Calcium Pyrophosphate Deposition Disease Flashcards Preview

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Flashcards in Calcium Pyrophosphate Deposition Disease Deck (12)
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1
Q

CPP in short

A

Deposition of CPP crystals into joints

Variety of clinical presentation from chronic polyarticular pain to acute inflammatory mono

2
Q

CPP pathogenesis up to the deposition of crystals

A

Inorganic pyrophosphate made from ATP

Chondrocyte membrane known as ANKH controls efflu of ATP out of condrocytes and is therefore responsible for concentration of ePPi

High amounts of PPi in synovial space increases formation of crystals

Alkaline phosphatase degrates Pi, making it unavailable for crystallization

Any process that decrease alkaline phosphatase will favor formation

Stress on chondrocytes increases ATP release and therefore favors crystal formation

3
Q

Effect of the crystals…pathologic

A

Induce infalmmatory reaction and increase release of matrix metalloproteinase from synoviocytes and chorndorcytes

Leads to cartilage degeneration

Also depostis in artticular cartilabe and alters mech processes

4
Q

Other diseases that are associated with CPPD and why

A

Joint diseases because of chondrocyte stress (osteoarthritis, gout)

Metabolic conditions (hypophosphatasia with low alkaline phosphatase)

Also hyperparathyroidism, hypomagnesaemia, hemochromatosis, hypothyroidism, Wilson’s dz

5
Q

CPPD epidemiology

A

Maybe 5% over 60…40% over 80

6
Q

Acute CPPD

A

Pseudogout

Acute mono or oligo artthritis…most in knee, wrist, elbow and or ankle

Tends to be asymmetric with multiple joints in the same limb affectred

Systemic sx may be present

Tend to be precipitated by physuologic stress…resolve slowly

7
Q

Chronic CPPD

A

POlyarticular involvement with similar joints to osteoarthritis

Chronic CPPD (different than OA), has intermittent flares characterized by an acute inflamm arthritis and progressive joint damage

Chronic also affects the shoulder, wrist, and MCP joints

Rarely presents like rheumatoid arthritis

8
Q

Acute dx

A

Over 60 with acute mono or oligo pain

Evelated or ESR and CRP

If joint effusion, then arthrocentesis…look for positively birefringent, rhomboid shaped crystals in synovial fluid (pathognomonic)

9
Q

Chronic dx

A

Over 60 with chornic polyarticlar…esp wrists or MCP joints with bouts of inflamm arthritis

If severe OA and joint degeneration, could also have CPPD dz

10
Q

Radiography CPPD

A

Visualization of chondrocalcinosis (calcifciation of cartilage)

Common in menisci of the knee, triangular cart of radioulnar wrist, or glenoid labrum

Can also use ultraosund to detect hyperechoic linear densitiies

11
Q

Acute manamgnet

A

Anti-inflam therapy

Intra-articular GCs…alternatives are NSAAIDs and colchicine

12
Q

Chronic managment

A

NSAIDs and colchicine may decreasefreq of acute flares