1. CPPD DEPOSITION DISEASE
Calcium Pyrophosphate Dihydrate

3. Epidemiology Most common in the elderly
10 to 15% of persons 65 to 75 years old and 30 to 60% of those more than 85 years old
In most cases this process is asymptomatic

4. What is CPPD
Ca2P2O2.2H2O

5. Etiology Cause of CPPD deposition is uncertain
Because over 80% of patients are more than 60 years old and 70% have preexisting joint damage from other conditions, it is likely that biochemical changes in aging cartilage favor crystal nucleation
There is an increased production of inorganic pyrophosphate and decreased levels of pyrophosphatases in cartilage extracts from patients

6. Pathophysioloy
The release of CPPD crystals into the joint space is followed by the phagocytosis of these crystals by neutrophils, which respond by releasing inflammatory substances. In addition, neutrophils release a glycopeptide that is chemotactic for other neutrophils, thus augmenting the inflammatory events

7. Pathophysioloy
A minority of patients with CPPD arthropathy have metabolic abnormalities or hereditary CPPD disease

8. Conditions associated with CPPD
Aging
Hyperparathyroidism
Hemochromatosis
Hypophosphatasia
Hypomagnesemia
Chronic thophaceous gout
Hereditary

10. . Clinical Manifestations
CPPD arthropathy may be asymptomatic, acute, subacute, or chronic or cause acute synovitis superimposed on chronically involved joints

11. Clinical Manifestations
Pseudogout
Pseudo-osteoarthritis
Pseudo-Rheumatoid
Destructive arthropathy
Bursitis,tendinitis,enthesitis

12. Acute Arthritis(Pseudogout)
May be precipitated by trauma
Knee, wrist, shoulder, ankle, elbow, and hands
Symptoms are the same as any acute arthritis
Occasionally systemic symptoms:Fever
Self limited
Patients are asymptomatic between attacks

14. Imaging
Chondrocalcinosis

18. IS all chondrocaclnosis caused by CPPD
Other calcium salts such as calcium hydroxyapatite
Ochronosis

19. Synovial fluid Several thousand cells to 100,000 cells/uL
Mean being about 24,000 cells/uL
Predominant cell being the PMN

20. Diagnosis
Polarization microscopy usually reveals rod - shape or rhomboid crystals inside fibrin and in PMN

23. Pseudo-osteoarthritis
Pattern of joint involvement
Knee,MCP,wrist,elbow,shoulder
More likely to be symmetrical
Chondrocalcinosis

25. Pseudo-Rheumatoid
RF 10%
Involvement of hands
CPPD Crystals
X-ray

27. Treatment
NSAIDS
Colchicin
Corticosteroids

28. CALCIUM HYDROXYAPATITE DEPOSITION DISEASE

29. Pathogenesis HA is the primary mineral of bone
HA may be released from exposed bone and cause the acute synovitis
Most patients with HA arthropathy are elderly.
Periarticular and articular deposits may coexist and be associated with acute and/or chronic damage to the joint capsule, tendons, bursa, or articular surfaces.

30. Clinical
The most common sites of HA deposition include bursa and tendons in and/or around the knees, shoulders, hips, and fingers
Clinical manifestations include: asymptomatic radiographic abnormalities, acute synovitis, bursitis, tendinitis, and chronic destructive arthropathy

31. Diagnosis Intra- and/or periarticular calcifications
crystals are very small, and can only be seen by electron microscopy.

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