![]() CT: can be used to identify chondrocalcinosis not typically used to evaluate joint pain.Operator-dependent good sensitivity and specificity if performed by experienced sonographers.Hyperechoic deposits within cartilage.Sensitivity: ∼ 40% (i.e., x-ray may appear normal).Fibrocartilage ( meniscus, annulus fibrosus of intervertebral disk).Appears as radiodense shadows within the cartilage.Chondrocalcinosis : calcification of cartilage in the affected joints.A negative SFA does not rule out CPPD disease. SFA can be falsely negative, as CPPD crystals are small and weakly birefringent. See also “ Interpretation of synovial fluid analysis.”.Cell count: WBC > 2000/μL with > 50% neutrophils.Crystals appear yellow when their axis is perpendicular to the polarizer.Crystals appear blue when their optical axis is oriented parallel to the polarizer.Rhomboid-shaped crystals that are weakly positively birefringent.Polarized light microscopy (with a red filter) appearance of CPP crystals.The most accurate diagnostic method, but crystals can often be difficult to identify.Arthrocentesis and synovial fluid analysis ( SFA) Diagnosis is based on the identification of CPP crystals on synovial fluid analysis and/or the presence of cartilage calcification on imaging in a patient with suggestive symptoms. There are currently no validated diagnostic criteria for CPPD disease. Crowned dens syndrome: CPP inflammatory arthritis of the C2 vertebra causes acute neck pain resembling meningitis or vertebral osteomyelitis.Pseudoneuropathic arthropathy: manifests with destructive monoarthritis similar to neuropathic arthropathy, but sensation and proprioception are preserved.In contrast to typical RA, joint involvement may be asymmetric and sequential.Manifests similarly to rheumatoid arthritis ( RA), with polyarticular distribution associated with morning stiffness.Rheumatoid arthritis-like presentation (chronic CPP crystal inflammatory arthritis).Often associated with pseudogout-like flares of acute inflammatory arthritis.Usually polyarticular can occur in joints not typically affected by OA.Characterized by progressive joint degeneration.Osteoarthritis-like presentation ( osteoarthritis with CPPD pseudo- osteoarthritis).Pseudogout refers to the acute, not chronic, form of CPPD disease. Triggers: can occur spontaneously or be triggered by joint trauma/ surgery or acute illness.Most commonly affects the knee and wrist can also affect other large joints (e.g., hips, ankles). ![]() Monoarthritis (occasionally oligoarthritis).Acute attack of pain and swelling in the affected joint (s).Acute CPP crystal arthritis ( pseudogout ) CPPD may also remain asymptomatic and be identified incidentally on imaging ( asymptomatic chondrocalcinosis). There are several distinct clinical phenotypes of CPPD disease. ![]()
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