Calcium Pyrophosphate Deposition (CPPD)


Calcium pyrophosphate deposition (CPPD)also known as “pseudogout” is a type of arthritis. In CPPD, calcium pyrophosphate (CPP) crystals form in the blood and settle in joint cartilage. People over 60 are more likely to get CPPD, although it may happen at an earlier age. Crystal deposits trigger an inflammatory attack in the joint. It is unknown why CPP crystals form. Excess iron or calcium, or low magnesium, and an abnormal thyroid gland may be contributing factors. CPP crystals may also be found in the joints of people with osteoarthritis or gout.

What Are the Signs/Symptoms?

CPPD symptoms include severe joint pain, warmth and swelling. Knees are the joints most commonly affected, but CPPD can other joints. If left untreated, CPPD may lead to severe, painful attacks and chronic joint inflammation. Joint cartilage may break down, causing disability. A rheumatologist diagnoses CPPD based on symptoms and medical tests. Additionally, the rheumatology provider may need to withdraw fluid from a joint to make the diagnosis of CPPD. MRI, ultrasound, CT scan or X-ray may show calcium containing deposits in cartilage.

What Are Common Treatments?

Nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed to treat joint pain and swelling in an acute CPPD event.There is no treatment to dissolve the crystals. The rheumatology provider may drain fluid from the affected joint and inject a corticosteroid. colchicine or low dose NSAIDs can be used to prevent future attacks. For severe attacks or chronic inflammation, drugs like methotrexate) or the interleukin beta-1 antagonist anakinra (Kineret) are treatment options. Surgery may be used to repair or replace damaged joints.

Living with CPPD

Prompt diagnosis and treatment of CPPD may ease symptoms and prevent joint damage. See a rheumatologist as soon as symptoms appear to rule out other possible causes and start treatment. Rheumatologists may refer some people with CPPD to physical and occupational therapists. These health care providers guide therapy to improve flexibility, ease joint pain and adapt movements for better function.

Updated February 2023 by Mohammad Ursani, MD, and reviewed by the American College of Rheumatology Committee on Communications and Marketing.

This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.

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