Calcium pyrophosphate dihydrate deposition disease (CPPD)
is a build up of
in the joints. These
in the joints, which causes arthritis like conditions known as: PseudoosteoarthritisPseudogoutPseudorheumatoid arthritis
Over time the inflammation can cause damage to the tissue inside the joint and lead to
CPPD can be managed with medical care.
Arthritis of the Knee
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It is not known what causes these calcium pyrophosates to form, but genetics appears to play a role.
Increasing age is the most common factor that may increase your chance of getting CPPD. Other factors include: Family members with CPPDPrevious joint damageOsteoarthritisHypothyroidism
—an underactive thyroid
—excess iron storage
Overactive parathyroid glandsHypercalcemia—excess calcium in the bloodLow magnesium levels in the blood
In most cases, CPPD does not lead to symptoms. Symptoms may come and go in acute attacks
Pseudoosteoarthritis symptoms are the most common type, especially in the knee. Symptoms may be on both sides of the body, but are generally worse on one side. Pseudoosteoarthritis may cause: Joint degeneration that worsens over timeJoint misalignment and deformityPeriodic swelling may be seen in chronic cases
Pseudogout symptoms occur more frequently in the knee, but can occur in other joints as well. There may be periods of time when there are no symptoms. Attacks of pseudogout may be spontaneous, or may be brought on by surgery, or illness. Pseudogout may cause: Sudden, intense pain in one jointWarmth, redness, and swellingFeverJoint damage from the breakdown of cartilage, which can lead to chronic pain
Pseudorheumatoid arthritis symptoms occur least frequently and affect both sides of the body. Pseudorheumatoid arthritis may cause: Joint swellingMorning stiffness in the jointsFatigueJoint deformities
Your doctor will ask about your symptoms and medical history. A physical exam will be done. Tests can be used to diagnose CPPD, or to rule out other conditions.
Tests may include: Synovial fluid analysis
on the affected joint
Blood tests—to rule out other conditions
Imaging tests such as:
There is no cure for CPPD and nothing is available to dissolve the crystal deposits that already exist.
Treatment of CPPD is
managing the discomfort during
flare-ups. Without treatment, the pain and discomfort of CPPD will go away on its own within days to weeks.
Talk with your doctor about the best treatment plan for you. Rest, ice, and elevation may help relieve some pain. Other treatment options may include:
Medication may help to decrease
inflammation, pain, and stiffness. Medications may include: Nonsteroidal anti-inflammatory drugs (NSAIDs)CorticosteroidsGout
that change the way the body reacts to the crystals
Additional procedures may be needed if home care and medications are not effective. Additional procedures may include: Corticosteroid shots—injected directly into the affected joint
to decrease inflammationArthrocentesis—to remove excess fluid and crystalsSurgery—to repair or replace any damaged joints
Steroids Injected into Joint
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There are no current guidelines to prevent CPPD because the cause is not clear.
Calcium pyrophosphate dihydrate deposition disease. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed. Updated June 18, 2013. Accessed August 26, 2013.
Calcium pyrophosphate dihydrate crystal deposition disease (CPPD) (Pseudogout). The Arthritis Foundation website. Available at:
http://www.arthritis.org/conditions-treatments/disease-center/calcium-pyrophosphate-dihydrate-crystal-deposition-disease-cppd-pseudo-gout. Accessed August 26, 2013.
Calcium pyrophosphate deposition (CPPD) (formerly called pseudogout). American College of Rheumatology website. Available at:
http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/pseudogout.asp. Updated September 2012. Accessed August 26, 2013.
Tenenbaum J. Inflammatory musculoskeletal conditions in older adults.
Geriatrics Aging. 2005; 8(3):14-17.
Pseudogout. Cleveland Clinic website. Available at:
http://my.clevelandclinic.org/orthopaedics-rheumatology/diseases-conditions/hic-pseudogout.aspx. Accessed on August 26 ,2013.
4/24/2014 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed: Wise JN, Weissman BN, et al. American College of Radiology (ACR) Appropriateness Criteria for chronic foot pain. Available at: http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/ChronicFootPain.pdf. Updated 2013. Accessed April 24, 2014.
Last reviewed June 2013 by Fahran Tahir, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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