Presentation is loading. Please wait.

Presentation is loading. Please wait.

CPPD & other Crystal Deposition Disease

Published byElfreda Price Modified over 6 years ago

Similar presentations

Presentation on theme: "CPPD & other Crystal Deposition Disease"— Presentation transcript:

1 CPPD & other Crystal Deposition Disease
Iraj Salehi-Abari MD., Internist Rheumatologist

2 Other Crystal Deposition Disease
Calcium Pyrophosphate Dihydrate (CPPD) Basic Calcium Phosphate (BCP): Hydroxy Apatite (HA) Octa Calcium Phosphate (OCP) Tri Calcium phosphate (TCP) Calcium Oxalate (Ca, Ox) Others: Cholesterol Corticosteroid Etc.

3 CPPD disease Epidemiology: Prevalence: 0.9/1000 F/M: #1; >1
Age: 80% of Pts> 60Yrs Classification Class 1: Hereditary/ Familial Class 2: Sporadic/ Idiopathic Class 3: Metabolic Class 4: Traumatic/ Surgery (0-3 days postsurgery)

4 Pathophysiology ATP ATP ppase AMP + PPi AMP 5NTase A + Pi
PPi PPi ase 2Pi Aging  elevated PPi; because Increased ATP ppase Increased 5NTase Decreased PPiase Aging dep. Chondroitin Sulfate dep,. Mg, dep. ALK. Ph., elev. Ca. elev. PPi

5 Clinical Feature Type A: Pseudo-Gout Type B: Pseudo-RA
Type C: Pseudo-OA (acute on chronic) Type D: Pseudo-OA (chronic) Type E: Lanthanic; Chondrocalcinosis Type F: Pseudo-Neuropathic Arthritis Others:Pseudo-AS, Hemarthrosis

6 Clinical Feature Type A: Pseudo-Gout Type B: Pseudo-RA
Type C: Pseudo-OA (acute on chronic) Type D: Pseudo-OA (chronic) Type E: Lanthanic; Chondrocalcinosis Type F: Pseudo-Neuropathic Arthritis Others:Pseudo-AS, Hemarthrosis

7 Clinical Feature Type A: Pseudo-Gout Type B: Pseudo-RA
Type C: Pseudo-OA (acute on chronic) Type D: Pseudo-OA (chronic) Type E: Lanthanic; Chondrocalcinosis Type F: Pseudo-Neuropathic Arthritis Others:Pseudo-AS, Hemarthrosis

8 Clinical Feature Type A: Pseudo-Gout Type B: Pseudo-RA
Type C: Pseudo-OA (acute on chronic) Type D: Pseudo-OA (chronic) Type E: Lanthanic; Chondrocalcinosis Type F: Pseudo-Neuropathic Arthritis Others:Pseudo-AS, Hemarthrosis

9 Clinical Feature Type A: Pseudo-Gout Type B: Pseudo-RA
Type C: Pseudo-OA (acute on chronic) Type D: Pseudo-OA (chronic) Type E: Lanthanic; Chondrocalcinosis Type F: Pseudo-Neuropathic Arthritis Others:Pseudo-AS, Hemarthrosis

10 Clinical Feature Type A: Pseudo-Gout Type B: Pseudo-RA
Type C: Pseudo-OA (acute on chronic) Type D: Pseudo-OA (chronic) Type E: Lanthanic; Chondrocalcinosis Type F: Pseudo-Neuropathic Arthritis Others:Pseudo-AS, Hemarthrosis

11 Diagnostic Criteria 1. Identification of CPPD by:
Chemical Analysis or X-Ray Diffraction or Electron Diffraction 2a CPPD morphology: LM, PM 2b chondrocalcinosis in X-Ray 3a. Acute Arthritis Attacks 3b. Subacute or Chronic Arthritis

12 Diagnostic Criteria (cont.d)
Categories: Definite: 1 or (2a + 2b) Probable: 2a or 2b Possible: 3

13 Approach to Pts with CPPDd
Age< 50 & (+) FH: Familial CPPDd Age <50 & (-)FH: Metabolic CPPDd Age >60 & (-)FH: Idiopathic

14 Management Acute: Subacute & Chronic Treatment of underlying disorders
Aspiration Steroid (intra articular) Colchicine NSAIDs Subacute & Chronic Similar to OA Treatment of underlying disorders

15 Hydroxy Apatite (HA) Clinical Forms: Periarthritis Arthritis
Gout like type Milwaukee shoulder/ knee synd. Erosive polyarticular type Mixed: HA + CPPD Secondary Arthropathies CRF, DM, Hypothyroidism, Acromegaly CTD:Dermatomyositis, PSS Tumor calcinosis

16 Milwaukee shoulder/knee synd
Destructive Arthritis Rare, old age, F/M #4/1 DJD +Tendonitis & Rupture of RC + Hydrops of shoulder DJD of lateral compartment of knee

17 X-Ray Findings (Milwaukee)
DJD Destruction Calcification Upward subluxation of humerous RC tearing (H to Ac< 6 mm) Pseudo articulation of H & Ac DJD of lateral compartment of knee

18 Synovial Fluid (Milwaukee)
Milky WBC < 1000/mm3 Crystals: Seen only with EM Shiny coin in LM No polarizing

19 Management (Milwaukee)
Decreased using of shoulder Recurrent aspiration Intra articular steroid NSAIDs (?) Supportive physiotherapy Surgery

20 Calcium Oxalate Skin Calcification Chondrocalcinosis
Erosive Arthropathy Tenosynovitis, Bursitis Vascular Calcification Cardiomyopathy Corneal Deposition Deposition in finger, wrist, elbow, knee, ankle, feet

21 Calcium Oxalate (Cont,d)
Miliary Calcification in finger & vessels: Characteristic Synovial Fluid: WBC < 2000 Crystal: Bipyramidal in LM (+) Birefringent in PM Treatment; Colchicine, NSAIDs

22 Clinical Feature Type A: Pseudo-Gout Type B: Pseudo-RA
Type C: Pseudo-OA (acute on chronic) Type D: Pseudo-OA (chronic) Type E: Lanthanic; Chondrocalcinosis Type F: Pseudo-Neuropathic Arthritis Others:Pseudo-AS, Hemarthrosis

23 Alkaptonuria(AKU): Alkaptonuria: Dark urine disease
Autosomal recessive Hemogentisic acid dioxygenase (HGD, HGO) deficiency The third enzyme in tyrosine degradation Elevated levels of Homogentisic acid (HGA) It polymerizes, forming a pigment that is deposited in connective tissue: Ochronosis

24 Alkaptonuria(AKU): Secodary OA in Shoulder, Hip and Knee
Axial involvement Urine turns dark brown or black if left standing or after alkalinization Levels of HGA are increased in blood, urine and tissue samples No effective therapy, dietary restriction of tyrosine and phenylalanine, Ascorbic acid, Nitisinone

25 Calcium Oxalate Skin Calcification Chondrocalcinosis
Erosive Arthropathy Tenosynovitis, Bursitis Vascular Calcification Cardiomyopathy Corneal Deposition Deposition in finger, wrist, elbow, knee, ankle, feet

26 Calcium Oxalate Skin Calcification Chondrocalcinosis
Erosive Arthropathy Tenosynovitis, Bursitis Vascular Calcification Cardiomyopathy Corneal Deposition Deposition in finger, wrist, elbow, knee, ankle, feet

27 Calcium Oxalate Skin Calcification Chondrocalcinosis
Erosive Arthropathy Tenosynovitis, Bursitis Vascular Calcification Cardiomyopathy Corneal Deposition Deposition in finger, wrist, elbow, knee, ankle, feet

28 Calcium Oxalate Skin Calcification Chondrocalcinosis
Erosive Arthropathy Tenosynovitis, Bursitis Vascular Calcification Cardiomyopathy Corneal Deposition Deposition in finger, wrist, elbow, knee, ankle, feet

29 Calcium Oxalate Skin Calcification Chondrocalcinosis
Erosive Arthropathy Tenosynovitis, Bursitis Vascular Calcification Cardiomyopathy Corneal Deposition Deposition in finger, wrist, elbow, knee, ankle, feet

30 Others: Wilson disease  Chondrocalcinosis of hand and knee
Hereditary Hemochromatosis (HH): The full spectrum of CPPD disease Squared-off bone ends and hook-like osteophytes in the MCPs (2, 3)

31 Calcium Oxalate Skin Calcification Chondrocalcinosis
Erosive Arthropathy Tenosynovitis, Bursitis Vascular Calcification Cardiomyopathy Corneal Deposition Deposition in finger, wrist, elbow, knee, ankle, feet

Download ppt "CPPD & other Crystal Deposition Disease"

Similar presentations

OSTEOARTHRITIS (OA) Rogelio A Balagat MD ASMPH.

OSTEOARTHRITIS (OA) Rogelio A Balagat MD ASMPH.
GOUT Disease caused by tissue deposition of Monosodium urate crystals as a result of supersatuaration of extra cellular fluid with MSU.

GOUT Disease caused by tissue deposition of Monosodium urate crystals as a result of supersatuaration of extra cellular fluid with MSU.
Arthritis and Other Joint Conditions

Arthritis and Other Joint Conditions
Articulations Points of contact between bones (Joints) Primary Joint Classifications Functional NameStructural NameDegree of Movement Example SynarthrosesFibrousImmovableSutures.

Articulations Points of contact between bones (Joints) Primary Joint Classifications Functional NameStructural NameDegree of Movement Example SynarthrosesFibrousImmovableSutures.
Inflammatory Disorders of Joints ¤ Bursitis ¤ Sprains ¤ Arthritis.

Inflammatory Disorders of Joints ¤ Bursitis ¤ Sprains ¤ Arthritis.
GOUT AND PSEUDOGOUT ANDRES QUICENO, MD Rheumatology Division

GOUT AND PSEUDOGOUT ANDRES QUICENO, MD Rheumatology Division
{ Gout and Bursitis Asfand Baig.   Inflammatory arthritis associated with hyperuricaemia* and intra-articular sodium urate crystals Gout.

{ Gout and Bursitis Asfand Baig.   Inflammatory arthritis associated with hyperuricaemia* and intra-articular sodium urate crystals Gout.
ARTHRITIS. Osteoarthritis is a degenerative joint disease is the most common joint disorder. It is a frequent part of aging and is an important cause.

ARTHRITIS. Osteoarthritis is a degenerative joint disease is the most common joint disorder. It is a frequent part of aging and is an important cause.
Metabolic conditions and the musculoskeletal system

Metabolic conditions and the musculoskeletal system
Gout By Shravya & Helen. Gout is… An inflammatory arthritis associated with hyperuricaemia and intra-articular sodium urate crystals.

Gout By Shravya & Helen. Gout is… An inflammatory arthritis associated with hyperuricaemia and intra-articular sodium urate crystals.
Joints. A joint is the location at which 2 or more bones make contact Joints, also called articulations, have 2 functions: 1.They hold bones together.

Joints. A joint is the location at which 2 or more bones make contact Joints, also called articulations, have 2 functions: 1.They hold bones together.
Diagnosis of gout.

Diagnosis of gout.
Arthritis Hip and Knee Nigel Brewster 1998. Aims l Types of arthritis l Symptoms of arthritis l Signs of arthritis l Treatment of arthritis.

Arthritis Hip and Knee Nigel Brewster Aims l Types of arthritis l Symptoms of arthritis l Signs of arthritis l Treatment of arthritis.
More than 100 different disorders

More than 100 different disorders
Case Report Submitted by: Eric Hames, MS IV Faculty reviewer:

Case Report Submitted by: Eric Hames, MS IV Faculty reviewer:
1983-1984 Carlos Pineda Roger Kerr. Roger Kerr, Los Angeles, CA 49 year old male with 6 month history of wrist pain and swelling. Past medical history.

Carlos Pineda Roger Kerr. Roger Kerr, Los Angeles, CA 49 year old male with 6 month history of wrist pain and swelling. Past medical history.
SKELETAL SYSTEM. Diseases/Disorders Sprain – stretched or torn ligament or tendon Arthritis – inflamed joint Osteomyelitis – infected bone Osteoporosis.

SKELETAL SYSTEM. Diseases/Disorders Sprain – stretched or torn ligament or tendon Arthritis – inflamed joint Osteomyelitis – infected bone Osteoporosis.
Orthopaedics Wa’el N. Qa’dan, MSc. Rheumatoid arthritis (RA): It is the commonest cause of chronic inflammatory joint disease. Most typical.

Orthopaedics Wa’el N. Qa’dan, MSc. Rheumatoid arthritis (RA): It is the commonest cause of chronic inflammatory joint disease. Most typical.
U Tariq MD MBBS, E Wun DDS, J Smith MD MS, W Millar MD MS Geisinger Medical Center Danville, PA. NEUROIMAGING FINDINGS OF UNILATERAL TEMPOROMANDIBULAR.

U Tariq MD MBBS, E Wun DDS, J Smith MD MS, W Millar MD MS Geisinger Medical Center Danville, PA. NEUROIMAGING FINDINGS OF UNILATERAL TEMPOROMANDIBULAR.
OSTEOARTHRITIS. Osteoarthritis (OA) is a common, degenerative disease, which is characterized by local degeneration of joint cartilage and new bone formation.

OSTEOARTHRITIS. Osteoarthritis (OA) is a common, degenerative disease, which is characterized by local degeneration of joint cartilage and new bone formation.

Similar presentations

Ads by Google