II. Epidemiology
- Autosomal Dominant inheritance and sporadic cases
III. Associated Conditions
IV. Signs: Pseudogout (25% of CPPD Deposition Disease)
- Acute self-limited joint inflammation
- Duration of Pseudogout attack: days to weeks
- Asymptomatic between episodes
- Distribution (may involve any joint)
- Knees (50%)
- First metatarsophalangeal Joint (similar to gout)
- Pseudogout precipitating factors
- Spontaneous attacks
- Trauma
- Surgery
- Cerebrovascular Accident (CVA)
- Myocardial Infarction
- Systemic signs
- Fever up to 103 F
V. Signs: Pseudo-Rheumatoid (5% of CPPD Deposition Disease)
- Symmetric Polyarthritis with low grade inflammation
- Synovial thickening
- Flexion contractures
- Morning Stiffness
- Fatigue
VI. Signs: Pseudo-Osteoarthritis (50% of CPPD)
VII. Labs
-
Arthrocentesis for Synovial Fluid exam
- CPPD crystals on Polarized Microscopy
- General studies for CPPD Deposition Disease
- Pseudogout attack
- Complete Blood Count
- Leukocytosis up to 15,000 per mm3
- Erythrocyte Sedimentation Rate (ESR) increased
- Complete Blood Count
- Pseudo-Rheumatoid
- Erythrocyte Sedimentation Rate (ESR) elevated
- Rheumatoid Factor may be positive at low titer
VIII. Radiology: Joint XRay
- Screening XRays for CPPD Deposition
- Bilateral AP Knee XRay
- AP Pelvis XRay
- Symphysis Pubis
- Hips
- Bilateral PA Hand and Wrist XRay
- Articular hyaline cartilage changes
- Punctate densities
- Linear densities
IX. Management
- Large joint acute attack
- Analgesia
- NSAIDs
- Colchicine (Intravenous is more effective than oral)
X. References
- Klippel (1997) Primer Rheumatic Diseases, p.226-9