CPPD & HADD Flashcards
What does CPPD stand for?
Calcium Pyrophosphate Dihydrate
What is another name for CPPD crystal deposition disease?
pseudogout
What age demographic is affected by CPPD deposition disease?
- onset after 30 yrs of age, peak at age 60
- experienced by 1/2 of those >85 yrs
What are the potential causes of CPPD deposition disease?
- idiopathic
- hereditary (rare)
- trauma
- metabolic disorders
What other pathologies may CPPD deposition disease simulate?
- gout (crystalline deposits in soft tiss.)
- RA (can be bilat. & symmetric)
- DJD (dull/achy pain)
- NA (slower destruction than CPPD)
- septic arthritis
Describe the pathogenesis of CPPD deposition disease.
- accumulation of CPPD crystals around joint tissue
- phagocytosis of CPPD crystals by synovial fluid & PMNs –> release of inflam. mediators
Where may CPPD crystals accumulate?
- articular cartilage (hyaline & fibrocartilage)
- synovial membranes
- tendons & ligaments
What is the term for the radiographic finding of crystalline deposits in articular cartilage?
chondrocalcinosis
What is the prognosis of acute CPPD attacks?
may be self-limiting (1 day to several days)
What is the prognosis of severe CPPD attacks involving peripheral and axial joints?
resolve slowly over weeks
What are the clinical manifestations of CPPD deposition disease?
- many cases asymptomatic (early stage)
- chronic progressive jt pain
- reduced ROM
- crepitus
- can be BL symmetric
- favors LE (knee) & peripheral jts (wrists, hands)
What types of cartilage does CPPD deposit into?
- hyaline
- fibrocartilage
What are the radiographic characteristics of CPPD?
- chondrocalcinosis
- calcification of periarticular soft tissues (synovium, fat, tendons, ligaments)
What is the most common pathology to involve chondrocalcinosis?
joint degeneration
(on boards, MC= CPPD)
What pathologies may involve chondrocalcinosis?
- DJD
- CPPD
- HPT (^Ca)
- Hemochromatosis
- Wilson’s Dz
What type of cartilage are menisci composed of?
fibrocartilage
Hyaline cartilage is composed of a _____ matrix which has what property related to water?
proteoglycans; hydrophilic
How does CPPD affect hyaline cartilage?
shreds cartilage and accelerates degenerative process
A patient who has deposits of calcium pyrophosphate dihydrate crystals in the meniscus of the knee, and synovial membrane will develop what condition?
pyrophosphate arthropathy
(long-standing degeneration in CPPD)
CPPD responds to what treatments?
- rest
- joint protection
- NSAIDs
- colchicine (for acute attacks)
- corticosteroids (only during exacerbations)
What treatment that is used for RA and psoriatic arthritis does NOT work for CPPD?
DMARDs
What is the average radiographic latent period for CPPD?
within 2 years
What does HADD stand for?
(calcium) hydroxyapatite deposition disease
What are other names for HADD?
- calcific tendinosis
- calcific bursitis
What tissues can HADD deposit into?
- bursa
- ligaments
- tendons
(“hadd a BLT”)
What is the most commonly involved tissue in HADD?
tendons
(calcific tendinosis)
How can you differentiate between CPPD and HADD radiographically?
CPPD involves cartilage, HADD does not
Describe the pathogenesis of HADD
- 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
What is the most common location in the body to find HADD?
shoulder (rotator cuff)
How does HADD in the shoulder present clinically?
as supraspinatus tendinosis
(should get x-rays)
What tissue in the c-spine is HADD commonly found?
longus coli tendon
How does HADD in the c-spine present clinically?
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
What age group is commonly affected by HADD?
40+
What are the general clinical manifestations of HADD?
- may be asymptomatic at first
- painful attacks can last days to months
- reduced ROM
HADD responds to what treatments?
ultrasound or shockwave (breaks up Ca2+)
How is HADD in the c-spine treated?
leave it alone
(naturally Hx of ~2wks)
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?
CPPD
