Calcium Pyrophosphate Dihydrate Crystal Deposition Disease (Pseudogout)
Also Know As Crystal Arthritis
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Calcium Pyrophosphate Dihydrate Crystal Deposition Disease (Chondrocalcinosis)
Calcium Pyrophosphate Dihydrate Crystal Deposition Disease (CPDD) also known as chondrocalcinosis, pseudogout or pyrophosphate arthropathy is a kind of arthritis wherein calcium phosphate crystals accumulate in the joints. [1] The European League Against Rheumatism (EULAR) consensus panel suggested how these terminologies should be utilized. Pseudogout correctly refers to the acute attacks of CPDD that mimics urate gout. In cases where there is only radiographic evidence in hyaline articular cartilage and/or fibrocartilage, chondrocalcinosis applies better. Lastly, pyrophosphate arthropathy describes a joint destruction or radiographic aberration associated with CPPD crystal deposition. [2]
Epidemiology
The risk of getting the disease increases with age. Usual occurrence is at the fifth decade of life. About half of people aged 85 and above have CPDD evidences seen in radiologic imaging. Women are more affected with female to male ratio estimated to be 1.4:1. [3]
Causes
The actual cause remains to be investigated. Aging and genetic factors are thought to play a role. [3] Some of the risk factors identified are dehydration, hyperparathyroidism, hyperthyroidism, hemachromatosis, myxedema, diabetes mellitus, and decreased minerals such as phosphate and magnesium. [4]
Signs and Symptoms
The asymptomatic form is the most common presentation. In this case, evidence of the disease is only seen in radiographic images. [3] In acute pseudogout, there is usually monoarticular or oligoarticular arthritis. Any joint can be affected but the mostly affected is the knee or the wrist. On clinical examination there are findings of warmth, tenderness, swelling and pain due to the inflammatory process. [3]
Diagnosis
After careful history taking and physical examination, laboratory exams are often performed. Complete blood exam may show elevated WBC count. Imaging studies are important to demonstrate deposition or calcification. Serum calcium is often normal.[4] Other procedures include obtaining levels of iron, phosphorus, magnesium and alkaline phosphatase, TIBC, transferrin saturation, ferritin, thyroid-stimulating hormone (TSH) and thyroxine. [3]
Treatment
Treatment is often done only in symptomatic patients. Pharmacologic treatment includes non-steroidal inflammatory drugs and colchicines for acute attacks. [4] The use of low dose steroid such as prednisone may be used for chronic arthropathies. [3]
References:
- http://arthritis.about.com/cs/gout/g/cppd.htm
- http://www.uptodate.com/contents/treatment-of-calcium-pyrophosphate-crystal-deposition-disease
- http://emedicine.medscape.com/article/330936-overview#a0156
- http://www.virtualmedicalcentre.com/diseases/calcium-pyrophosphate-deposition-disease-chondrocalcinosis-pseudogout/142
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