When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Calcium pyrophosphate deposition

Last reviewed: 23 Sep 2025
Last updated: 15 Feb 2024

Summary

Definição

História e exame físico

Principais fatores diagnósticos

  • painful and tender joints
  • osteoarthritis-like involvement of joints (wrists, shoulders)
  • sudden worsening of osteoarthritis
Detalhes completos

Outros fatores diagnósticos

  • red and swollen joints
  • joint effusion and fluctuance
  • fever and malaise
Detalhes completos

Fatores de risco

  • advanced age
  • injury
  • hyperparathyroidism
  • hemochromatosis
  • family history of CPPD
  • hypomagnesemia
  • hypophosphatasia
  • gout
  • other metabolic conditions
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • arthrocentesis with synovial fluid analysis
  • radiographs of affected joints
  • serum calcium
  • serum parathyroid hormone
  • iron studies
  • serum magnesium
  • serum alkaline phosphatase
Detalhes completos

Investigações a serem consideradas

  • ultrasonography
  • CT scan
Detalhes completos

Algoritmo de tratamento

AGUDA

mono- or oligoarticular disease

polyarticular disease

CONTÍNUA

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

with osteoarthritis-like disease or rheumatoid-like disease

Colaboradores

Autores

Ann K. Rosenthal, MD
Ann K. Rosenthal

Professor of Medicine

Medical College of Wisconsin

Milwaukee

WI

Declarações

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

Revisores

Priyanka Iyer, MD

Clinical Assistant Professor

University of California, Irvine

Irvine

CA

Disclosures

PI declares that she has no competing interests.

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.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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.Full text  Abstract

Rosenthal AK, Ryan LM. Calcium Pyrophosphate Deposition Disease. N Engl J Med. 2016 Jun 30;374(26):2575-84.Full text  Abstract

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.Full text  Abstract

Creamer P. Intra-articular corticosteroid treatment in osteoarthritis. Curr Opin Rheumatol. 1999 Sep;11(5):417-21. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • 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
  • Videos

    Aspiration and injection of the knee: animated demonstration

    Más vídeos
  • padlock-lockedInicie sesión o suscríbase para acceder a todo el BMJ Best Practice

El uso de este contenido está sujeto a nuestra cláusula de exención de responsabilidad