Calcium pyrophosphate deposition - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Calcium pyrophosphate arthritis is caused by deposition of articular calcium pyrophosphate (CPP) crystals.
It can be difficult to diagnose as CPP crystals in synovial fluid can be small, sparse, and difficult to find.
In patients <60 years of age, underlying metabolic conditions associated with calcium pyrophosphate deposition (CPPD), such as hyperparathyroidism or hemochromatosis, should be investigated.
There is no definitive treatment for CPP arthritis, but intra-articular or systemic anti-inflammatory drugs can be effective for both acute and chronic forms.

Knee radiograph with linear calcific deposits of cartilage calcification

From the personal collection of Ann K. Rosenthal, MD

Quick Reference

History & Exam
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Images of intracellular calcium pyrophosphate crystals under compensated polarizing light microscopy
Knee radiograph with linear calcific deposits of cartilage calcification
Wrist radiograph from a patient with chronic calcium pyrophosphate arthritis showing severe degenerative changes

Citations

Key Articles

McCarty DJ. Diagnostic mimicry in arthritis: patterns of joint involvement associated with calcium pyrophosphate dihydrate crystal deposits. Bull Rheum Dis. 1975;25:804-809.
Zhang W, Doherty M, Bardin T, et al. European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann Rheum Dis. 2011 Apr;70(4):563-70.[Abstract][Full Text]
Rosenthal AK, Ryan LM. Calcium Pyrophosphate Deposition Disease. N Engl J Med. 2016 Jun 30;374(26):2575-84.[Abstract][Full Text]
Martinez Sanchis A, Pascual E. Intracellular and extracellular CPPD crystals are a regular feature in synovial fluid from uninflamed joints of patients with CPPD related arthropathy. Ann Rheum Dis. 2005 Dec;64(12):1769-72.[Abstract]
Zhang W, Doherty M, Pascual E, et al. EULAR recommendations for calcium pyrophosphate deposition. Part II: management. Ann Rheum Dis. 2011 Apr;70(4):571-5.[Abstract][Full Text]
Creamer P. Intra-articular corticosteroid treatment in osteoarthritis. Curr Opin Rheumatol. 1999 Sep;11(5):417-21.[Abstract]

Other Online Resources

Arthritis Research UK: acute CPP crystal arthritis (pseudogout)
American College of Rheumatology: calcium pyrophosphate deposition

Referenced Articles

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