Calcium pyrophosphate arthritis
Calcium pyrophosphate dihydrate (CPPD) arthritis is a joint disease that can cause attacks of arthritis. Like gout, crystals form in the joints. But in this arthritis, the crystals are not formed from uric acid.
Calcium pyrophosphate dihydrate deposition disease; CPPD disease; Acute CPPD arthritis; Pseudogout; Calcium pyrophosphate dihydrate (CPPD) crystal deposition; Acute CPPD crystal-associated arthritis; Chondrocalcinosis
Deposition of calcium pyrophosphate dihydrate (CPPD) causes this form of arthritis. The buildup of this chemical forms crystals in the joints. This leads to attacks of joint swelling and pain in the knees, wrists, ankles, and other joints.
Among older adults, CPPD is a common cause of sudden (acute) arthritis in one joint.
CPPD arthritis mainly affects the elderly because joint degeneration and osteoarthritis increases with age. Such joint damage increases the tendency of CPPD deposition. However, CPPD arthritis can sometimes affect younger people who have conditions such as:
- Parathyroid disease
- Thyroid disease
In most cases, CPPD arthritis does not show any symptoms.
Some people with chronic CPPD deposition in large joints may have the following symptoms:
Attacks of joint pain can last for months. There may be no symptoms between attacks.
Because the symptoms are similar, CPPD arthritis can be confused with:
Exams and Tests
Most arthritic conditions show similar symptoms. Carefully testing the joint fluid for crystals can help the doctor diagnose the condition.
You may undergo the following tests:
- An exam of joint fluid to detect white blood cells and calcium pyrophosphate crystals.
- Joint x-rays to look for joint damage and calcium deposits in joint spaces.
- Occasionally, other joint imaging tests may be done, including CT scan, MRI or ultrasound.
- Blood tests to screen for conditions that are linked to calcium pyrophosphate arthritis,
Treatment may involve removing fluid to relieve pressure in the joint. A needle is placed into the joint and fluid is removed (aspirated). Some common treatment options are:
- Steroid injections: to treat severely swollen joints
- Oral steroids: to treat multiple swollen joints
- Nonsteroidal anti-inflammatory medications (NSAIDS): to ease the pain
- Colchicine: to treat acute arthritis of pseudogout
Most people do well with treatment to reduce the acute joint pain. A medicine such as colchicine may help prevent repeat attacks. There is no treatment to remove the CPPD crystals.
Permanent joint damage can occur without treatment.
When to Contact a Medical Professional
Call your health care provider if you have attacks of joint swelling and joint pain.
There is no known way to prevent this disorder. However, treating other problems that may cause CPPD arthritis may make the condition less severe.
Regular follow-up visits may help prevent permanent damage of the affected joints.
Edwards NL. Crystal deposition diseases. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 273.
Schrank KS. Joint disorders. In: Adams JG, ed. Emergency Medicine. 2nd Ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 107.
Terkeltaub R. Calcium crystal disease. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, eds. Kelley's Textbook of Rheumatology. 9th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 96.
Reviewed By: Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.