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General Medicine

Pseudogout (Calcium Pyrophosphate Dihydrate)

Pradeepa P. Vimalachandran, MD, MPH Reviewed 06/2019
 


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 in 50% of cases; ankle, wrist, toe, and shoulder involvement are also c...

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
Zhang W, Doherty M, Bardin T, et al. European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann Rheum Dis.  2011;7...

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 (e.g., metacarpophalangeal joints, wrists).

  • Perform arthrocentesis to confirm diagnosi...

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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...
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 ...
Chronic tophaceous gout involving the hands and wrists.
Chronic tophaceous gout involving the hands and wrists.
Gouty (uric acid) tophi in a middle-aged woman with longstanding gout
Gouty (uric acid) tophi in a middle-aged woman with longstanding gout
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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