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Review
. 2014 May 8:6:39-47.
doi: 10.2147/OARRR.S39039. eCollection 2014.

Calcium pyrophosphate crystal deposition disease: diagnosis and treatment

José Luis Rosales-Alexander  1 , Jerónimo Balsalobre Aznar  1 , César Magro-Checa  2
Affiliations
Review

Calcium pyrophosphate crystal deposition disease: diagnosis and treatment

José Luis Rosales-Alexander et al. Open Access Rheumatol. .

Abstract

Calcium pyrophosphate dihydrate crystal deposition disease (CPPD) is an inflammatory arthritis produced by the deposition of calcium pyrophosphate (CPP) crystals in the synovium and periarticular soft tissues. It is the third most common inflammatory arthritis. Diagnosis is suspected on the basis of the clinical picture and radiographic/laboratory findings. The reference standard for the diagnosis of CPPD is based on the identification of CPP crystals in synovial fluid by light microscopy, compensated polarized light microscopy, or phase contrast microscopy. Most treatment approaches for CPPD are based upon clinical experience and not upon controlled trials. They range - depending on the subtype and the characteristics of symptoms - from no treatment to interleukin-1 blockade antibodies or specific therapy for an underlying disease. This review summarizes all we know so far about the diagnosis and management of CPPD.

Keywords: CPPD; calcium pyrophosphate dihydrate deposition disease; chondrocalcinosis; crystal-induced arthritides.

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Figures

Figure 1
Figure 1
CPP crystal in SF. Notes: (A) Parallelepipedic CPP crystals in SF by light microscopy. (B) CPP crystal by phase contrast microscopy. (C) CPP crystal showing weakly positive birefringence in compensated polarized light microscopy. All images had a 400× increase. Abbreviations: CPP, calcium pyrophosphate; SF, synovial fluid.
Figure 2
Figure 2
Radiographic CC. Notes: (A) Plain film X-ray demonstrating CC involving the menisci (white arrow). (B) Disc of the triangular fibrocartilage complex of the wrist (white arrow). (C) Supraspinatus tendon calcification of the humerus (white arrows). Abbreviation: CC, chondocalcinosis.
Figure 3
Figure 3
US findings of CPP crystals. Notes: (A) US longitudinal scan demonstrates a hyperechoic band (white arrow) within hyaline cartilage of knee. (B) US transversal scan showing thin hyperechoic band within middle layer of hyaline cartilage of knee (white arrow). (C) US longitudinal scan of lateral dorsum of wrist that demonstrates hyperechoic band of carpal triangular ligament (white arrow). Abbreviations: CPP, calcium pyrophosphate; US, ultrasonography; cf, femoral condyle; r, patella.
See this image and copyright information in PMC

References

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