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Last reviewed: 21 Apr 2025
Last updated: 15 Feb 2024

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • painful and tender joints
  • osteoarthritis-like involvement of joints (wrists, shoulders)
  • sudden worsening of osteoarthritis
Full details

Other diagnostic factors

  • red and swollen joints
  • joint effusion and fluctuance
  • fever and malaise
Full details

Risk factors

  • advanced age
  • injury
  • hyperparathyroidism
  • haemochromatosis
  • family history of CPPD
  • hypomagnesaemia
  • hypophosphatasia
  • gout
  • other metabolic conditions
Full details

Diagnostic investigations

1st investigations to order

  • arthrocentesis with synovial fluid analysis
  • x-rays of affected joints
  • serum calcium
  • serum parathyroid hormone
  • iron studies
  • serum magnesium
  • serum alkaline phosphatase
Full details

Investigations to consider

  • ultrasonography
  • CT scan
Full details

Treatment algorithm

ACUTE

mono- or oligo-articular disease

polyarticular disease

ONGOING

chronic recurrent involvement of knee, hip, or shoulder joint with severe degeneration

with osteoarthritis-like disease or rheumatoid-like disease

Contributors

Authors

Ann K. Rosenthal, MD
Ann K. Rosenthal

Professor of Medicine

Medical College of Wisconsin

Milwaukee

WI

Disclosures

AKR is the author of several articles cited in this topic.

Peer reviewers

Priyanka Iyer, MD

Clinical Assistant Professor

University of California, Irvine

Irvine

CA

Disclosures

PI declares that she has no competing interests.

Ade Adebajo, MBBS, MSc, FRCP (Glasgow), FACP

Consultant Rheumatologist

Rheumatology

University of Sheffield Medical School

Sheffield

UK

Disclosures

AA declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

McCarty DJ. Diagnostic mimicry in arthritis: patterns of joint involvement associated with calcium pyrophosphate dihydrate crystal deposits. Bull Rheum Dis. 1975;25:804-809.

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. 2011 Apr;70(4):563-70.Full text  Abstract

Rosenthal AK, Ryan LM. Calcium Pyrophosphate Deposition Disease. N Engl J Med. 2016 Jun 30;374(26):2575-84.Full text  Abstract

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 Dec;64(12):1769-72. Abstract

Zhang W, Doherty M, Pascual E, et al. EULAR recommendations for calcium pyrophosphate deposition. Part II: management. Ann Rheum Dis. 2011 Apr;70(4):571-5.Full text  Abstract

Creamer P. Intra-articular corticosteroid treatment in osteoarthritis. Curr Opin Rheumatol. 1999 Sep;11(5):417-21. Abstract

Reference articles

A full list of sources referenced in this topic is available here.

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