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General Medicine

Pseudogout (Calcium Pyrophosphate Dihydrate)

Juliana Chang, MD Reviewed 06/2020
 


BASICS

DESCRIPTION

  • Autoinflammatory disease triggered by calcium pyrophosphate dihydrate (CPPD) crystal deposition within joints

  • One of many diseases associated with pathologic deposition of crystal; mi...

DIAGNOSIS

HISTORY

  • Presentation often mimics gout (“pseudogout”).

  • Acute CPPD: pain and swelling of ≥1 or more joints; knee involved 50% of the time; ankle, wrist, toe, and shoulder are also common.

  • Proxim...

TREATMENT

GENERAL MEASURES

Target symptom relief (reduce inflammation): 

  • Rest and elevate affected joint(s).

  • Apply ice/cool compresses to affected joints.

  • Non–weight-bearing on affected joint while painfu...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

Reevaluate response to therapy 48 to 72 hours after beginning treatment; reexamine in 1 week, then as needed. 

DIET

No known relationship to diet 

PATIENT EDUCATION

REFERENCES

1
Bilezikian JP, Connor TB, Aptekar R, et al. Pseudogout after parathyroidectomy. Lancet.  1973;1(7801):445–446.
2
Zhang W, Doherty M, Bardin T, et al. European League Against Rheumatism ...

ADDITIONAL READING

  • Bruges-Armas J, Bettencourt BF, Couto AR, et al. Effectiveness and safety of infliximab in two cases of severe chondrocalcinosis: nine years of follow-up. Case Rep Rheumatol.  ...

CODES

ICD10

  • M11.20 Other chondrocalcinosis, unspecified site

  • M11.269 Other chondrocalcinosis, unspecified knee

  • M11.29 Other chondrocalcinosis, multiple sites

ICD9

  • 275.49 Other disorders of calcium metaboli...

CLINICAL PEARLS

  • Suspect CPPD in arthritis cases that do not follow a pattern typical of degenerative joint disease.

  • Perform arthrocentesis to confirm diagnosis.

  • If septic arthritis is suspected, treat e...

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Gout in Knee Labeled
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Gouty (uric acid) tophi in a middle-aged woman with longstanding gout
Gouty (uric acid) tophi in a middle-aged woman with longstanding gout
Gouty (uric acid) tophi in a middle-aged woman with longstanding gout
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FIG. 4.4. This "chalky" substance was aspirated from a patient's inflamed olecranon bursa, an appearance that is virtually diagnostic of tophaceous gout.
FIG. 4.4. This "chalky" substance was aspirated from a patient's inflamed olecranon bursa, an appearance that is virtually diagnostic of to...
Chronic tophaceous gout involving the hands and wrists.
Chronic tophaceous gout involving the hands and wrists.
Fig B 10-17. Gout. Two examples of typical rat-bite erosions about the first metatarsophalangeal joint (arrows). The cystlike lesions have thin sclerotic margins and characteristic overhanging edges.
Fig B 10-17. Gout. Two examples of typical rat-bite erosions about the first metatarsophalangeal joint (arrows). The cystlike lesions have ...
Fig B 10-18. Gout. Diffuse deposition of urate crystals in periarticular tissues of the hand produce multiple large, lumpy soft-tissue swellings representing gouty tophi. Note the erosive changes that typically involve the carpal bones and the distal interphalangeal and metacarpophalangeal joints of the fifth digits.
Fig B 10-18. Gout. Diffuse deposition of urate crystals in periarticular tissues of the hand produce multiple large, lumpy soft-tissue swel...
Figure 10-207 SKELETAL DISTRIBUTION OF GOUT.
Figure 10-207 SKELETAL DISTRIBUTION OF GOUT.
Figure 10-210 GOUT: BONE EROSIONS. PA Foot. Observe the marginal erosion, demonstrating a classic overhanging margin sign (arrow), periarticular erosion (arrowhead), and intraosseous erosion (crossed arrow).
Figure 10-210 GOUT: BONE EROSIONS. PA Foot. Observe the marginal erosion, demonstrating a classic overhanging margin sign (arrow), periarti...
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