Calcium pyrophosphate dihydrate deposition disease

Dr Henry Knipe and A.Prof Frank Gaillard et al.

Calcium pyrophosphate dihydrate disease (CPPD disease), also referred as pyrophosphate arthropathy and perhaps confusingly as pseudogout, is common, especially in the elderly, and is characterised by the deposition of calcium pyrophosphate in soft tissues and cartilage.

CPPD is one of many causes of soft tissue calcification (chondrocalcinosis). It is not synonymous with chondrocalcinosis and not the only cause of soft tissue calcification.

Where crystal deposition causes acute clinical manifestation, the term pseudogout should be used. Pyrophosphate arthropathy is a term that describes arthropathy secondary to CPPD deposition. However, it is often used indiscriminately to refer to chondrocalcinosis too.

CPPD is commonest in patients over the age of 50. Men and women are equally affected. 

The crystals are weakly positively birefringent on polarised microscopy and have a rhomboid or rod shape. Causes of CPPD can be divided into:

CPPD has many features of osteoarthritis with unusual distribution, for example, they tend to be symmetric in distribution and involve non-weight bearing joints or, in the hands, mainly involve intercarpal and MCP joints. 

Features of degenerative joint disease in joints that are not commonly affected by it (i.e. non-weight bearing joints):

Chondrocalcinosis can occur in many locations. Notable sites include:

  • knee: medial meniscus and patellofemoral joint
  • wrist: triangular fibrocartilage complex and lunotriquetral ligaments 
  • spine: periodontoid tissue

Large subchondral cysts may be present.

It is controversial whether gout leads to calcification of articular fibrocartilage or hyaline cartilage 6. CPPD disease can be differentiated from gout on ultrasound given that echogenic monosodium urate crystals line the surface of articular cartilage, whereas echogenic CPPD calcifications are located within the cartilage itself 7.

Possible imaging differential considerations include

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Article information

rID: 1037
Synonyms or Alternate Spellings:
  • Pseudogout
  • Calcium pyrophosphate dihydrate deposition arthropathy
  • CPPD
  • Calcium pyrophosphate deposition disease (CPPD)
  • CPPD arthropathy
  • Calcium pyrophosphate dihydrate deposition disease (CPPD)

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Cases and figures

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    Case 1: T2 : CPPD of dens
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     Case 2: knee
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    Case 3: shoulder
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    Case 4: knee
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    CT cervical spine...
    Case 5
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    Case 6
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    Case 7
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