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20-September-2008 10:21:21 - Chondrocalcinosis Chondrocalcinosis Classification and external resources Chondrocalcinosis of the articular and fibrocartilage of the left knee in a patient with calcium pyrophosphate dihydrate deposition disease CPPD ICD-10 M11.1-M11.2 ICD-9 712.3 DiseasesDB 10832 MedlinePlus 000421 eMedicine med/1938 radio/125 orthoped/382 emerg/221 MeSH D002805 Calcium pyrophosphate deposition disease CPPD is a rheumatologic disorder with varied clinical manifestations due to precipitation of calcium pyrophosphate dihydrate crystals in the connective tissues. It is more commonly known by alternative names that specify certain clinical or radiographic findings, although neither is synonymous with CPPD. Pseudogout refers to the clinically evident acute synovitis with red, tender, and swollen joints that may resemble gouty arthritis a similar condition with joint deposition of monosodium urate crystals. Chondrocalcinosis12, on the other hand, refers to the radiographic evidence of calcification in hyaline and/or fibrocartilage. Pyrophosphate arthropathy is a term that may refer to either of the above.3 Statistically, the interphalangeal joints are the most commonly affected.1 Contents 1 General 2 Signs and symptoms 3 Diagnosis 4 Treatment 5 Epidemiology 6 References 7 External links General CPPD crystal deposition disease is a polyarticular arthritis i.e. it leads to an inflammation of several joints in the body, although it can initially present as monoarticular i.e. confined to just one joint.4 CPPD crystals tend to form within articular tissues.4 Although, in theory, any joint may be affected, the knees, wrists, and hips are the statistically the most commonly attributed areas.2 In rare case, pseuogout may affect the spinal canal and cause myelopathy.5 The exact pathology of CPPD is unknown, although increased adenosine triphosphate the molecule used as energy currency in all animals breakdown, which results in increased pyrophosphate levels in joints, is thought to be a method of crystal development.2 There is some recent evidence suggesting that the gene ANKH is involved in crystal-related inflammatory reactions and inorganic phosphate transport.2 Signs and symptoms Patients usually present with inflammation of one or more joints often resulting in pain in the affected joints.2 Hyperparathyroidism, hemochromatosis, hypophosphatemia and renal osteodystrophy are often also associated with chondrocalcinosis.2 In some cases, traumatic arthritis has resulted in chondrocalcinosis.24 In general, the white blood cell count is raised2. Rarely, patients may also present with signs of carpal tunnel syndrome.2 Diagnosis Radiography has a large role to play in the diagnosis of chondrocalcinosis with radiographs, CT scans, MRIs, ultrasound and nuclear medicine all having a part.1 CT scans and MRIs show calcific masses usually within the ligamentum flavum or joint capsule however radiography is more successful.1 As with most conditions, chondrocalcinosis can present with similarity to other diseases such as Ankylosing spondylitis or Gout.12 Treatment Treatment for asymptomatic chondrocalcinosis is not advised to prevent end-organ damage.2 For acute pseudogout, intra-articular corticosteroid injection, systemic corticosteroids, non-steroidal anti-inflammatory drugs NSAIDs, or occasionally, high-dose colchicine.2 NSAIDs are generally administered in low doses to help prevent chondrocalcinosis, however in an acute attack is already occurring, higher doses are administered.2 Research into surgical removal of calcifications is underway, however this still remains an experimental procedure.2 Epidemiology All cultural races are affected by CPDD, and in the United States around 50% of the population over 85 years of age are affected.2 Morbidity is the primary result of CPDD, although mortality is never experienced from the disease itself.2 Females are at a slightly larger risk than men, with an estimated ratio of occurrence of 1.4:1 respectively.2 References ^ a b c d e Rothschild, Bruce M. Calcium Pyrophosphate Deposition Disease radiology. Retrieved on 2008-02-18. ^ a b c d e f g h i j k l m n o p q Rothschild, Bruce M. Calcium Pyrophosphate Deposition Disease rheumatology. Retrieved on 2008-02-18. ^ Longmore, Murray; Ian Wilkinson, Tom Turmezei, Chee Kay Cheung 2007. Oxford Handbook of Clinicial Medicine. Oxford, 841. ISBN 0-19-856837-1. ^ a b c Wright GD, Doherty M 1997. Calcium pyrophosphate crystal deposition is not always 'wear and tear' or aging. Ann. Rheum. Dis. 56 10: 586-8. PMID 9389218. ^ Walid M S, Yelverton JC, Ajjan M, Grigorian AA. 2008. Pseudogout of the thoracic spine mimicking a tumor.. Russian Neurosurgery Online. 1 20. External links Penn State v d e Diseases of the musculoskeletal system and connective tissue M, 710-739 Arthropathies Arthritis Septic arthritis - Reactive arthritis - Rheumatoid arthritis - Psoriatic arthritis - Felty syndrome - Juvenile idiopathic arthritis - Still's disease - crystal Gout, Chondrocalcinosis - Osteoarthritis Heberden's node, Bouchard's nodes - Monoarthritis/Polyarthritis Specific joints shoulder Winged scapula - elbow Cubitus valgus, Cubitus varus - hand Wrist drop, Boutonniere deformity, Swan neck deformity hip Protrusio acetabuli, Coxa valga, Coxa vara - leg Foot drop, Flat feet, Club foot, Unequal leg length - patella Luxating patella, Chondromalacia patellae - foot Bunion/hallux valgus, Hallux varus, Hallux rigidus, Hammer toe general terms Valgus deformity, Varus deformity Other Hemarthrosis - Arthralgia - Osteophyte - Hypermobility Systemic CT disorders vasculitis: Arteritis Polyarteritis nodosa, Takayasu's arteritis, Temporal arteritis - arterioles/capillaries Wegener's granulomatosis, Kawasaki disease, Churg-Strauss syndrome, Microscopic polyangiitis hypersensitivity/autoimmune: Hypersensitivity vasculitis - Goodpasture's syndrome - Systemic lupus erythematosus Drug-induced - Dermatomyositis Juvenile dermatomyositis - Polymyositis - Scleroderma - Sjögren's syndrome - Behçet's disease - Polymyalgia rheumatica - Eosinophilic fasciitis Dorsopathies spinal curvature Kyphosis, Lordosis, Scoliosis - Scheuermann's disease - Spondylolysis - Torticollis - Spondylolisthesis Spondylopathies Ankylosing spondylitis, Spondylosis, Spinal stenosis - Schmorl's nodes - Degenerative disc disease - Coccydynia - Back pain Radiculopathy, Neck pain, Sciatica, Low back pain Soft tissue disorders Muscle Myositis Pyomyositis - Myositis ossificans Fibrodysplasia ossificans progressiva Synovium and tendon Synovitis/Tenosynovitis Calcific tendinitis, Stenosing tenosynovitis, Trigger finger, DeQuervain's syndrome - Irritable hip - Ganglion cyst Bursa Bursitis Olecranon, Prepatellar, Trochanteric - Baker's cyst Fascia/fibroblastic Fasciitis Plantar fasciitis, Nodular fasciitis, Necrotizing fasciitis - Dupuytren's contracture - Fibromatosis Shoulder lesions Adhesive capsulitis - Rotator cuff tear - Subacromial bursitis Enthesis Enthesopathies Iliotibial band syndrome, Achilles tendinitis, Patellar tendinitis, Golfer's elbow, Tennis elbow, Metatarsalgia, Bone spur, Tendinitis Other, NEC Muscle weakness - Rheumatism - Myalgia - Neuralgia - Neuritis - Panniculitis - Fibromyalgia Osteopathies disorders of bone density and structure: Osteoporosis - Osteomalacia - continuity of bone Pseudarthrosis, Stress fracture - Monostotic fibrous dysplasia - Skeletal fluorosis - Aneurysmal bone cyst - Hyperostosis - Osteosclerosis Osteomyelitis - Avascular necrosis - Paget's disease of bone - Algoneurodystrophy - Osteolysis - Infantile cortical hyperostosis Chondropathies Juvenile osteochondrosis Legg-Calvé-Perthes syndrome, Osgood-Schlatter disease, Köhler disease, Sever's disease - Osteochondritis - Tietze's syndrome - Relapsing polychondritis See also congenital Retrieved from http://en..org/wiki/Chondrocalcinosis Categories: Arthritis Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch 日本語 Português Svenska This page was last modified on 31 July 2008, at 15:01
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