Crystal induced arthropathy (CPPD)

Case contributed by Dr Yasser Asiri

Presentation

Chronic recurrent joint pain and swelling.

Patient Data

Age: 35 years
Gender: Male
X-ray

Mild narrowing of the bilateral radiocarpal joints. Soft tissue calcification is seen at the expected location of the triangular fibrocartilage complex and scapholunate ligament in keeping with chondrocalcinosis. Normal bone mineralization and maintained alignment of the carpal bones with no evidence of SLAC. 

X-ray

Symmetrical narrowing of the bilateral knee joints with secondary osteoarthritic changes and large osteophytes involving the tibiofemoral and patellofemoral joints. Intra-articular calcification taking the shape of the meniscus in keeping with chondrocalcinosis. The overall imaging appearance is highly suggestive of CPPD.

X-ray

Annotated images

The areas of chondrocalcinosis in the wrist and knees as indicated by white arrows.

Case Discussion

Calcium pyrophosphate deposition disease (CPPD) is a type of crystal arthropathy which affects middle-aged and old populations. Clinical manifestation of this deposition disease rages from pseudogout syndrome to asymptomatic joint disease. The radiographic hallmark of CPPD is the presence of chondrocalcinosis and secondary osteoarthritic changes. 

This patient presented with a long history of severe polyarthritis involving his hands, feet, wrist and knees manifested with recurrent joint pain and swelling. The patient was investigated and his workup revealed that he has a form of crystal-induced arthropathy related to calcium pyrophosphate deposition disease (CPPD). 

Bare in mind that chondrocalcinosis related to CPPD deposition can be caused by hyperparathyroidism and hemochromatosis.

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Case information

rID: 65507
Published: 16th Feb 2019
Last edited: 9th Apr 2019
Inclusion in quiz mode: Included

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