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Clinical presentations associated with CPPD
CPPD associated arthritis can present in a number of different ways; the diverse clinical presentations allow for classification in to the subgroups listed in the below table
Classification of CPPD
| Asymptomatic CPPD ( lanthanic ) | Radiographic CC without clinical manifestations; commonly involves the knee. |
| Acute CPP crystal arthritis ( pseudogout ) | An acute, self-limited mono- or oligoarticular arthritis. Most common form when CPPD presents as an inflammatory arthritis (89%). The knee and wrist are the most commonly involved joints. |
| Chronic CPP crystal inflammatory arthritis ( pseudo-RA ) | A chronic, polyarticular arthritis. A less common form when CPPD presents as an inflammatory arthritis (11%). This should be considered in any elderly patient with new onset seronegative RA or polymyalgia rheumatica. |
| OA with CPPD ( pseudo-OA ) | OA changes associated with CPPD. Patients may (50%) or may not have superimposed attacks of acute CPP crystal arthritis (pseudogout). CPPD causes OA in joints that are not usually involved by OA, such as the MCPs and radiocarpal and elbow joints. |
| Other presentations | Tumoral CPP crystal deposition in periarticular and bony structures ( pseudo-tophaceous pattern ). Tendon deposits, most commonly in the Achilles, gastrocnemius and/or quadriceps tendons. Less common triceps and rotator cuff. Pseudo-neuropathic pattern: radiographic appearance is Charcot-like but the patient has normal pain perception. Cervical stenosis: from CPPD in the ligamentum flavum and/or transverse ligament of the atlas. Crowned dens: CPPD above the odontoid process can lead to acute neck pain and meningismus with crystal shedding. Axial involvement: intervertebral disc calcifications and sacroiliac joint involvement are more common in familial forms. |
CPPD-associated arthritis is the third most common cause of inflammatory arthritis, occurring in 3.4% of adult patients. It should be considered in the diagnosis of any acute or chronic mono-, oligo-, or polyarticular inflammatory or noninflammatory arthritis occurring in patients over the age of 55 years. If it occurs in a patient aged <55 years, then familial forms, certain metabolic diseases (hyperparathyroidism, hemochromatosis, hypomagnesemia, dialysis-dependent renal failure, others; , and/or a history of joint trauma/meniscectomy need to be considered.
