Calcium pyrophosphate deposition

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.

Calcium pyrophosphate deposition (CPPD) is associated with both acute and chronic arthritis. Acute calcium pyrophosphate (CPP) crystal arthritis is an acute inflammatory arthritis of one or more joints. Knees, wrists, shoulders, ankles, elbows, or hands can be affected. The chronic form of CPP arthritis mimics osteoarthritis or rheumatoid arthritis and is associated with variable degrees of inflammation.[1]McCarty DJ. Diagnostic mimicry in arthritis: patterns of joint involvement associated with calcium pyrophosphate dihydrate crystal deposits. Bull Rheum Dis. 1975;25:804-809. CPPD typically occurs in older people but can occur in younger people with associated metabolic conditions, such as hyperparathyroidism and hemochromatosis.[2]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. http://ard.bmj.com/content/70/4/563.long http://www.ncbi.nlm.nih.gov/pubmed/21216817?tool=bestpractice.com Familial forms of the disease have been reported and often affect younger individuals.[3]Couto AR, Brown MA. Genetic factors in the pathogenesis of CPPD crystal deposition disease. Curr Rheumatol Rep. 2007 Jun;9(3):231-6. http://www.ncbi.nlm.nih.gov/pubmed/17531177?tool=bestpractice.com [4]Williams CJ. Familial calcium pyrophosphate dihydrate deposition disease and the ANKH gene. Curr Opin Rheumatol. 2003 May;15(3):326-31. http://www.ncbi.nlm.nih.gov/pubmed/12707589?tool=bestpractice.com