Question 37

A 55 year old male has bilateral knee pain, redness, and swelling for many years. The pain comes and goes, with the interval between flare-ups shortening and the episodes lengthening. Radiographs reveal chondrocalcinosis of the menisci and moderate degenerative changes. What is the most likely diagnosis?

Answer 37

CPPD