Pseudogout (CPPD)

What is Pseudogout?

Calcium pyrophosphate deposition disease (CPPD) is a crystal deposition arthropathy involving the synovial and periarticular tissues. The condition can present as acute or chronic inflammatory arthritis.

Acute calcium pyrophosphate (CPP) deposition arthritis, frequently referred to as "pseudogout" presents as an acute flare of synovitis that resembles acute urate arthropathy (gout). The common crystals involved are calcium pyrophosphate dihydrate. Most patients affected by acute calcium pyrophosphate deposition arthritis are over the age of 65 years.

Aetiology

The deposition of calcium pyrophosphate may be due to an imbalance between the production of pyrophosphate and the levels of pyrophosphatases in diseased cartilage. This pyrophosphate combines with calcium in synovium and adjacent tissues to form CPP. The formed CCP causes activation of the immune system causing soft tissue injury.

Hyperparathyroidism is significantly associated with CPPD. Other comorbidities include gout, osteoarthritis, rheumatoid arthritis, and hemochromatosis.

Sign and symptoms

The manifestations mimic acute urate arthropathy. 50 percent of the patients complain of low grade fever. Other signs like joint oedema, erythema and tenderness. It commonly affects the knee joint, however weight-bearing joints like hips, knees or shoulders may also be involved.

Diagnosis

A thorough physical examination of the patients must be performed. Subsequently, arthrocentesis for synovial fluid analysis must be undertaken. The presence of rhomboid crystals in the synovial fluid aspirate confirms the diagnosis. Radiological signs such as joint cartilage calcification, known as chondrocalcinosis, may be visualized through radiographic imaging.

General management

The treatment for patients with calcium pyrophosphate deposition disease is based on decreasing inflammation and stabilizing any underlying metabolic disease that may predispose to calcium pyrophosphate crystal deposition. Also, measures like application of ice packs and joint rest with restriction of any weight-bearing exercise are advised.

Warning: Above information provided is an overview of the disease, we strongly recommend a doctor's consultation to prevent further advancement of disease and/or development of complications.

Disclaimer: The information provided herein on request, is not to be taken as a replacement for medical advice or diagnosis or treatment of any medical condition. DO NOT SELF MEDICATE. PLEASE CONSULT YOUR PHYSICIAN FOR PROPER DIAGNOSIS AND PRESCRIPTION.