Skip to main content

Calcium Pyrophosphate Dihydrate (CPPD) Crystal Deposition Disease

  • Chapter
A Clinician's Pearls and Myths in Rheumatology

Abstract

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is a clinically heterogeneous disorder that is characterized by the presence of intraarticu-lar CPPD crystals. CPPD crystals deposit primarily in cartilage but can traffic within the joint space. CPPD crystals form in the normally unmineralized peri-cellular matrix of articular hyaline and fibrocartilage. The most common sites of involvement are the knee meniscus, the triangular fibrocartilage of the wrist, and the glenohumeral joint. Asymptomatic disease is common in these sites as well as in others (e.g., the symphy-sis pubis). Pathologic cartilage calcification is promoted by changes in inorganic pyrophosphate (PPi) metabolism, extracellular matrix, and chondrocyte differentiation. CPPD deposition disease has a close and complex relationship with osteoarthritis. CPPD most commonly afflicts the elderly but can occur in younger patients who have a familial variant of the condition or who are afflicted with any of several metabolic diseases that predispose to CPPD deposition. No specific evidence-based therapies for CPPD exist. However, the inflammation promoted by CPPD crystal deposition can be managed successfully in most patients through strategies typically employed for the treatment and prophylaxis of gout.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 69.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 89.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Alloway J, Moriarty M, Hoogland Y, et al Comparison of triamcinolone acetonide with indomethacin in the treatment of acute gouty arthritis J Rheumatol. 1993;20:111–3

    PubMed  CAS  Google Scholar 

  • Chollet-Janin A, Finckh A, Dudler J, et al Methotrexate as an alternative therapy for chronic calcium pyrophosphate deposition disease: an exploratory analysis. Arthritis Rheum. 2007;56:688–92

    Article  PubMed  Google Scholar 

  • Dieppe P, Crocker P, Corke C, et al Synovial fluid crystals. Q J Med. 1979;48:533–55

    PubMed  CAS  Google Scholar 

  • Doan TH, Chevalier X, Leparc JM, et al Premature enthusiasm for the use of methotrexate for refractory chondrocalcinosis: comment on the article by Chollet-Janin et al Arthritis Rheum. 2008;58:2210–1

    Article  PubMed  Google Scholar 

  • Ellman MH, Levin B. Chondrocalcinosis in elderly persons. Arthritis Rheum. 1975;18:43–7

    Article  PubMed  CAS  Google Scholar 

  • Fisseler-Eckhoff A, Muller KM. Arthroscopy and chondrocalcinosis. Arthroscopy 1992;8:98–104

    Article  PubMed  CAS  Google Scholar 

  • Galvez J, Saiz E, Linares L, et al Delayed examination of synovial fluid by ordinary and polarized light microscopy to detect and identify crystals. Ann Rheum Dis. 2002;61:444–7

    Article  PubMed  CAS  Google Scholar 

  • Gerster J, Varisco P, Kern J, et al CPPD crystal deposition disease in patients with rheumatoid arthritis. Clin Rheumatol. 2006;25:468–9

    Article  PubMed  CAS  Google Scholar 

  • Gordon C, Swan A, Dieppe P. Detection of crystals in synovial fluid by light microscopy: sensitivity and reliability. Ann Rheum Dis. 1989;48:737–42

    Article  PubMed  CAS  Google Scholar 

  • Goto S, Umehara J, Aizawa T, et al Crowned dens syndrome. J Bone Joint Surg Am. 2007;89:2732–6

    Article  PubMed  Google Scholar 

  • Hasselbacher P. Variation in synovial fluid analysis by hospital laboratories. Arthritis Rheum. 1987;30:637–42

    Article  PubMed  CAS  Google Scholar 

  • Hearn P, Russell R, Elliott J, et al Formation products of calcium pyro-phosphate crystals in vitro and the effect of iron salts. Clin Sci. 1978;54:29P

    Google Scholar 

  • Job-Deslandre C, Menkes CJ, Guinot M, et al Does hypothyroidism increase the prevalence of chondrocalcinosis? Br J Rheumatol. 1993;32:177–9

    Article  Google Scholar 

  • Komatireddy GR, Ellman MH, Brown NL. Lack of association between hypothyroidism and chondrocalcinosis. J Rheumatol. 1989;16:807–8

    PubMed  CAS  Google Scholar 

  • 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; 64:1769–72

    Article  PubMed  CAS  Google Scholar 

  • Masuda I, Ishikawa K. Clinical features of pseudogout attack: a survey of 50 cases. Clin Orth Rel Res. 1987;229:173–81

    Google Scholar 

  • McCarty DJ. Diagnostic mimicry in arthritis: patterns of joint involvement associated with calcium pyrophosphate dihydrate crystal deposits. Ann Rheum Dis. 1975;25:804–9

    Google Scholar 

  • Mitrovic D, Stankovic A, Iriarte-Borda O, et al The prevalence of chon-drocalcinosis in the human knee joint. An autopsy survey. J Rheumatol. 1988;15:633–41

    CAS  Google Scholar 

  • Neogi T, Nevitt M, Niu J, et al Lack of association between chondrocal-cinosis and increased risk of cartilage loss in knees with osteoarthri-tis: results of two prospective longitudinal magnetic resonance imaging studies. Arthritis Rheum. 2006;54:1822–8

    Article  PubMed  CAS  Google Scholar 

  • O'Duffy J. Clinical studies of acute pseudogout attacks. Comments on prevalence, predisposition and treatment. Arthritis Rheum. 1976;19 (Suppl):349–52

    Article  PubMed  Google Scholar 

  • Roane D, Harris M, Carpenter M, et al Prospective use of intramuscular triamcinolone in pseudogout. J Rheumatol. 1997;24:1168–70

    PubMed  CAS  Google Scholar 

  • Rosenthal AK. Calcium crystal deposition and osteoarthritis. Rheum Dis Clin North Am. 2006;32:401–12

    Article  PubMed  Google Scholar 

  • Schumacher H, Sieck M, Rothfuss S, et al Reproducibility of synovial fluid analyses. Arthritis Rheum. 1986;29:770–4

    Article  PubMed  Google Scholar 

  • Terkeltaub R. Firestein GS, Budd RC, Harris ED, Jr., Mclnnes IB, Ruddy S, Sergent JS. Diseases associated with articular deposition of calcium pyrophosphate dihydrate and basic calcium phosphate crystals. In: Firestein G et al, editor. Kelley's textbook of rheumatology, 8th ed, WB Saunders, Philadelphia, 2008

    Google Scholar 

  • Viriyavejkul P, Wilairatana V, Tanavalee A, et al Comparison of characteristics of patients with and without calcium pyrophosphate dihy-drate crystal deposition disease who underwent total knee replacement surgery for osteoarthritis. Osteoarthr Cartil 2006;13: 232–5

    Google Scholar 

  • Visinoni RA, Ferraz MB, Furlanetto RP, et al Hypothyroidism and chondrocalcinosis: new evidence for lack of association between the 2 pathologies. J Rheumatol. 1993;20:1991–2

    PubMed  CAS  Google Scholar 

  • Wilkins E, Dieppe P, Maddison P, et al Osteoarthritis and articular chondrocalcinosis in the elderly. Ann Rheum Dis. 1983;42: 280–4

    Article  PubMed  CAS  Google Scholar 

  • Yuan S, Bien C, Wener M, et al Repeat examination of synovial fluid for crystals: Is it useful? Clin Chem. 2003;49:1562–3

    Article  PubMed  Google Scholar 

  • Zaka R, Williams CJ. Role of the progressive ankylosis gene in cartilage mineralization. Curr Opin Rheumatol. 2006;18:181–6

    Article  PubMed  CAS  Google Scholar 

  • Zhang Y, Johnson K, Russell RG, et al Association of sporadic chondro-calcinosis with a -4-basepair G-to-A transition in the 5′-untranslated region of ANKH that promotes enhanced expression of ANKH protein and excess generation of extracellular inorganic pyrophosphate. Arthritis Rheum. 2005;52:1110–7

    Article  PubMed  CAS  Google Scholar 

  • Zhang Y, Terkeltaub R, Nevitt M, et al Lower prevalence of chondrocal-cinosis in Chinese subjects in Beijing than in white subjects in the United States: the Beijing Osteoarthritis Study. Arthritis Rheum. 2006;54:3508–12

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Springer Science+Business Media B.V.

About this chapter

Cite this chapter

Rosenthal, A.K., Terkeltaub, R.A. (2009). Calcium Pyrophosphate Dihydrate (CPPD) Crystal Deposition Disease. In: Stone, J.H. (eds) A Clinician's Pearls and Myths in Rheumatology. Springer, London. https://doi.org/10.1007/978-1-84800-934-9_37

Download citation

  • DOI: https://doi.org/10.1007/978-1-84800-934-9_37

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84800-933-2

  • Online ISBN: 978-1-84800-934-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics