Calcium Pyrophosphate Dihydrate Crystal Deposition Disease (CPPD) (Pseudo Gout)

What is it?

Arthritis is a complex family of musculoskeletal disorders consisting of more than 100 different diseases or conditions that destroy joints, bones, muscles, cartilage and other connective tissues, hampering or halting physical movement. Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease occurs when these crystals collect in joints and the tissues surrounding the joints. The calcium deposits induce inflammation in the joint, which can cause cartilage within the joint to break down. The disease can take a few different arthritis-related forms:

  • Acute arthritis often called pseudogout
  • Chronic rheumatoid arthritis-like inflammatory arthritis
  • Osteoarthritis

Pseudogout occurs in about one-quarter of all CPPD cases and an osteoarthritis-like disease occurs in about half of all cases. However, many people with CPPD crystal deposits have no joint symptoms at all.

Women and men get the disease equally, and its frequency dramatically increases with age.

What are the effects?

Calcium pyrophosphate dehydrate (CPPD) crystal deposition disease can manifest in the joints in a few different ways, but about 25 percent of people with CPPD deposition will experience some of the following symptoms related to Pseudogout:

  • Sudden onset of intense, constant pain in one joint. The joint may be hot, red, swollen, and stiff. The average attack is less painful than in gout.
  • The attack will last for several days to two weeks.
  • The knee is the site of almost half of all attacks (as opposed to gout’s predilection for the big toe), but attacks can occur in nearly any joint, including the big toe.
  • Fever may accompany an acute attack.
  • Attacks can occur spontaneously or can be provoked by trauma, surgery, or severe illness (such as stroke or heart attack).
  • Periods in between attacks are usually pain-free.
  • Damage to the joint progresses after years of these attacks. Cartilage within the joint may break down and pieces will float in the joint space causing additional pain. As the cartilage wears away, your bones will rub together, resulting in chronically sore, stiff joints.

Pseudorheumatoid arthritis -- about five percent of people with CPPD deposition will have this presentation.

  • Several joints will be involved in a symmetric pattern (the same joint on each side of the body, such as both wrists).
  • Inflammation will be low-grade rather than the intense swelling and pain of pseudogout.
  • Morning stiffness, fatigue, joint deformities, and elevated erythrocyte sedimentation rates (a marker of inflammation) can all be found in people with this presentation of CPPD deposition disease, as well as in people with rheumatoid arthritis.

Pseudoosteoarthritis -- about half of people with CPPD deposition will have this presentation.

  • Characterized by a progressive degeneration of several joints.
  • The joints affected most commonly are the knees, followed by the wrists, metacarpophalangeal joints (where the finger attaches to the hand), hips, shoulders, elbows, and ankles. Symmetric involvement is the rule, but degeneration may be more advanced on one side.
  • The joints involved may become malaligned or deformed over time.
  • Patients with chronic symptoms of pseudoosteoarthritis may have superimposed episodes of joint inflammation.

How is it diagnosed?

Differentiating calcium pyrophosphate dihydrate (CPPD) crystal deposition disease from other forms of arthritis can be difficult when using only a physical exam for clues. So if your doctor suspects from the symptoms you describe and the results of your physical exam that you may have CPPD disease, he or she may need to perform a couple of other tests.

  • Joint fluid examination
  • X-rays

Along with those two, your doctor will probably run some other tests to help rule out other diseases.

What are the treatment options?

There is no cure for calcium pyrophosphate dihydrate (CPPD) crystal deposition disease or pseudogout, but there are steps you can take to reduce your pain and stiffness. Your doctor may prescribe medications such as nonsteroidal anti-inflammatory drugs or corticosteroids. A well-rounded treatment plan may also call for exercise and joint protection.

What resources are available?

The Arthritis Foundation leads the way in helping people with arthritis live better today and create better tomorrows through new treatments, better access and, ultimately, cures. We do this by:

  • Funding life-changing research that has restored mobility in patients for more than six decades
  • Fighting for health care policies that improve the lives of the millions of Americans with arthritis
  • Partnering with families to provide empowering programs and information

If you are diagnosed with pseudo gout, some Arthritis Foundation resources that may help you better manage and live with your disease are: