![]() ![]() Giant cell tumor (GCT): subchondral cysts of CPPD can be large and simulate subchondral GCTĭifferential diagnosis of erosive arthritis ![]() Osteoarthritis: usually have the typical weight-bearing distribution Possible imaging differential considerations include CPPD disease can be differentiated from gout on ultrasound given that echogenic monosodium urate crystals line the surface of articular cartilage, whereas echogenic CPPD calcifications are located within the cartilage itself 7.ĬPPD in the knee is associated with scalloping of the anterior femoral cortex at the level of the patella 13. It is controversial whether gout leads to calcification of articular fibrocartilage or hyaline cartilage 6. Wrist: triangular fibrocartilage complex and lunotriquetral ligamentsĬrowned dens syndrome: acute pain and systemic inflammatory syndrome 5 Knee: medial meniscus and patellofemoral joint Some authors suggest isolated STT arthropathy being quite specific for CPPD 8.Ĭhondrocalcinosis can occur in many locations. Wrist joint (mainly radiocarpal and scapholunate joints)Ī stepladder pattern of joint narrowing is classically described in which the narrowing is progressively less severe from the radiocarpal joint to the midcarpal joint ![]() EtiologyĪD pattern mutation in the ANKH gene which encodes a transmembrane inorganic pyrophosphate transporterĬPPD has many features of osteoarthritis with an unusual distribution, for example, they tend to be symmetric in distribution and involve non-weight bearing joints or, in the hands, mainly involve the intercarpal and metacarpophalangeal joints.įeatures of osteoarthritis in joints that are not commonly affected by it (i.e. The crystals are weakly positively birefringent on polarized microscopy and have a rhomboid or rod shape. Another common joint is the pubic symphysis.Ĭhronic CPPD crystal inflammatory arthritis presents with chronic, intermittent painful swelling in the peripheral joints of upper and lower extremities. Unlike gout, it most commonly involves the knee and the upper joints (shoulder, elbow, wrist). The presentation classically resembles an acute gout attack. Most patients with imaging findings of CPPD are clinically asymptomatic.Īcute CPPD crystal arthritis ( pseudogout) presents with severe acute or subacute pain, swelling, erythema, and warmth, of one or more joints and is usually self-limited. EpidemiologyĬPPD is commonest in patients over the age of 50. NB: in CPPD, the D stands for deposition not disease nor dihydrate, so it is "CPPD disease" 9. Osteoarthritis with CPPD: typical changes of osteoarthritis in the setting of CPPDĬhronic CPPD crystal inflammatory arthritis In response, in 2011 the European League Against Rheumatism (EULAR) proposed a standardized terminology corresponding to clinical presentation 9:ĬPPD: occurrence of calcium pyrophosphate crystals, with or without symptomsĪsymptomatic CPPD: chondrocalcinosis +/- changes of osteoarthritis, but clinically asymptomaticĪcute CPPD crystal arthritis (formerly pseudogout): self-limiting synovitis in the setting of CPPD Indeed, although initially described as chondrocalcinosis articularis, it is now understood that imaging findings of chondrocalcinosis do not always indicate CPPD disease 9. The terminology regarding CPPD disease has been confusing, with chondrocalcinosis, CPPD, and pseudogout often used synonymously. ![]()
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