Skip to main content
SpringerLink
Log in

CPPD and Other Microcrystalline Disorders

  • Chapter
  • First Online:
A Clinician's Pearls & Myths in Rheumatology

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  • Abhishek A, Doherty M. Pathophysiology of articular chondrocalcinosis--role of ANKH. Nat Rev Rheumatol. 2011;7(2):96–104.

    CAS  PubMed  Google Scholar 

  • Abhishek A, Doherty S, Maciewicz R, Muir K, Zhang W, Doherty M. Chondrocalcinosis is common in the absence of knee involvement. Arthritis Res Ther. 2012;14(5):R205.

    PubMed  PubMed Central  Google Scholar 

  • Abhishek A, Doherty S, Maciewicz R, et al. The association between ANKH promoter polymorphism and chondrocalcinosis is independent of age and osteoarthritis: results of a case–control study. Arthritis Res Ther. 2014;16:R25.

    PubMed  PubMed Central  Google Scholar 

  • Andres M, Sivera F, Pascual E. Methotrexate is an option for patients with refractory calcium pyrophosphate crystal arthritis. J Clin Rheumatol. 2012;18(5):234–6.

    PubMed  Google Scholar 

  • Andrés M, Vela P, Jovaní V, Pascual E. Most needle-shaped calcium pyrophosphate crystals lack birefringence. Rheumatology (Oxford). 2019;58(6):1095–8.

    PubMed  Google Scholar 

  • Announ N, Guerne PA. Treating difficult crystal pyrophosphate dihydrate deposition disease. Curr Rheumatol Rep. 2008;10(3):228–34.

    CAS  PubMed  Google Scholar 

  • Baldwin CT, Farrer LA, Adair R, Dharmavaram R, Jimenez S, Anderson L. Linkage of early-onset osteoarthritis and chondrocalcinosis to human chromosome 8q. Am J Hum Genet. 1995;56(3):692–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Boumans D, et al. The added value of centrifugation for monosodium urate and calcium pyrophosphate crystal detection. Clin Rheumatol. 2017;36:1599–605.

    CAS  PubMed  Google Scholar 

  • Chiba D, Tsuda E, Sasaki E, et al. Low prevalence of knee chondrocalcinosis and its catabolic association with serum matrix metalloproteinase 3: a rural Japanese population study. Int J Rheum Dis. 2017;21:2011–8.

    PubMed  Google Scholar 

  • Conti F, et al. Hypophosphatasia: clinical manifestation and burden of disease in adults. Clin Cases Miner Bone Metab. 2017;14(2):230–4.

    PubMed  PubMed Central  Google Scholar 

  • Crawford R, Puddle B, Hunt N, et al. Deposition of calcium pyrophosphate in tissue after revision arthroplasty of the hip. J Bone Joint Surg Br. 1999;81(3):552–4.

    CAS  PubMed  Google Scholar 

  • Dieppe P, Crocker P, Corke C, et al. Synovial fluid crystals. Quarter J Med. 1979;48:533–55.

    CAS  Google Scholar 

  • Doaré E, Robin F, Racapé H, Le Mélédo G, Orione C, Guggenbuhl P, Goupille P, Gervais E, Dernis E, Bouvard B, Marhadour T, Coiffier G, Saraux A. Features and outcomes of microcrystalline arthritis treated by biologics: a retrospective study. Rheumatol Ther. 2021;8(3):1241–53. https://doi.org/10.1007/s40744-021-00335-7. Epub ahead of print. PMID: 34218418

    Article  PubMed  PubMed Central  Google Scholar 

  • Dumusc A, So A. Answer to Cipolletta et al. “Treatment of acute CPP crystal arthritis: what are we missing?”. Joint Bone Spine. 2021;88:105217.

    Google Scholar 

  • Ea HK, et al. Calcium pyrophosphate dihydrate crystal deposition in gouty tophi. Arthritis Rheum. 2021;73(2):324–9.

    CAS  Google Scholar 

  • Finckh A, Mc Carthy GM, Madigan A, et al. Methotrexate in chronic-recurrent calcium pyrophosphate deposition disease: no significant effect in a randomized crossover trial. Arthritis Res Ther. 2014;16(5):458.

    PubMed  PubMed Central  Google Scholar 

  • Fisseler-Eckhoff A, Muller KM. Arthroscopy and chondrocalcinosis. Arthroscopy. 1992;8:98–104.

    CAS  PubMed  Google Scholar 

  • Galvez J, Saiz E, Linares L, et al. Delayed examination of synovial fluid by ordinary and polarized light microscopy to detect and identify crystals. Ann Rheum Dis. 2002;61:444–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Gerster J, Varisco P, Kern J, et al. CPPD crystal deposition disease in patients with rheumatoid arthritis. Clin Rheumatol. 2006;25:468–9.

    CAS  PubMed  Google Scholar 

  • Haikal A, Everist BM, Jetanalin P, Maz M. Cervical CT-dependent diagnosis of crowned dens syndrome in calcium pyrophosphate dihydrate crystal deposition disease. Am J Med. 2020;133(2):e32–7.

    CAS  PubMed  Google Scholar 

  • Harato K, Yoshida H. Pseudogout in the early postoperative period after total knee arthroplasty. J Arthroplast. 2013;28(2):374.e9–374.e11.

    Google Scholar 

  • Hearn P, Russell R, Elliott J, et al. Formation products of calcium pyrophosphate crystals in vitro and the effect of iron salts. Clin Sci. 1978;54:29P.

    Google Scholar 

  • Hirose CB, Wright RW. Calcium pyrophosphate dihydrate deposition disease (pseudogout) after total knee arthroplasty. J Arthroplast. 2007;22(2):273–6.

    Google Scholar 

  • Holt G, Vass C, Kumar CS. Acute crystal arthritis mimicking infection after total knee arthroplasty. BMJ. 2005;331(7528):1322–3.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Hughes AE, McGibbon D, Woodward E, Dixey J, Doherty M. Localisation of a gene for chondrocalcinosis to chromosome 5p. Hum Mol Genet. 1995;4(7):1225–8.

    CAS  PubMed  Google Scholar 

  • Ivorra J, Rosas J, Pascual E. Most calcium pyrophosphate crystals appear as non-birefringent. Ann Rheum Dis. 1999;58(9):582–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Kleiber Balderrama C, Rosenthal AK, Lans D, Singh JA, Bartels CM. Calcium pyrophosphate deposition disease and associated medical comorbidities: a National Cross-Sectional Study of US veterans. Arthritis Care Res (Hoboken). 2017;69(9):1400–6.

    CAS  PubMed  Google Scholar 

  • Latourte A, Ea HK, Frazier A, et al. Tocilizumab in symptomatic calcium pyrophosphate deposition disease: a pilot study. Ann Rheum Dis. 2020;79(8):1126–8.

    PubMed  Google Scholar 

  • Martinez-Sanchis A, Pascual E. Intracellular and extracellular CPPD crystals are a regular feature in synovial fluid from uninflamed joints of patients with CPPD related arthropathy. Ann Rheum Dis. 2005;64:1769–72.

    CAS  PubMed  Google Scholar 

  • McCarty DJ. Diagnostic mimicry in arthritis: patterns of joint involvement associated with calcium pyrophosphate dihydrate crystal deposits. Ann Rheum Dis. 1975;25:804–9.

    Google Scholar 

  • Mitrovic D, Stankovic A, Iriarte-Borda O, et al. The prevalence of chondrocalcinosis in the human knee joint. An autopsy survey. J Rheumatol. 1988;15:633–41.

    CAS  PubMed  Google Scholar 

  • Mitton-Fitzgerald E, Gohr CM, Williams CJ, Ortiz A, Mbalaviele G, Rosenthal AK. The TNFRSF11B mutation associated with calcium pyrophosphate deposition disease results in ineffective osteoclast suppression. Rheumatol. 2021;73(8):1543–9. https://doi.org/10.1002/art.41678.

    Article  CAS  Google Scholar 

  • Moltó A, Ea HK, Richette P, Bardin T, Lioté F. Efficacy of anakinra for refractory acute calcium pyrophosphate crystal arthritis. Joint Bone Spine. 2012;79(6):621–3.

    PubMed  Google Scholar 

  • Moshrif A, Laredo JD, Bassiouni H, Abdelkareem M, Richette P, Rigon MR, Bardin T. Spinal involvement with calcium pyrophosphate deposition disease in an academic rheumatology center: a series of 37 patients. Semin Arthritis Rheum. 2019;48(6):1113–26.

    CAS  PubMed  Google Scholar 

  • O'Duffy J. Clinical studies of acute pseudogout attacks. Comments on prevalence, predisposition and treatment. Arthritis Rheum. 1976;19(Suppl):349–52.

    PubMed  Google Scholar 

  • Ottaviani S, Brunier L, Sibilia J, Maurier F, Ardizzone M, Wendling D, Gill G, Palazzo E, Meyer O, Dieudé P. Efficacy of anakinra in calcium pyrophosphate crystal-induced arthritis: a report of 16 cases and review of the literature. Joint Bone Spine. 2013;80(2):178–82.

    CAS  PubMed  Google Scholar 

  • Parperis K, Papachristodoulou E, Kakoullis L, Rosenthal AK. Management of calcium pyrophosphate crystal deposition disease: a systematic review. Semin Arthritis Rheum. 2021;51(1):84–94.

    CAS  PubMed  Google Scholar 

  • Pascual E, Tovar J, Ruiz MT. The ordinary light microscope: an appropriate tool for provisional detection and identification of crystals in synovial fluid. Ann Rheum Dis. 1989;48(12):983–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Quilis N, Andrés M, Vela P, Pascual E. Interleukin-6 pathway blockade as an option for managing refractory cases of crystal arthritis: two cases report. Joint Bone Spine. 2018;85(3):377–8.

    PubMed  Google Scholar 

  • Rosenthal AK, Ryan LM. Calcium pyrophosphate deposition disease. N Engl J Med. 2016;374(26):2575–84.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Rothschild B, Yakubov LE. Prospective 6-month, double-blind trial of hydroxychloroquine treatment of CPPD. Compr Ther. 1997;23(5):327–31.

    CAS  PubMed  Google Scholar 

  • Sabchyshyn V, Konon I, Ryan LM, Rosenthal AK. Concurrence of rheumatoid arthritis and calcium pyrophosphate deposition disease: A case collection and review of the literature. Semin Arthritis Rheum. 2018;48(1):9–11. https://doi.org/10.1016/j.semarthrit.2017.11.009. Epub 2017 Dec 2. PMID: 29338885; PMCID: PMC6240440.

  • Sonsale PD, Philipson MR. Pseudogout after total knee arthroplasty. J Arthroplast. 2007;22(2):271–2.

    CAS  Google Scholar 

  • Thomas M, Forien M, Palazzo E, Dieudé P, Ottaviani S. Efficacy and tolerance of anakinra in acute calcium pyrophosphate crystal arthritis: a retrospective study of 33 cases. Clin Rheumatol. 2019;38(2):425–30.

    PubMed  Google Scholar 

  • Williams CJ, Qazi U, Bernstein M, et al. Mutations in osteoprotegerin account for the CCAL1 locus in calcium pyrophosphate deposition disease. Osteoarthr Cartil. 2018;26(6):797–806.

    CAS  Google Scholar 

  • Yates KA, Yoshida K, Xu C, et al. Acute calcium pyrophosphate crystal arthritis flare rate and risk factors for recurrence. J Rheumatol. 2020;47(8):1261–6.

    CAS  PubMed  Google Scholar 

  • Younis AA. Crowned dens syndrome as a cause of acute neck pain: a case report and review of the literature. Mediterr J Rheumatol. 2017;28(2):101–5.

    PubMed  PubMed Central  Google Scholar 

  • Yuan S, Bien C, Wener M, et al. Repeat examination of synovial fluid for crystals: is it useful? Clin Chem. 2003;49:1562–3.

    CAS  PubMed  Google Scholar 

  • Zaka R, Williams CJ. Role of the progressive ankylosis gene in cartilage mineralization. Curr Opin Rheumatol. 2006;18:181–6.

    CAS  PubMed  Google Scholar 

  • Zell M, Zhang D, FitzGerald J. Diagnostic advances in synovial fluid analysis and radiographic identification for crystalline arthritis. Curr Opin Rheumatol. 2019;31(2):134–43.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Zhang W, Doherty M, Bardin T, et al. European league against rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann Rheum Dis. 2011a;70(4):563–70.

    CAS  PubMed  Google Scholar 

  • Zhang W, Doherty M, Pascual E, et al. EULAR recommendations for calcium pyrophosphate deposition. Part II: management. Ann Rheum Dis. 2011b;70(4):571–5.

    CAS  PubMed  Google Scholar 

  • Zhang Y, Johnson K, Russell RG, et al. Association of sporadic chondrocalcinosis with a −4-basepair G-to-a transition in the 5′-untranslated region of ANKH that promotes enhanced expression of ANKH protein and excess generation of extracellular inorganic pyrophosphate. Arthritis Rheum. 2005;52:1110–7.

    CAS  PubMed  Google Scholar 

  • Zhang Y, Terkeltaub R, Nevitt M, et al. Lower prevalence of chondrocalcinosis in Chinese subjects in Beijing than in white subjects in the United States: the Beijing osteoarthritis study. Arthritis Rheum. 2006;54:3508–12.

    PubMed  Google Scholar 

  • Zitnan D, Sitaj S. Chondrocalcinosis polyarticularis (familiaris): roentgenological and clinical analysis. Cesk Rentgenol. 1960;14:27–34.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Division of Rheumatology, Medical College of Wisconsin, Milwaukee, WI, USA

    Ann K. Rosenthal

  2. Sección de Reumatología, Hospital General Universitario de Alicante, Departamento de Medicina Clínica, Universidad Miguel Hernández, and ISABIAL, Elche, Spain

    Mariano Andres

  3. University of Nottingham, Nottingham, UK

    Abhishek Abhishek

  4. Rheumatology, Allergy-Immunology Section, San Diego VA Medical Center, University of California at San Diego, San Diego, CA, USA

    Robert Terkeltaub

Authors
  1. Ann K. Rosenthal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mariano Andres
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Abhishek Abhishek
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert Terkeltaub
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ann K. Rosenthal .

Editor information

Editors and Affiliations

  1. Massachusetts General Hospital, Harvard University Massachusetts General Hospital, Boston, MA, USA

    John H. Stone

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Rosenthal, A.K., Andres, M., Abhishek, A., Terkeltaub, R. (2023). CPPD and Other Microcrystalline Disorders. In: Stone, J.H. (eds) A Clinician's Pearls & Myths in Rheumatology. Springer, Cham. https://doi.org/10.1007/978-3-031-23488-0_37

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-23488-0_37

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-23487-3

  • Online ISBN: 978-3-031-23488-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation