Calcium pyrophosphate deposition

Last reviewed: 19 Apr 2022
Last updated: 10 Dec 2019

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • painful and tender joints
  • osteoarthritis-like involvement of joints (wrists, shoulders)
  • sudden worsening of osteoarthritis
More key diagnostic factors

Other diagnostic factors

  • red and swollen joints
  • joint effusion and fluctuance
  • fever and malaise
Other diagnostic factors

Risk factors

  • advanced age
  • injury
  • hyperparathyroidism
  • haemochromatosis
  • family history of CPPD
  • hypomagnesaemia
  • hypophosphatasia
  • gout
  • other metabolic conditions
More risk factors

Diagnostic investigations

1st investigations to order

  • arthrocentesis with synovial fluid analysis
  • x-rays of affected joints
  • serum calcium
  • serum parathyroid hormone
  • iron studies
  • serum magnesium
  • serum alkaline phosphatase
More 1st investigations to order

Investigations to consider

  • ultrasonography
  • CT scan
More investigations to consider

Treatment algorithm

ACUTE

mono- or oligo-articular disease

polyarticular disease

ONGOING

chronic recurrent involvement of knee, hip, or shoulder joint with severe degeneration

with osteoarthritis-like disease or rheumatoid-like disease

Contributors

Authors

Ann K. Rosenthal, MD
Ann K. Rosenthal

Professor of Medicine

Medical College of Wisconsin

Milwaukee

WI

Disclosures

AKR is the author of several articles cited in this topic.

Peer reviewers

Ade Adebajo, MBBS, MSc, FRCP (Glasgow), FACP

Consultant Rheumatologist

Rheumatology

University of Sheffield Medical School

Sheffield

UK

Disclosures

AA declares that he has no competing interests.

Ralph Schumacher, MD

Professor of Medicine

VA Medical Center

Arthritis Clinic

Philadelphia

PA

Disclosures

RS declares that he has no competing interests. We have since been made aware that RS is deceased.

  • Calcium pyrophosphate deposition images
  • Differentials

    • Acute gouty arthritis
    • Acute septic arthritis
    • Milwaukee shoulder syndrome
    More Differentials
  • Guidelines

    • European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis
    • EULAR recommendations for calcium pyrophosphate deposition. Part II: management
    More Guidelines
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