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 corticosteroids can be effective for both acute and chronic forms.
Calcium pyrophosphate deposition (CPPD) is associated with both acute and chronic arthritis. Acute 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. CPPD typically occurs in older people but can occur in younger people with associated metabolic conditions, such as hyperparathyroidism and hemochromatosis. Familial forms of the disease have been reported.
History and exam
Key diagnostic factors
- painful and tender joints
- osteoarthritis-like involvement of joints (wrists, shoulders)
- sudden worsening of osteoarthritis
Other diagnostic factors
- red and swollen joints
- joint effusion and fluctuance
- fever and malaise
- advanced age
- family history of CPPD
- other metabolic conditions
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
Investigations to consider
- CT scan
mono- or oligoarticular disease
chronic recurrent involvement of knee, hip, or shoulder joint with severe degeneration
with osteoarthritis-like disease or rheumatoid-like disease
- Acute gouty arthritis
- Acute septic arthritis
- Milwaukee shoulder syndrome
- European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis
- EULAR recommendations for calcium pyrophosphate deposition. Part II: management
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