Calcium Pyrophosphate Deposition
Arthropathy
(CPPD)
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- Terminology
- Chondrocalcinosis – calcification of hyaline (articular) cartilage or fibrocartilage (menisci) or ligaments
- Usually but not always due to calcium pyrophosphate
- May also be seen with oxalosis
- Pseudogout is an older clinical term referring to acute pain (similar to gout) but without response to the usual treatment for gout
- CPPD – Deposition of crystals in the joint with or without chondrocalcinosis
- Most common crystalline arthropathy
- Prevalence
- Widespread in older population
- M:F = 3:2
- Clinical
- Intermittent attacks
- May be mono-articular or polyarticular (more often)
- Types
- Frequently occurs in association with osteoarthritis
- Aging process with no known etiology
- In association with metabolic diseases
- Hyperparathyroidism
- Hemochromatosis
- Hypothyroidism
- Hypomagnesemia
- Hypophosphatasia
- Ochronosis
- Calcium pyrophosphate crystals may be recovered from synovial fluid (most often) or within leukocytes
- Characteristic weakly positive birefringent diffraction pattern
- Location
- Knee
- Especially meniscus
- Cartilage of patellofemoral joint
- Wrist
- Triangular fibrocartilage in distal radioulnar joint bilaterally
- Pelvis
- Sacroiliac joint
- Symphysis
- Spine
- Annulus fibrosis of lumbar intervertebral disk
- Never in nucleus pulposus as in ochronosis
- Shoulder
- Glenoid
- Hip
- Elbow
- Ankle
- Acromioclavicular joint
- Imaging Findings
- Pyrophosphate arthropathy resembles osteoarthritis
- Joint space narrowing
- Extensive subchondral sclerosis
- Polyarticular chondrocalcinosis (in fibro- and hyaline cartilage)
- In knee, disproportionate narrowing of patellofemoral joint
- Large subchondral cysts are a hallmark
- Numerous intra-articular bodies
- Fragmentation of subchondral bone
- In hand, beaklike projections from 2nd, 3rd metacarpal heads
- Subchondral cysts (esp. carpal bones)
- Unusual distribution of disease (radiocarpal/ulnar joint, patellofemoral joint)
- SLAC - scapholunate advanced collapse
- Caused by laxness of the ligaments and malpositioning of the scaphoid and lunate
- May develop in 25% with CPPD but also occurs for other reasons
- Radio-scaphoid, but not radio-lunate, joint is narrowed
- Usually have a deep concave scaphoid fossa in distal radius in CPPD as opposed to SLAC from trauma
- Treatment
- Oral anti-inflammatory drugs (NSAIDs) and corticosteroid joint injections successful in shortening the length of pain and dysfunction of acute attacks of pseudogout
- Treatments to prevent attacks, such as colchicine, may be effective
- No treatment is available to dissolve the crystal deposits
- Controlling inflammation helps to halt the progression of joint degeneration
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CPPD Arthropathy. There is chondrocalcinosis in the triangular fibrocartilage of the ulna (white arrow). There is narrowing of the radio-carpal joint and proximal migration of the capitate into the widened space between the scaphoid and the lunate (yellow arrow).
For this same photo without the arrows, click here
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Imaging of the Wrist and Hand: Gilula and Yin, W.B. Saunders, 1996. |
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