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Calcium Pyrophosphate Dihydrate Disease (Pseudogout)

 

Clinical manifestations: CPPD can present with a wide range of clinical features

  • Asymptomatic disease
  •  Pseudo-RA: clinically very similar to RA, but joints do not demonstrate erosions
  • Pseudo-OA: involves joints typically not affected by OA: MCP, shoulder, elbow, spine
  • Pseudo-neruopathhic joint disease: joint degeneration resembling Charcot joint, with intact neurologic function
  • Diffuse inflammatory response that mimics sepsis
  •  Pseudogout:
    • Like gout, can be triggered by severe illness
    • Unlike gout, typically involves larger joints, such as the knee (50% of cases) and wrist
    • Crystal analysis yields weakly-positively birefringent rhomboid crystals, but these are notoriously difficult to detect, and thus sensitivity poor
    • Plain films can show chondrocalcinosis
    • Associated conditions:
      • Hemochromatosis
      • Hyperparathyroidism
      • Hypothyroidism
      • Hypomagnesemia
      • Hypophosphatemia
      • Familial hypocalciuric hypercalcemia

 

(Christopher Woo MD, 11/1/10)