EMed

Pseudogout / CPPD

Background

  • Destruction of joints and soft tissues by deposition of Calcium pyrophosphate dihydrate (CPPD) crystals
  1. Asymptomatic (majority)
    • X-ray: ↓joint space, subchondral sclerosis
  2. Acute "gout" (hot, red, swollen, and stiff joint)
  3. Chronic (Pseudorheumatoid) arthritis (5%)
    • Oligoarthritris, chronic cooler arthritis, ↑ESR
  • M = F, ↑↑ with age

Clinical

  • Sudden onset of intense, constant pain in one joint
  • ? triggered by stressor, lasts for 5 - 14 days
  • Knee involved in ½ cases (great toe in gout)
  • ± pyrexia
  • Eventul joint cartilage destructin with loose bodies and erosions

Differential Dx

  • Gout
  • Septic arthritis
  • Rheumatoid arthritis

Investigations

  • Plain x-rays (chondrocalcinosis)
  • Synovial fluid aspiration(sterile technique)

CUH arthrocentesis samples

  • Direct microscopy - micro
  • Crystal analysis - cytology
  • C & S - micro
  • Sample into blood culture media - micro
  • Fluid in FBC bottle for WCC - Haematology

Management

  • No cure - aim for symptomatic management
  • NSAIDs
  • ±steroids
  • GP long term Mx

Content by Dr Íomhar O' Sullivan. Last review Dr ÍOS 15/04/24.