Systemic (Rheumatic)
Pseudogout (CPPD Disease)
가성 통풍
Acute/chronic arthritis from calcium pyrophosphate (CPPD) crystal deposition in cartilage
- How common
- 10–15% of adults >65
- Typical age
- Elderly (>65)
What is it?
CPPD crystals deposit in articular cartilage (fibrocartilage); crystal shedding triggers acute inflammation. Chondrocalcinosis is characteristic.
Commonly affected: Knee (most common), wrist, MCP, shoulder, pubic symphysis
How it develops
- Pyrophosphate DysregulationChondrocyte PPi overproduction (aging, metabolic disease)
- CPPD DepositionCrystals form in fibrocartilage (menisci, TFCC)
- Crystal SheddingCrystals shed into joint space
- Acute InflammationNeutrophil influx and IL-1β-mediated (gout-like)
Symptoms
- Acute monoarthritisAcute knee or wrist pain, swelling, redness
- TriggersSurgery, trauma, acute illness trigger attacks
- Chronic arthropathyOA-like pattern (knee, MCP, wrist)
- Pseudo-RA patternSymmetric polyarthritis in 5%
- Possible feverLow-grade fever may accompany acute attack
How it is examined
- CPPD crystals on aspirationPositively birefringent rhomboid/rectangular crystals on polarized microscopy
- Joint swelling/warmth/tendernessDifficult to distinguish from gout attack clinically
- Chondrocalcinosis on X-rayLinear calcification in menisci/TFCC — characteristic
- Secondary cause workupCheck hyperparathyroidism, hemochromatosis, hypomagnesemia
Imaging
Chondrocalcinosis on X-ray — linear calcifications in fibrocartilage (knee menisci, wrist TFCC, pubic symphysis).
- Meniscal linear calcification
- Wrist TFCC calcification
- Pubic symphysis calcification
- Joint space narrowing (chronic)
MRI/CT confirms calcification; US can detect intracartilaginous deposits.
- Intracartilaginous calcifications
- Synovitis
- Bone marrow edema (acute)
- Hyperdense calcification on CT
Non-surgical care
- Acute — NSAIDs/colchicine/steroidsSame approach as gout; intra-articular steroids especially effective
- Joint aspiration/lavageDiagnostic and therapeutic — crystal removal brings rapid relief
- Low-dose colchicine prophylaxisFor frequent recurrence: 0.6 mg 1–2x/day
- Treat underlying conditionCorrect hyperparathyroidism, hemochromatosis, hypomagnesemia
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Severe joint destruction, refractory symptoms
Procedures that may be discussed
- Joint lavage/synovectomy
- Arthroscopic lavage
- Joint replacement (end-stage)
Outlook
Acute attacks resolve in 1–3 weeks; chondrocalcinosis is permanent with possible recurrence.