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Calcium pyrophosphate deposition

Last reviewed: 6 Nov 2023
Last updated: 10 Dec 2019



History and exam

Key diagnostic 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
  • hemochromatosis
  • family history of CPPD
  • hypomagnesemia
  • hypophosphatasia
  • gout
  • other metabolic conditions
More risk factors

Diagnostic investigations

1st investigations to order

  • arthrocentesis with synovial fluid analysis
  • radiographs 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


mono- or oligoarticular disease

polyarticular disease


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

with osteoarthritis-like disease or rheumatoid-like disease



Ann K. Rosenthal, MD
Ann K. Rosenthal

Professor of Medicine

Medical College of Wisconsin




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

Peer reviewers

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

Consultant Rheumatologist


University of Sheffield Medical School




AA declares that he has no competing interests.

Ralph Schumacher, MD

Professor of Medicine

VA Medical Center

Arthritis Clinic




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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