Chondrocalcinosis

Chondrocalcinosis
Chondrocalcinosis of the articular and fibrocartilage of the left knee in a patient with calcium pyrophosphate dihydrate deposition disease (CPPD)
ICD-10	M11.1-M11.2
ICD-9	712.3
DiseasesDB	10832
MedlinePlus	000421
MeSH	D002805

Template:Search infobox Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2] Luke Rusowicz-Orazem, B.S.

Synonyms and keywords: Pyrophosphate arthropathy; chondrocalcinosis; pseudogout; CPPD; Calcium pyrophosphate dihydrate deposition disease; CPPD disease

Overview

Calcium pyrophosphate deposition disease (CPPD) is a rheumatologic disorder with varied clinical manifestations due to precipitation of calcium pyrophosphate dihydrate crystals in the connective tissues. It is more commonly known by alternative names that specify certain clinical or radiographic findings, although neither is synonymous with CPPD. Pseudogout refers to the clinically evident acute synovitis with red, tender, and swollen joints that may resemble gouty arthritis (a similar condition with joint deposition of monosodium urate crystals). Chondrocalcinosis, on the other hand, refers to the radiographic evidence of calcification in hyaline and/or fibrocartilage. Pyrophosphate arthropathy is a term that may refer to either of the above, but is uncommonly used.

Causes

Life Threatening Causes

• Wilson's disease 

Causes by Organ System

Cardiovascular	No underlying causes
Chemical/Poisoning	Breakdown of adenosine triphosphate
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	Acromegaly, Growth hormone secreting pituitary adenoma, Hyperparathyroidism, Hypophosphatemia, Hypothyroidism
Environmental	No underlying causes
Gastroenterologic	Wilson's disease
Genetic	Alkaptonuria, Ochronosis, Wilson's disease
Hematologic	Hemochromatosis, Hypercalcemia , Hyperparathyroidism, Hypomagnesemia, Hypophosphatemia
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal/Orthopedic	Osteoarthritis
Neurologic	Hadd
Nutritional/Metabolic	Ochronosis
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	Oxalosis
Rheumatology/Immunology/Allergy	Arthritides, Familial chondrocalcinosis, Gout, Osteoarthritis
Sexual	No underlying causes
Trauma	Trauma
Urologic	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

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Clinical aspects

CPPD crystal deposition disease is a polyarticular arthritis (i.e. it leads to an inflammation of several joints in the body), although it can initially present as monoarticular (i.e. confined to just one joint).

CPPD crystals tend to form within articular tissues. Diagnosis is by microscopy of fluid from a joint aspiration. Rhomboidal crystals should be seen under the microscope which exhibit weakly positive birefringence under polarized light. X-rays of the joint may show signs of chondrocalcinosis. Asymptomatic deposits can form in cartilage, joint capsules, intervertebral discs, tendons, and ligaments. Crystal deposition within cartilage (both hyaline and fibrocartilage) is known as chondrocalcinosis. Chondrocalcinosis initially is only visible microscopically, but if there is enough calcification, we can seen it radiographically as well. Common locations of chondrocalcinosis include the knees, wrists, elbows, and hips.

Crystal-induced synovitis is the result of shedding of crystals in the joint space after rupture of a CPPD deposit. Clinically this presents as an acute inflammatory synovitis very similar to that of an attack of gout, and has been referred to as "pseudogout."

• Other conditions associated with chondrocalcinosis:
  • hyperparathyroidism
  • hemochromatosis
  • hypophosphatemia
  • Renal osteodystrophy

Radiologic findings

Three main manifestations of CPPD deposition:

1. chondrocalcinosis
2. crystal induced synovitis (pseudogout syndrome)
3. pyrophosphate arthropathy

Treatment

Treatment of CPPD is mostly aimed at preventing further crystal formation and reducing symptoms from crystal deposition. CPPD crystal deposition cannot be reversed. If CPPD results from underlying metabolic abnormalities (hyperparathyroidism, hemochromatosis, hypophosphatasia, or hypomagnesemia), these can be treated directly.

For symptomatic joints, treatment is similar to treatment of gout. When a single joint is involved, joint aspiration and intra-articular corticosteroid injection is often used, in addition to NSAIDs and/or colchicine. When multiple joints are involved, joint injection is often impractical, or limited only to the most severely involved joint, and oral systemic treatment is chosen instead.

Because pyrophosphate complexes with magnesium prior to its degradation , and CPPD can result from pathologically low magnesium levels, magnesium supplementation may be of help, particularly in a few patients with underlying hypomagnesemia. It may be possible to end attacks by ingesting large (maximum RDA) doses of magnesium supplement accompanied by vitamin B6 to help absorption. What that does is assist the body in re-dissolving the calcium in the joint fluid, and with maintenance doses, often in the form of snacking on magnesium-rich foods such as almonds, further attacks can be prevented altogether - without medication.

References

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