Chondrocalcinosis 2425583 216581918 2008-06-02T08:31:13Z Cyclonenim 1572590 Reverted to revision 212665662 by [[Special:Contributions/Cyclonenim|Cyclonenim]]; Vandalism. ([[WP:TW|TW]]) {{Infobox_Disease | Name = Chondrocalcinosis | Image = CPPDKnees.jpg | Caption = Chondrocalcinosis of the articular and fibrocartilage of the left knee in a patient with calcium pyrophosphate dihydrate deposition disease (CPPD) | DiseasesDB = 10832 | ICD10 = {{ICD10|M|11|1|m|05}}-{{ICD10|M|11|2|m|05}} | ICD9 = {{ICD9|712.3}} | ICDO = | OMIM = | MedlinePlus = 000421 | eMedicineSubj = med | eMedicineTopic = 1938 | eMedicine_mult = {{eMedicine2|radio|125}} {{eMedicine2|orthoped|382}} {{eMedicine2|emerg|221}} | MeshID = D002805 | }} '''Calcium pyrophosphate deposition disease''' ('''CPPD''') is a [[rheumatology|rheumatologic]] disorder with varied clinical manifestations due to precipitation of [[calcium pyrophosphate]] dihydrate crystals in the connective tissues. It is more commonly known by alternative names that specify certain clinical or radiographic findings, although neither is synonymous with CPPD. ''Pseudogout'' refers to the clinically evident acute [[synovitis]] with red, tender, and swollen joints that may resemble [[gout]]y arthritis (a similar condition with joint deposition of monosodium [[urate]] crystals). ''Chondrocalcinosis''<ref name="emedicine1">{{cite web | last = Rothschild | first = Bruce M | title = Calcium Pyrophosphate Deposition Disease (radiology) | url=http://www.emedicine.com/radio/topic125.htm | accessdate = 2008-02-18 }}</ref><ref name="emedicine2"/>, on the other hand, refers to the radiographic evidence of calcification in hyaline and/or fibrocartilage. ''Pyrophosphate arthropathy'' is a term that may refer to either of the above.<ref name="oxford">{{cite book | last = Longmore | first = Murray | coauthors = Ian Wilkinson, Tom Turmezei, Chee Kay Cheung | title = Oxford Handbook of Clinicial Medicine | publisher = Oxford | date = 2007 | pages = 841 | isbn = 0-19-856837-1 }}</ref> Statistically, the [[Interphalangeal articulations of hand|interphalangeal]] joints are the most commonly affected.<ref name="emedicine1"/> ==General== CPPD crystal deposition disease is a polyarticular arthritis (i.e. it leads to an inflammation of several joints in the body), although it can initially present as monoarticular (i.e. confined to just one joint).<ref name="PMID"/> CPPD crystals tend to form within articular tissues.<ref name="PMID"/> Although, in theory, any joint may be affected, the knees, wrists, and hips are the statistically the most commonly attributed areas.<ref name="emedicine2"/> The exact pathology of CPPD is unknown, although increased [[adenosine triphosphate]] (the molecule used as energy currency in all animals) breakdown, which results in increased pyrophosphate levels in joints, is thought to be a method of crystal development.<ref name="emedicine2"/> There is some recent evidence suggesting that the gene [[ANKH]] is involved in crystal-related inflammatory reactions and inorganic phosphate transport.<ref name="emedicine2"/> ==Signs and symptoms== Patients usually present with inflammation of one or more joints often resulting in pain in the affected joint(s).<ref name="emedicine2">{{cite web | last = Rothschild | first = Bruce M | title = Calcium Pyrophosphate Deposition Disease (rheumatology) | url=http://www.emedicine.com/radio/topic125.htm | accessdate = 2008-02-18 }}</ref> [[Hyperparathyroidism]], [[hemochromatosis]], [[hypophosphatemia]] and renal [[osteodystrophy]] are often also associated with chondrocalcinosis.<ref name="emedicine2"/> In some cases, traumatic [[arthritis]] has resulted in chondrocalcinosis.<ref name="emedicine2"/><ref name="PMID">{{cite journal | author= Wright GD, Doherty M |title= Calcium pyrophosphate crystal deposition is not always 'wear and tear' or aging | journal= Ann. Rheum. Dis. | volume= 56 | issue= 10 | pages= 586–8 | year= 1997 | pmid= 9389218}}</ref> In general, the [[white blood cell]] count is raised<ref name="emedicine2"/>. Rarely, patients may also present with signs of [[carpal tunnel syndrome]].<ref name="emedicine2"/> ==Diagnosis== Radiography has a large role to play in the diagnosis of chondrocalcinosis with [[Radiography|radiographs]], [[Computed Tomography|CT scans]], [[Magnetic Resonance Imaging|MRIs]], [[ultrasound]] and [[nuclear medicine]] all having a part.<ref name="emedicine1"/> CT scans and MRIs show calcific masses (usually within the [[ligamentum flavum]] or joint capsule) however radiography is more successful.<ref name="emedicine1"/> As with most conditions, chondrocalcinosis can present with similarity to other diseases such as [[Ankylosing spondylitis]] or [[Gout]].<ref name="emedicine1"/><ref name="emedicine2"/> ==Treatment== Treatment for asymptomatic chondrocalcinosis is not advised to prevent end-organ damage.<ref name="emedicine2"/> For [[acute]] pseudogout, intra-articular corticosteroid injection, systemic corticosteroids, [[non-steroidal anti-inflammatory drugs]] (NSAIDs), or occasionally, high-dose [[colchicine]].<ref name="emedicine2"/> NSAIDs are generally administered in low doses to help prevent chondrocalcinosis, however in an acute attack is already occurring, higher doses are administered.<ref name="emedicine2"/> Research into surgical removal of calcifications is underway, however this still remains an experimental procedure.<ref name="emedicine2"/> ==Epidemiology== All cultural races are affected by CPDD, and in the United States around 50% of the population over 85 years of age are affected.<ref name="emedicine2"/> Morbidity is the primary result of CPDD, although mortality is never experienced from the disease itself.<ref name="emedicine2"/> Females are at a slightly larger risk than men, with an estimated ratio of occurrence of 1.4:1 respectively.<ref name="emedicine2"/> ==References== {{reflist|2}} ==External links== * [http://www.hmc.psu.edu/healthinfo/pq/pseudogout.htm Penn State] {{Diseases of the musculoskeletal system and connective tissue}} [[Category:Arthritis]] [[de:Pseudogicht]] [[ja:偽痛風]] [[pt:Condrocalcinose]] [[sv:Pyrofosfatsynovit]]