Calcium pyrophosphate dihydrate deposition disease
Updates to Article Attributes
Calcium pyrophosphate dihydrate disease (CPPD disease) is common, especially in the elderly, and is characterised by the deposition of calcium pyrophosphate in soft tissues and cartilage.
CPPD is one of many causes of soft tissue calcification (chondrocalcinosis). It is not synonymous with chondrocalcinosis and not the only cause of soft tissue calcification.
Where crystal deposition causes synovitis
Pathology
The crystals are weekly positively birefringent on polarized microscopy.
Associations
- primary hyperparathyroidism
- haemochromatosis
- hypomagnesaemia 2
- gout (controversial in articular cartilage)
Radiographic features
Chondrocalcinosis can occurCPPD has many features of osteoarthritis with unusual distribution, for example they tend to be symmetric in many locations. Notable sites include:
-
knee: medial meniscusdistribution and involve non weight bearing joints or in hands mainly involve inter carpal andpatellofemoral joint triangular fibrocartilage complex of wrist (TFCC)-
peri odontoid tissue around the dens:MCP joints.crowned dens syndrome5 intervertebral discs
Features of degenerative joint disease in joints that are not normally affected by it (i.e. non-weightbearing joints):
- shoulder joint
- elbow joint
- radiocarpal
jointand scapholunate joints(SLAC wrist in advanced cases). - patellofemoral joint
Chondrocalcinosis can occur in many locations. Notable sites include:
- knee: medial meniscus and patellofemoral joint
- wrist: triangular fibrocartilage complex and lunotriquetral ligaments
- spine: peri odontoid tissue around the dens: crowned dens syndrome5,and intervertebral discs
Large subchondral cysts may be present.
It is controversial whether gout leads to calcification of articular fibrocartilage or hyaline cartilage 6. CPPD disease can be differentiated from gout on ultrasound given that echogenic monosodium urate crystals line the surface of articular cartilage, whereas echogenic CPPD calcifications are located within the cartilage itself 7.
See also
-<p><strong>Calcium pyrophosphate dihydrate disease (CPPD disease)</strong> is common, especially in the elderly, and is characterised by the deposition of calcium pyrophosphate in soft tissues and cartilage.</p><p>CPPD is one of many causes of soft tissue calcification (<a href="/articles/chondrocalcinosis">chondrocalcinosis</a>). It is not synonymous with chondrocalcinosis and not the only cause of soft tissue calcification.</p><p>Where crystal deposition causes <a href="/articles/synovitis">synovitis</a>, the term <a href="/articles/calcium-pyrophosphate-dihydrate-deposition-disease">pseudogout</a> should be used. <a href="/articles/pyrophosphate-arthropathy">Pyrophosphate arthropathy</a> is a term that describes arthropathy secondary to CPPD deposition. However, it is often used indescriminantly to refer to chondrocalcinosis too.</p><h4>Pathology</h4><p>The crystals are weekly positively birefringent on polarized microscopy.</p><h5>Associations</h5><ul>- +<p><strong>Calcium pyrophosphate dihydrate disease (CPPD disease)</strong> is common, especially in the elderly, and is characterised by the deposition of calcium pyrophosphate in soft tissues and cartilage.</p><p>CPPD is one of many causes of soft tissue calcification (<a href="/articles/chondrocalcinosis">chondrocalcinosis</a>). It is not synonymous with chondrocalcinosis and not the only cause of soft tissue calcification.</p><p>Where crystal deposition causes acute clinical manifestation, the term <a href="/articles/calcium-pyrophosphate-dihydrate-deposition-disease">pseudogout</a> should be used. <a href="/articles/pyrophosphate-arthropathy">Pyrophosphate arthropathy</a> is a term that describes arthropathy secondary to CPPD deposition. However, it is often used indescriminantly to refer to chondrocalcinosis too.</p><h4>Pathology</h4><p>The crystals are weekly positively birefringent on polarized microscopy.</p><h5>Associations</h5><ul>
-</ul><h4>Radiographic features</h4><p>Chondrocalcinosis can occur in many locations. Notable sites include:</p><ul>-<li>knee: medial meniscus and patellofemoral joint</li>-<li>triangular fibrocartilage complex of wrist (TFCC)</li>-<li>peri odontoid tissue around the dens: <a href="/articles/crowned-dens-syndrome">crowned dens syndrome</a> <sup>5</sup>-</li>-<li>intervertebral discs</li>-</ul><p>Features of degenerative joint disease in joints that are not normally affected by it (i.e. non-weightbearing joints):</p><ul>- +</ul><h4>Radiographic features</h4><p>CPPD has many features of osteoarthritis with unusual distribution, for example they tend to be symmetric in distribution and involve non weight bearing joints or in hands mainly involve inter carpal and MCP joints. </p><p>Features of degenerative joint disease in joints that are not normally affected by it (i.e. non-weightbearing joints):</p><ul>
-<li>radiocarpal joint</li>- +<li>radiocarpal and scapholunate joints(<a title="SLAC wrist" href="/articles/scapholunate-advanced-collapse">SLAC wrist</a> in advanced cases).</li>
- +</ul><p>Chondrocalcinosis can occur in many locations. Notable sites include:</p><ul>
- +<li>knee: medial meniscus and patellofemoral joint</li>
- +<li>wrist: triangular fibrocartilage complex and lunotriquetral ligaments </li>
- +<li>spine: peri odontoid tissue around the dens: <a href="/articles/crowned-dens-syndrome">crowned dens syndrome</a> <sup>5</sup>,and intervertebral discs</li>
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