CPPD

Question 1

• deposition of CPP crystals in articular tissues is most common in the elderly
• occurs in 10-15% of persons age 65-75 years , 30-50% of those >85 years
• Asymptomatic in most cases
• cause is uncertain

Answer 1

CALCIUM PYROPHOSPHATE DEPOSITION (CPPD) DISEASE

Question 2

Mutations in the ANKH gene

Answer 2

CPPD

Question 3

CLINICAL MANIFESTATIONS OF CPPD

Answer 3

• may be asymptomatic
• acute/subacute or chronic
• may cause acute synovitis superimposed on chronically involved joints
• association with or enhancement of peculiar forms of osteoarthritis
• induction of severe destructive disease that may radiographically mimic neuropathic arthritis
• intervertebral disk and ligament calcification with restriction of spine mobility, the crowned
  dens syndrome, or spinal stenosis (most commonly seen in the elderly)
• production of chronic symmetric synovitis that is clinically similar to rheumatoid arthritis
• rarely periarticular tophus-like nodules

Question 4

Most frequently affected in CPPD

Answer 4

Knee joint

Question 5

Other sites affected in CPPD

Answer 5

• wrist
• shoulder
• ankle
• elbow
• hands
• temporomandibular joint

Question 6

Is seen in at least 2/3 of patients

Answer 6

polyarticular

Question 7

diagnostic likelihood of CPPD

Answer 7

If radiographs or ultrasound reveal punctate and/or linear radiodense deposits within fibrocartilaginous joint menisci or articular hyaline cartilage (chondrocalcinosis)

Question 8

Definitive diagnosis of CPPD

Answer 8

typical rhomboid or rodlike crystals (generally weakly positively birefringent or
nonbirefringent w/ polarized light) in synovial fluid or articular tissue

Question 9

is essential to rule out the possibility of infection in dx of CPPD

Answer 9

synovial fluid analysis with microbial cultures

Question 10

synovial fluid analysis with microbial cultures IN CPPD

Answer 10

Neutrophil

Question 11

TX of CPPD

Answer 11

• rest, joint aspiration, and NSAIDs or by intraarticular
  glucocorticoid injection may result in more rapid return to prior status.
• Low doses of colchicine for frequent recurrent attacks
• Severe polyarticular attacks usually require short courses of glucocorticoids or an IL-18 antagonist, anakinra

Question 12

is the primary mineral of normal bone and teeth

Answer 12

Apatite

Question 13

Apatite crystals are deposited primarily on

Answer 13

matrix vessels

Question 14

Apatite aggregates are commonly present in synovial fluid in an extremely destructive chronic arthropathy of the elderly that occurs most often in the ___

Answer 14

shoulders (Milwaukee shoulder)

Question 15

most common sites of apatite deposition include

Answer 15

• bursae and tendons in and/or around the knees,
• shoulders,
• hips, and
• fingers

Question 16

Clinical manifestations of CALCIUM APATITE DEPOSITION DISEASE

Answer 16

• asymptomatic radiographic abnormalities,
• acute synovitis,
• bursitis,
• tendinitis,
• chronic destructive arthropathy

Question 17

synovial fluid leukocyte count in apatite arthritis is ___ despite dramatic symptoms, with predominance of mononuclear cells

Answer 17

usually low (<2000/uL)

Question 18

Clumps of crystals may appear as 1- to 20-um shiny intra- or extracellular
nonbirefringent globules or aggregates that stain purplish with _____
and bright red with ____.
Tetracycline binding and other investigative techniques are under
consideration as labeling alternatives.

Answer 18

• Wright’s stain
• alizarin red S

Question 19

is a rare hereditary metabolic disorder

Answer 19

Primary oxalosis

Question 20

• Hyperoxalemia
• deposition of CaOx crystals in tissues
• nephrocalcinosis and renal failure
• Acute and/or chronic CaOx arthritis, periarthritis, and bone disease may complicate primary oxalosis during later years of illness

Answer 20

CaOx DEPOSITION DISEASE

Question 21

• more common than the primary disorder
• In chronic renal disease, CaOx deposits have long been recognized in visceral
  organs, blood vessels, bones, and cartilage and are now known to be one of the causes of arthritis in chronic renal failure

Answer 21

Secondary oxalosis

Question 22

CaOx-induced synovial effusions are usually ____ with ___

Answer 22

noninflammatory, with <2000 leukocytes/uL, or mildly inflammatory

Question 23

most easily recognized forms of CaQOx crystals are ____, have strong birefringence and stain with alizarin red S

Answer 23

bipyramidal

Question 24

TREATMENT: CaOx DEPOSITION DISEASE

Answer 24

• NSAIDs,
• colchicine,
• intraarticular glucocorticoids,
• and/or an increased frequency of dialysis has produced only slight
  improvement.