Presentation
Bullough, MB, ChB, presents a unique, lavishly illustrated account of the pathology of arthritic disorders, metabolic disturbances, and soft tissue and bone tumors. [books.google.com]
The breakdown of collagen cells has been proposed to be the source of the inorganic pyrophosphate. [2, 3, 4] Presentation Following are the 4 separate and distinct manifestations of this disease: Pseudogout An acute presentation appears very similar to [thehealthscience.com]
Incidence Affects males and females equally Usually more than 50 years Increased incidence with increased age 3 - 5% of population have CPPD deposition in the knee at autopsy Seen in 40% of patients with haemochromatosis or hyperparathyroidism Clinically Presents [orthopaedicsone.com]
The most common presentation is acute monoarthritis but patients may present mimicking OA and rheumatoid arthritis. Metabolic and endocrine disorders can be associated with CPPD arthritis. [omagdigital.com]
Acute 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. The presentation classically resembles an acute gout attack. [radiopaedia.org]
Entire Body System
- Swelling
Osteoarthritis causes joint pain and swelling due to damage to the cartilage in the joint. [orthop.washington.edu]
"Attacks" of osteoarthritis associated with pain, swelling, and redness of the joint may in fact, in certain cases, be due to CPPD. CPPD in young patients is unusual. [my.clevelandclinic.org]
Medications To help with acute attacks, your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce the swelling and relieve the pain. [healthline.com]
For example, mild and painless swelling of the foot joints may often mask extremely severe bone destruction. Several other bone changes associated with diabetes are only detectable by radiography. [books.google.com]
Chronic CPPD crystal inflammatory arthritis presents with chronic, intermittent painful swelling in the peripheral joints of upper and lower extremities. [radiopaedia.org]
- Fever
Ask patients about: 6, 10 The number and site of affected joints The speed of onset and the severity of the pain The presence of systemic symptoms, e.g. fever – up to 50% of people with acute CPPD disease will have a fever, and rarely, older patients [bpac.org.nz]
Patients may have prominent inflammatory symptoms of morning stiffness and fatigue, but fever is rare. [omagdigital.com]
Sudden painful (acute) attacks are usually less severe than those of gout, but, as in gout, attacks in calcium pyrophosphate arthritis can cause fever. [msdmanuals.com]
• 50% of cases, episodes of CPPD-induced inflammation are associated with low-grade fever and, on occasion, temperatures as high as 40°C. • synovial fluid analysis with microbial cultures is essential to rule out the possibility of infection • The leukocyte [slideshare.net]
Pseudogout usually lasts anywhere from several days to two weeks and may be accompanied by fever. [verywell.com]
- Amyloidosis
Pseudogout can occur along with aging, be inherited, or be associated with hemophilia, hemochromatosis, ochronosis, amyloidosis, or hormonal disorders (such as hyperparathyroidism and hypothyroidism ). [medicinenet.com]
The crystals often occur in people who have the following: A joint injury (including surgery) Accumulations of protein in various organs and tissues ( amyloidosis ) An abnormally high calcium level in the blood caused by a high level of parathyroid hormone [msdmanuals.com]
[…] thyroid disorders hypothyroidism and hyperparathyroidism hemophilia, a hereditary bleeding disorder that prevents the blood from clotting normally ochronosis, a condition that causes a dark pigment to deposit in the cartilage and other connective tissues amyloidosis [healthline.com]
People who are diagnosed with hyperparathyroidism, amyloidosis, gout, and degenerative arthritis (osteoarthritis) Joint trauma – Caused by serious injury or surgery Genetic disorder – Some people have genetic predisposition to develop pseudogout and unlike [jointhealthmagazine.com]
Disease Associations: Several conditions are associated with CPPD crystal deposition disease: hyperparathyroidism, hypocalciuria, hypercalcemia, hemochromatosis, hemosiderosis, hypophosphatasia, hypomagnesemia, hypothyroidism, gout, neuropathic joints, amyloidosis [rheumaknowledgy.com]
- Weakness
[…] visualized under compensated polarized light microscopy - crystals may be more difficult to detect than MSU crystals because of their smaller size, more intraphagolysosomal location, & less brilliant colors; - in contrast to MSU crystals, CPPD crystals show weak [wheelessonline.com]
• Polarized light microscopy usually reveals rhomboid, square, or rod-like crystals with weak positive birefringence inside tissue fragments and fibrin clots and in neutrophils. • CPPD crystals may coexist with MSU and apatite in some cases. 14. [slideshare.net]
Gout can be distinguished from pseudogout in that gout crystals (sodium urate) are needle shaped and have negative birefringence, while pseudogout crystals (calcium pyrophosphate) are rod or rhomboid shaped and have no or weak positive birefringence. [thehealthscience.com]
Polarized light microscopy usually reveals rhomboid, square, or rod-like crystals with weak positive birefringence inside tissue fragments and fibrin clots and in neutrophils (Fig. 19-2). CPPD crystals may coexist with MSU and apatite in some cases. [what-when-how.com]
Symptoms usually start between ages 40-60 in males and after the menopause in females. [ 5 ] Initial symptoms are usually vague and nonspecific - eg, fatigue, weakness, arthropathy affecting various joints, nonspecific abdominal problems, erectile dysfunction [patient.info]
- Falling
The medical activity is prognosis from the Greek pro (forward) and gnosis (special knowledgeL thus foreknowledge, and the practitioner is the prognosticator, a sobriquet which falls unhappily upon the ear. [books.google.com]
Medications can be prescribed to ease the pain, which typically fall into the nonsteroidal anti-inflammatory category. [medical-dictionary.thefreedictionary.com]
For diseases that fall into these categories, genetic testing is the ultimate diagnostic tool. [centogene.com]
Skin
- Erythema
Acute 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. The presentation classically resembles an acute gout attack. [radiopaedia.org]
Acute symptoms of CPPD disease therefore, include pain, swelling, stiffness, erythema, loss of function and marked tenderness of the affected joint(s). 10 Patients with CPPD disease may also present with systemic features, such as neck pain, headache [bpac.org.nz]
Musculoskeletal
- Joint Swelling
[…] arthropathy [ ahr-throp´ah-the ] any joint disease. chondrocalcific arthropathy progressive polyarthritis with joint swelling and bony enlargement, most commonly in the small joints of the hand but also affecting other joints, characterized radiographically [medical-dictionary.thefreedictionary.com]
The "attacks" of joint inflammation, characterized by acute joint swelling, warmth, stiffness, and pain, may last for days to weeks and can resolve spontaneously. The inflammation leads to loss of range of motion and function of the involved joint. [medicinenet.com]
Pseudogout is defined as a type of inflammation of joints or arthritis that is characterized by sudden and painful swelling in one or more joints. [jointhealthmagazine.com]
- Morning Stiffness
Patients may have prominent inflammatory symptoms of morning stiffness and fatigue, but fever is rare. [omagdigital.com]
Rheumatoid arthritis causes chronic swelling, heat, morning stiffness and pain in the joints and can also involve other tissues. The hands and fingers are involved in most cases. [orthop.washington.edu]
- Joint Dislocation
[…] laxity, type 1, with or without fractures B3GALT6 Spondyloepimetaphyseal dysplasia, MATN3 related MATN3 Spondyloepiphyseal dysplasia with congenital joint dislocations CHST3 Spondylometaepiphyseal dysplasia, short limb-hand type DDR2 Steatocystoma multiplex [centogene.com]
Neurologic
- Seizure
[…] dominant type ATP6V1B1 Renal tubular acidosis with deafness BCS1L Bjornstad syndrome BDP1 Hearing loss BSND Bartter syndrome, Sensorineural deafness with mild renal dysfunction BTD Biotinidase deficiency CABP2 Deafness CACNA1D Primary aldosteronism, seizures [genda.com.ar]
Autosomal dominant early childhood seizures associated with chondrocalcinosis and a mutation in the ANKH gene. Epilepsia 2004, 45: 1258–1260. PubMed CrossRef Google Scholar 36. [link.springer.com]
[…] distal, type 2B TNNI2 Arthrogryposis, distal, type 2B TNNT3 Arthrogryposis, distal, type 3 PIEZO2 Arthrogryposis, distal, type 5D ECEL1 Arthrogryposis, distal, type 5 PIEZO2 Arthrogryposis, distal, type 7 MYH8 Arthrogryposis, mental retardation, and seizures [centogene.com]
- Stroke
[…] sporadic cases) Disease-associated Hyperparathyroidism Milk-alkali syndrome Renal failure/long-term dialysis Connective tissue diseases (e.g., systemic sclerosis, idiopathic myositis, SLE) Heterotopic calcification following neurologic catastrophes (e.g., stroke [what-when-how.com]
- Hyperactivity
Hyperparathyroidism : A condition caused by an overactive or hyperactive parathyroid gland in which there is too much calcium in the blood; this can lead to CPPD crystal deposition disease as well as bone and kidney problems. [orthop.washington.edu]
- Irritability
Neurological or psychiatric symptoms - impaired memory, mood swings, irritability, depression. [patient.info]
Urogenital
- Renal Insufficiency
It is generally prescribed in low doses and should not be used by anyone with significant bone marrow dysfunction or renal insufficiency. [medical-dictionary.thefreedictionary.com]
Both NSAIDs and colchicine should be used with caution in patients with renal insufficiency and liver disease. [omagdigital.com]
- Kidney Failure
People who have a thyroid condition, kidney failure, or disorders that affect calcium, phosphate, or iron metabolism have an increased risk for CPPD. The condition is also commonly present in people who have osteoarthritis. [my.clevelandclinic.org]
Workup
(See Etiology, Presentation, and Workup .) Calcium pyrophosphate deposition disease. Radiograph of the knee showing chondrocalcinosis involving the meniscal cartilage, as well as evidence of osteoarthritis. Calcium pyrophosphate deposition disease. [emedicine.medscape.com]
Indeed, as the experts at MedlinePlus indicated, "careful workup, with analysis of crystals found in the joints, should ultimately lead to the correct diagnosis." Treatment There are a variety of treatment options. [medical-dictionary.thefreedictionary.com]
Treatment
SLIDESHOW Gout Attack Symptoms, Causes, Treatment, and Diet See Slideshow What are treatments for pseudogout? The treatment of pseudogout is directed toward stopping the inflammation in the joints. Local ice applications and resting can help. [medicinenet.com]
Treatment Traditional treatment includes anti-inflammatory medications to prevent or control joint symptoms. Typical treatment includes prescription non-steroidal anti-inflammatory drugs (NSAIDS). [glutathionediseasecure.com]
Calcium pyrophosphate crystal deposition disease: diagnosis and treatment. Open Access Rheumatology : Research and Reviews. 2014;6:39-47. doi:10.2147/OARRR.S39039 MacMullan P, McCarthy G. [rarediseases.org]
Recommendations for the management of CPPD disease tend to be based on expert opinion or extrapolated from research on the treatment of gout. 15 Treatment of an acute attack Treatments to reduce the pain and swelling associated with an acute attack of [bpac.org.nz]
Treatment Treatment of CPPD disease includes treatment of acute attacks, prophylaxis against recurrent acute attacks, and management of chronic symptoms12 (See Table 3). This treatment includes both pharmacological and non-pharmacological options. [omagdigital.com]
Prognosis
One would think the task of estimating prognosis impossible. [books.google.com]
Prognosis of Pseudogout (Calcium pyrophosphate deposition disease) Prognosis is good for acute episodes of psuedogout, which usually improve over a period of 10 days or so. [myvmc.com]
Chondrocalcinosis Prognosis As aforesaid, Chondrocalcinosis is often left untreated if there is no pain. In case a patient is experiencing pain, certain medications are used to relieve painful sensations. This may, however, cause damage to organs. [hxbenefit.com]
Prognosis With regard to an acute attack of pseudogout, the prognosis is usually very good. The symptoms usually go away within two weeks. However, over time, joint degeneration can occur. [medical-dictionary.thefreedictionary.com]
Etiology
They are organised into groups, and further divided into clinical, etiological or histopathological sub-types. [orpha.net]
Etiology Although the exact mechanism for the development of CPDD remains unknown, increased adenosine triphosphate breakdown with resultant increased inorganic pyrophosphate in the joints results from aging, genetic factors, or both. [emedicine.medscape.com]
Etiology See Pathophysiology. Pathophysiology The exact physiologic dysfunction is not clear, but studies appear to implicate the chondrocyte and surrounding matrix as the responsible agents. [thehealthscience.com]
Etiology: The cause of CPPD crystal deposition disease is unknown. Formation of CPPD crystals in cartilage may be related to matrix changes or result from elevated levels of calcium or inorganic pyrophosphate. [rheumaknowledgy.com]
Therefore, a gram stain and cultures of joint fluid and blood are necessary to rule out an infectious etiology. Polyarticular or oligoarticular inflammatory presentations can mimic rheumatoid arthritis (RA) and other inflammatory joint diseases. [omagdigital.com]
Epidemiology
The book also provides updated epidemiologic and statistical data throughout and includes a section on biostatistics in physical medicine and rehabilitation. [books.google.com]
[…] author={Josep Ausi and Josep Brugulat and Miquel Casadevall and Teresa Esquerra and Josep Fontarnau and Alejandro Ganiko and Vicenc Grenzner}, year={2004} } Josep Ausi, Josep Brugulat, +4 authors Vicenc Grenzner Published 2004 Objectives-To undertake an epidemiological [semanticscholar.org]
Epidemiology Frequency Estimates on the frequency of CPPD disease in the United States vary widely. Rates range from 4% to more than 25% of the population by age 80 years. [thehealthscience.com]
Chondrocalcinosis Epidemiology Chondrocalcinosis is known to affect people from all cultural and ethnic backgrounds. In United States, nearly 50% of people over the age of 85 are estimated to be suffering from the disorder. [hxbenefit.com]
Presents in 4th decade Pain & stiffness In spine & larger joints XR shows calcification of intervertebral discs Progressing to obliteration of the disc space And bony ankylosis Excretion of homogentisic acid Causes the urine to turn dark on standing Epidemiology [orthofracs.com]
Pathophysiology
Etiology See Pathophysiology. Pathophysiology The exact physiologic dysfunction is not clear, but studies appear to implicate the chondrocyte and surrounding matrix as the responsible agents. [thehealthscience.com]
Definition / general Also called pseudogout, chondrocalcinosis Common finding in arthritic joints Pathophysiology Calcium pyrophosphate dehydrate (CPPD) crystals develop first in menisci and intervertebral discs, may seed the joint and elicit neutrophilic [pathologyoutlines.com]
Further studies are needed in order to enlighten the pathophysiology and prevalence of CC in patients with GS. [omicsonline.org]
Subsequent messenger RNA expression analysis of the relevant genes in this pathway, in articular cartilage of independent patients undergoing joint replacement surgery for osteoarthritis, showed that upregulation of TNFRSF11B is a general phenomenon in the pathophysiological [emedicine.medscape.com]
Hemochromatosis: Genetics, Pathophysiology, diagnosis, and treatment. [physio-pedia.com]
Prevention
Prevention There are not specific techniques applicable to every patient to prevent the formulation of the crystals; however, some patients with certain diseases are at greater risk of developing them. [medical-dictionary.thefreedictionary.com]
These problems are preventable if hemochromatosis is recognized in time. [orthop.washington.edu]
Drainage of joint fluid and injection of a corticosteroid Nonsteroidal anti-inflammatory drugs Colchicine to help prevent attacks Physical therapy Usually, treatment can stop acute attacks and prevent new attacks but cannot reverse changes in already [msdmanuals.com]
While you can’t prevent the disease, you can find treatments to reduce the inflammation and relieve the pain. Treating the underlying condition that causes pseudogout may slow its development and lessen the severity of symptoms. [healthline.com]
For the purpose of preventing further attacks, low doses of Colcrys (colchicine) and NSAIDs are typically prescribed, along with recommendations for proper hydration. [verywell.com]