Calcium Pyrophosphate Crystal Deposition Disease and Pseudogout

Calcium pyrophosphate crystal deposition (CPPD) disease is a common arthritis in adults caused by crystals (calcium pyrophosphate) in the joint. CPPD disease sometimes causes attacks of pseudogout, characterized by one or more swollen, warm, painful red joints.

Causes and Risk Factors

The following have been associated with an increased risk of CPPD and pseudogout:

  • Older age
  • Joint trauma – injury or joint replacement surgery
  • Inherited disorders

Symptoms

Symptoms can include:

  • Sudden onset or “attack” of joint pain, ranging from mild to severe, most often in the knees, ankles and wrists
  • Warmth in joint(s)
  • Swelling in joint(s)

Usually the attack involves just one joint, but in some patients, several joints are involved. An attack can from last days to a few weeks without treatment.

Only a fraction of patients with CPPD disease will develop pseudogout in their lifetime. Some patients only have one attack, while others have recurrent attacks.

Notably, many patients with CPPD disease have no joint pain and may never develop joint pain. These patients have X-rays that show chondrocalcinosis, which is evidence of calcium pyrophosphate crystal deposits in the cartilage. Chondrocalcinosis is most common in older adults and can be asymptomatic, meaning that patients with this X-ray finding may have no joint symptoms at all. 

Diagnosis

To determine if your joint symptoms are due to CPPD disease or pseudogout, our physicians may perform one or more of the following tests:

  • Complete medical history: to learn your symptoms, medications, and family members with similar symptoms
  • Physical examination: to evaluate the pattern of affected joints and determine if joint inflammation is present
  • Joint fluid analysis: the physician removes a sample of fluid from the joint and analyzes it for calcium pyrophosphate crystals
  • X-ray: to look for chondrocalcinosis (calcium pyrophosphate crystal deposits in cartilage) and/or joint damage
  • Musculoskeletal ultrasound: to look for joint inflammation, crystal deposits, and/or joint damage
  • Dual-energy CT scan: to look for crystal deposits and/or joint damage

Treatment

Our physicians work with patients to develop an individualized treatment plan. Treatments to prevent or remove calcium pyrophosphate crystals do not currently exist. However, CPPD disease and pseudogout symptoms can be treated with medications that target joint pain and inflammation, including:

  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Colchicine
  • Corticosteroids, such as Prednisone
  • Corticosteroids injected into the joint (often called a “cortisone shot”)

Contact Us

To learn more about our services or to make an appointment with a Brigham and Women’s Hospital rheumatologist, contact one of our trained coordinators at 1-800-294-9999 to get connected with the best doctor for your needs.

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