musculoskeletal and connective tissue disorders
Calcium Pyrophosphate Arthritis
Introduction
Calcium pyrophosphate arthritis (CPP arthritis) involves intra-articular and/or extra-articular deposition of calcium pyrophosphate dihydrate (CPPD) crystals. Manifestations are protean and may be minimal or include intermittent flares of acute arthritis, termed pseudogout or acute CPP arthritis, and a degenerative arthropathy that is often severe. Diagnosis requires identification of CPPD crystals in synovial fluid. Treatment of pseudogout flares is with intra-articular corticosteroids or oral glucocorticoids, nonsteroidal anti-inflammatory drugs (NSAIDs), orcolchicine. (See also Overview of Crystal-Induced Arthritides .) CPPD crystal deposition (chondrocalcinosis, pyrophosphate arthropathy), whether symptomatic and asymptomatic, becomes more common with age. Asymptomatic chondrocalcinosis is common in the knee, metacarpophalangeal joints, hip, wrist, annulus fibrosus of the intervertebral disks, symphysis pubis, and spine. Men and women are affected about equally. The incidental detection of chondrocalcinosis on plain x-rays or other imaging does not mean that the patient should be treated for CPP arthritis. 