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Concept
Calcium pyrophosphate dihydrate crystal deposition disease
Summary
Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, also known as pseudogout and pyrophosphate arthropathy, is a rheumatologic disease which is thought to be secondary to abnormal accumulation of calcium pyrophosphate dihydrate crystals within joint soft tissues. The knee joint is most commonly affected. The disease is metabolic in origin and its treatment remains symptomatic.
CPPD has also been classified as an Autoimmune Paraneoplastic Manifestation of Myelodysplastic Syndrome. Patients are exhausted of the classification name of "pseudogout" because it alters the course of the doctor/patient conversation and treatment.
When symptomatic, the disease classically begins with symptoms that are similar to a gout attack (thus the moniker "pseudogout"). These include:
severe pain
warmth
swelling of one or more joints
severe fatigue
fever
feeling of malaise or flu-like symptoms
inability to walk or perform everyday tasks or hobbies
gnawing/chewing sensations in the joints
burning
The symptoms can be monoarticular (involving a single joint) or polyarticular (involving several joints). Symptoms usually last for days to weeks, and often recur. Although any joint may be affected, the knees, wrists, and hips are most common.
CPPD chrystals appear as shattered glass under the microscope. When released into the synovial fluid, it causes unbearable pain to the patient.
Flares are sudden, severe and without warning. Diet does not appear to cause flares. Overexertion of any exercise, standing too long, shopping, stressful or loud environments, can or may lead to severe flares, which can last from one hour to months. Although, in some patient interviews, alcohol may be a known trigger.
X-ray, CT, or other imaging usually shows accumulation of calcium within the joint cartilage, known as chondrocalcinosis. There can also be findings of osteoarthritis. The white blood cell count is often raised.
The cause of CPPD disease is unknown.
Official source
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