Imaging and Management of Calcium Pyrophosphate Deposition Disease

Overview

Journal Skeletal Radiol

Specialties Orthopedics
Radiology

Date 2025 Jan 8

PMID 39775910

Authors

Wasim Issa

Ronald Mercer

Janeth Yinh

Ali Guermazi

Mohamed Jarraya

Affiliations

Soon will be listed here.

Abstract

The radiological manifestations of calcium pyrophosphate deposition (CPPD) revolve around two main axes: the asymptomatic form and CPPD disease. The latter is a consequence of an immune response to calcium phosphate crystals. Chondrocalcinosis is broadly considered the radiographic manifestation of CPPD regardless of whether it is asymptomatic or associated with inflammatory arthritis. CPPD is associated with osteoarthritis although the direction of such association is still unclear. Apart from the detection of CPP crystals in synovial fluid, imaging (mainly conventional radiography and increasingly ultrasound) plays a central role in the diagnosis of CPPD disease. Recently, CT has been added as a diagnostic tool, especially in deep anatomic locations such as crowned dens. To date, no treatment is effective in dissolving CPP crystals. For now, the focus of current treatment strategies remains inflammation control. Our aim is to review the epidemiology, pathogenesis, and clinical and imaging manifestations of asymptomatic and symptomatic CPPD. We will also discuss recent consensus definitions and classifications of CPPD disease.

References

KOHN N, Hughes R, McCarty Jr D, FAIRES J . The significance of calcium phosphate crystals in the synovial fluid of arthritic patients: the "pseudogout syndrome". II. Identification of crystals. Ann Intern Med. 1962; 56:738-45. DOI: 10.7326/0003-4819-56-5-738. View

Jarraya M, Roemer F, Kwoh C, Guermazi A . Crystal arthropathies and osteoarthritis-where is the link?. Skeletal Radiol. 2022; 52(11):2037-2043. DOI: 10.1007/s00256-022-04246-8. View

Abhishek A, Tedeschi S, Pascart T, Latourte A, Dalbeth N, Neogi T . The 2023 ACR/EULAR Classification Criteria for Calcium Pyrophosphate Deposition Disease. Arthritis Rheumatol. 2023; 75(10):1703-1713. PMC: 10543651. DOI: 10.1002/art.42619. View

Neame R, Carr A, Muir K, Doherty M . UK community prevalence of knee chondrocalcinosis: evidence that correlation with osteoarthritis is through a shared association with osteophyte. Ann Rheum Dis. 2003; 62(6):513-8. PMC: 1754579. DOI: 10.1136/ard.62.6.513. View

Felson D, Zhang Y, Hannan M, Naimark A, Weissman B, Aliabadi P . Risk factors for incident radiographic knee osteoarthritis in the elderly: the Framingham Study. Arthritis Rheum. 1997; 40(4):728-33. DOI: 10.1002/art.1780400420. View

Jarraya M, Guermazi A, Liew J, Tolstykh I, Lynch J, Aliabadi P . Prevalence of intra-articular mineralization on knee computed tomography: the multicenter osteoarthritis study. Osteoarthritis Cartilage. 2023; 31(8):1111-1120. PMC: 10524737. DOI: 10.1016/j.joca.2023.04.004. View

Ramonda R, Musacchio E, Perissinotto E, Sartori L, Punzi L, Corti M . Prevalence of chondrocalcinosis in Italian subjects from northeastern Italy. The Pro.V.A. (PROgetto Veneto Anziani) study. Clin Exp Rheumatol. 2010; 27(6):981-4. View

Cipolletta E, Di Matteo A, Smerilli G, Di Carlo M, Di Battista J, Abhishek A . Ultrasound findings of calcium pyrophosphate deposition disease at metacarpophalangeal joints. Rheumatology (Oxford). 2022; 61(10):3997-4005. DOI: 10.1093/rheumatology/keac063. View

Gibilisco P, Schumacher Jr H, HOLLANDER J, Soper K . Synovial fluid crystals in osteoarthritis. Arthritis Rheum. 1985; 28(5):511-5. DOI: 10.1002/art.1780280507. View

10.

Nalbant S, Martinez J, Kitumnuaypong T, Clayburne G, Sieck M, Schumacher Jr H . Synovial fluid features and their relations to osteoarthritis severity: new findings from sequential studies. Osteoarthritis Cartilage. 2002; 11(1):50-4. DOI: 10.1053/joca.2002.0861. View

11.

Pattrick M, Hamilton E, Wilson R, Austin S, Doherty M . Association of radiographic changes of osteoarthritis, symptoms, and synovial fluid particles in 300 knees. Ann Rheum Dis. 1993; 52(2):97-103. PMC: 1004986. DOI: 10.1136/ard.52.2.97. View

12.

Ivory D, Velazquez C . The forgotten crystal arthritis: calcium pyrophosphate deposition. Mo Med. 2012; 109(1):64-8. PMC: 6181683. View

13.

Flores D, Mejia Gomez C, Pathria M . Layered Approach to the Anterior Knee: Normal Anatomy and Disorders Associated with Anterior Knee Pain. Radiographics. 2018; 38(7):2069-2101. DOI: 10.1148/rg.2018180048. View

14.

Lee R, Kayser M, Ali S . Calcium phosphate microcrystal deposition in the human intervertebral disc. J Anat. 2006; 208(1):13-9. PMC: 2100183. DOI: 10.1111/j.1469-7580.2006.00504.x. View

15.

Ehioghae M, Lawlor M, Mesfin A . Calcium pyrophosphate dihydrate of the ligamentum flavum in the cervical spine - A review of the literature. Surg Neurol Int. 2022; 13:470. PMC: 9609877. DOI: 10.25259/SNI_684_2022. View

16.

Markiewitz A, Boumphrey F, Bauer T, Bell G . Calcium pyrophosphate dihydrate crystal deposition disease as a cause of lumbar canal stenosis. Spine (Phila Pa 1976). 1996; 21(4):506-11. DOI: 10.1097/00007632-199602150-00019. View

17.

Godfrin-Valnet M, Godfrin G, Godard J, Prati C, Toussirot E, Michel F . Eighteen cases of crowned dens syndrome: Presentation and diagnosis. Neurochirurgie. 2013; 59(3):115-20. DOI: 10.1016/j.neuchi.2013.03.003. View

18.

Rosenthal A, Ryan L . Calcium Pyrophosphate Deposition Disease. N Engl J Med. 2016; 374(26):2575-84. PMC: 6240444. DOI: 10.1056/NEJMra1511117. View

19.

Liu Y, Wang W, Yeh J, Wu Y, Mantilla J, Fletcher C . Calcified chondroid mesenchymal neoplasms with FN1-receptor tyrosine kinase gene fusions including FGFR2, FGFR1, MERTK, NTRK1, and TEK: a molecular and clinicopathologic analysis. Mod Pathol. 2021; 34(7):1373-1383. DOI: 10.1038/s41379-021-00786-x. View

20.

Bernabei I, So A, Busso N, Nasi S . Cartilage calcification in osteoarthritis: mechanisms and clinical relevance. Nat Rev Rheumatol. 2022; 19(1):10-27. DOI: 10.1038/s41584-022-00875-4. View