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Calcium Pyrophosphate Dihydrate Deposition Disease

(CPPD; Pseudogout; Chondrocalcinosis)
  • Definition

    Calcium pyrophosphate dihydrate deposition disease (CPPD) is a build up of calcium crystals in the joints. These crystals cause inflammation in the joints, which causes arthritis like conditions known as:
    • Pseudoosteoarthritis
    • Pseudogout
    • Pseudorheumatoid arthritis
    Arthritis of the Knee
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  • Causes

    It is not known what causes these calcium pyrophosates to form, but genetics appears to play a role.
  • Risk Factors

    Older adults are at increased risk of getting CPPD. Other factors include:
    • Family members with CPPD
    • Previous joint damage
    • Osteoarthritis
    • Hypothyroidism —an underactive thyroid
    • Hemochromatosis —excess iron storage
    • Overactive parathyroid glands
    • Hypercalcemia—excess calcium in the blood
    • Low magnesium levels in the blood
  • Symptoms

    In most cases, CPPD does not lead to symptoms. When symptoms occur, they may come and go in acute attacks called flare-ups.
    Pseudoosteoarthritis symptoms are the most common type, especially in the knee. Symptoms may be on both sides of the body, but are generally worse on one side. Pseudoosteoarthritis may cause:
    • Joint degeneration that worsens over time
    • Joint misalignment and deformity
    • Periodic swelling may be seen in chronic cases
    Pseudogout symptoms occur more frequently in the knee, but can occur in other joints as well. There may be periods of time when there are no symptoms. Attacks of pseudogout may be spontaneous, or may be brought on by surgery, or illness. Pseudogout may cause:
    • Sudden, intense pain in one joint
    • Warmth, redness, and swelling
    • Fever
    • Joint damage from the breakdown of cartilage, which can lead to chronic pain
    Pseudorheumatoid arthritis symptoms occur least frequently and affect both sides of the body. Pseudorheumatoid arthritis may cause:
    • Joint swelling
    • Morning stiffness in the joints
    • Fatigue
    • Joint deformities
  • Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will be done. Tests can be used to diagnose CPPD, or to rule out other conditions.
    Your bodily fluids may be tested. This can be done with:
    • Synovial fluid analysis
    • Blood tests
    Images may be needed of your bodily structures. This can be done with:
  • Treatment

    There is no cure for CPPD and nothing is available to dissolve the crystal deposits that already exist.
    Treatment of CPPD is focused on managing the discomfort during flare-ups. Without treatment, the pain and discomfort of CPPD will go away on its own within days to weeks.
    Talk with your doctor about the best treatment plan for you. Rest, ice, and elevation may help relieve some pain. Other treatment options may include:
    Medications
    Medication may help to decrease inflammation, pain, and stiffness. Medications may include:
    • Nonsteroidal anti-inflammatory drugs (NSAIDs)
    • Corticosteroids
    • Gout medications that change the way the body reacts to the crystals
    Procedures
    Additional procedures may be needed if home care and medications are not effective. Additional procedures may include:
    • Corticosteroid shots—injected directly into the affected joint to decrease inflammation
    • Arthrocentesis—to remove excess fluid and crystals
    • Surgery—to repair or replace any damaged joints
    Steroids Injected into Joint
    Steroid in Knee
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  • Prevention

    There are no current guidelines to prevent CPPD because the cause is not clear.
  • RESOURCES

    American College of Rheumatology http://www.rheumatology.org

    National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca

    The Arthritis Society http://www.arthritis.ca

    References

    Calcium pyrophosphate dihydrate deposition disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 30, 2015. Accessed June 29, 2015.

    Calcium pyrophosphate dihydrate crystal deposition disease (CPPD) (Pseudogout). The Arthritis Foundation website. Available at: http://www.arthritis.org/about-arthritis/types/calcium-pyrophosphate-deposition-disease-cppd/. Accessed June 29, 2015.

    Calcium pyrophosphate deposition (CPPD) (formerly called pseudogout). American College of Rheumatology website. Available at: http://www.rheumatology.org/practice/clinical/patients/diseases%5Fand%5Fconditions/pseudogout.asp. Updated September 2012. Accessed June 29, 2015.

    Tenenbaum J. Inflammatory musculoskeletal conditions in older adults. Geriatrics Aging. 2005; 8(3):14-17.

    Pseudogout. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/orthopaedics-rheumatology/diseases-conditions/hic-pseudogout.aspx. Updated October 17, 2014. Accessed June 29, 2015.

    4/24/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Wise JN, Weissman BN, et al. American College of Radiology (ACR) Appropriateness Criteria for chronic foot pain. Available at: http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/ChronicFootPain.pdf. Updated 2013. Accessed June 29, 2015.

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