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Chondrocalcinosis and other calcifications.

P S Jensen1

  • 1Department of Diagnostic Imaging, Yale University School of Medicine, New Haven, Connecticut.

Radiologic Clinics of North America
|November 1, 1988
PubMed
Summary
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Calcium pyrophosphate deposition (CPPD) disease, or pseudogout, presents as gout-like arthritis. Early diagnosis and differentiation from other crystal arthropathies are crucial for effective treatment.

Area of Science:

  • Rheumatology
  • Crystal-induced Arthropathies
  • Orthopedics

Background:

  • Calcium pyrophosphate deposition (CPPD) disease, initially termed pseudogout, mimics gouty arthritis due to CPPD crystals.
  • Chondrocalcinosis was historically considered essential for radiographic diagnosis of CPPD disease.
  • Recent findings suggest CPPD deposition disease can be diagnosed radiographically even without chondrocalcinosis.

Purpose of the Study:

  • To differentiate pyrophosphate arthropathy from degenerative joint disease based on specific clinical and radiographic patterns.
  • To highlight the importance of recognizing CPPD deposition disease due to its association with systemic conditions like hemochromatosis and hyperparathyroidism.
  • To discuss the recent discovery of intra-articular hydroxyapatite (HA) crystal-induced synovitis and co-deposition of CPPD and HA crystals.

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Main Methods:

  • Clinical and radiographic pattern analysis for diagnosing CPPD deposition disease.
  • Differentiation of pyrophosphate arthropathy from degenerative joint disease.
  • Review of associations between CPPD deposition disease and other systemic diseases.
  • Evaluation of newly identified inflammatory synovitis linked to intra-articular HA crystals.
  • Identification of patients with co-existing CPPD and HA crystal deposition.

Main Results:

  • A clinical and radiographic pattern for CPPD deposition disease has emerged, allowing diagnosis without chondrocalcinosis.
  • Pyrophosphate arthropathy is distinguished from degenerative joint disease by its unique pattern and distribution.
  • Intra-articular HA crystal deposition can cause acute inflammatory synovitis.
  • Patients are increasingly identified with CPPD deposition in one location and HA deposition in another.

Conclusions:

  • Recognizing CPPD deposition disease is vital due to its links with hemochromatosis and hyperparathyroidism.
  • The discovery of HA crystal-associated synovitis expands the spectrum of crystal-induced arthropathies.
  • Accurate differentiation of various crystal-induced arthropathies is essential for future therapeutic advancements.