Description

• One of many diseases associated with pathological mineralization and ossification:
  • Chondrocalcinosis and pseudogout are characterized by calcium pyrophosphate dihydrate (CPPD) deposition, whereas ankylosing spondylitis, osteoarthritis, and vascular calcification are characterized by hydroxyapatite deposition (1).
• CPPD crystal deposition may cause a progressive degenerative arthritis in numerous joints:
  • Primarily affects the elderly
  • Usually involves large joints
• Symptom onset is insidious, resulting in symmetric polyarthritis similar to rheumatoid arthritis (RA).
• Definitive CPPD diagnosis requires the presence of CPPD crystals in synovial fluid (2)[A].
• System(s) affected: Endocrine/Metabolic; Musculoskeletal

Epidemiology

• Predominant age: 80% of patients >60
• Predominant sex: Male = Female
• Chondrocalcinosis is present in 1:10 adults age 60–75 and 1:3 by >80 ; only a small percentage develop pseudogout (3).

Risk Factors

• Advanced age
• Traumatic injury
• Pseudogout often occurs as a complication in patients hospitalized for other medical and surgical illnesses.

Genetics
Uncommonly seen in familial pattern with autosomal-dominant inheritance (<1% of patients); most cases are sporadic.

General Prevention

Colchicine 0.6 mg b.i.d. may reduce frequency of episodes in recurrent monoarthritic CPPD.

Etiology

• Arthropathy results from an acute inflammatory reaction to CPPD crystals shed into synovial cavity.
• Physical and chemical changes in aging cartilage favor crystal growth.

Commonly Associated Conditions

• Hyperparathyroidism
• Hemochromatosis
• Gout
• Hypophosphatasia
• Hypothyroidism
• Ochronosis
• Wilson disease
• Amyloidosis
• Hypomagnesemia