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🌱 來自: crystal deposition arthritides

calcium pyrophosphate dihydrate - cppd - deposition disease

Definition (NEJM 2016;374:2575)

• Deposition of CPPD crystals w/in tendons, ligaments, articular capsules, synovium, cartilage; frequently asymptomatic

Etiologies (Nat Rev Rheumatol 2018;14:592)

• Most cases idiopathic; consider further metabolic eval in young (<50 y) and florid forms

• Metabolic (3 H’s):

  • hemochromatosis
  • hyperparathyroidism;
  • hypomagnesemia (esp. in Gitelman’s or Bartter’s syndromes)

• Joint trauma (incl. previous surgery);

• intra-articular hyaluronate can precipitate attacks

• Familial chondrocalcinosis (autosomal dominant disorder); early-onset, polyarticular dis.

• Clinical manifestations of CPPD

• Diagnostic studies of CPPD

Treatment (NEJM 2016;374:2575)

• Asymptomatic chondrocalcinosis requires no treatment
• Acute therapy for pseudogout: no RCTs, extrapolated from practice in gout; ∴ same as for gout, though colchicine not as effective
• If associated metabolic disease, Rx of underlying disorder may improve arthritis sx
• Low-dose daily colchicine or NSAID may be effective for prophylaxis or chronic arthropathy