Pseudogout (Calcium Pyrophosphate Dihydrate)
Basics
Description
- Autoinflammatory disease triggered by calcium pyrophosphate dihydrate (CPPD) crystal deposition within joints
- One of many diseases associated with pathologic deposition of crystal; mineralization and ossification
- CPPD crystal deposition = chondrocalcinosis (calcification of hyaline or fibrocartilage), pseudogout, and pyrophosphate arthropathy
- Monosodium urate crystal deposition = gout
- Hydroxyapatite deposition = ankylosing spondylitis, osteoarthritis, and vascular calcification
- Suspect pseudogout with arthritis and a pattern of joint involvement inconsistent with degenerative joint disease (e.g., metacarpophalangeal joints, wrists).
- Clinical presentation is broad:
- Asymptomatic CPPD (incidentally identified on radiograph with or without additional findings of osteoarthritis)
- Acute CPPD arthritis (acute onset, self-limiting, synovitis)
- Knee is affected in >50% of all acute attacks versus MTP in gout.
- Can be brought on my trauma, medical illness, or surgery (after parathyroidectomy) (1)
- Chronic CPPD crystal inflammatory arthritis (2)[C]
- Osteoarthritis with CPPD
- Chronic CPPD crystal deposition may cause a progressive degenerative arthritis in numerous joints; usually large joints; primarily in elderly patients
- Symptom onset is usually insidious.
- Definitive diagnosis requires the identification of CPPD crystals in synovial fluid.
- System(s) affected: endocrine/metabolic; musculoskeletal
- Synonyms: pseudogout; CPPD; pyrophosphate arthropathy; chondrocalcinosis
Prevalence
- Thought to affect 4–7% of adults in Europe and United States; 80% of patients >60 years
- No gender predominance; men more likely to present acutely; women more likely to present atypically
- Chondrocalcinosis present in 1:10 adults aged 60 to 75 years, 1:3 age >80 years; only a small percentage develop arthropathy.
Etiology and Pathophysiology
- Arthropathy results from an acute autoinflammatory reaction to CPPD crystals in the synovial cavity.
- CPPD crystal deposition occurs in three stages:
Genetics
Most cases are sporadic; rare familial pattern with autosomal dominant inheritance (<1% of patients); mutation in ANKH gene increases risk for calcium crystal formation.
Risk Factors
Advanced age; joint trauma
General Prevention
Colchicine 0.6 mg BID may be used prophylactically to reduce frequency of episodes in recurrent CPPD.
Commonly Associated Conditions
- Gout
- Hyperparathyroidism
- Amyloidosis
- Hemochromatosis; ochronosis
- Hypothyroidism
- Wilson disease
- Hypomagnesemia
- Familial hypocalciuric hypercalcemia
- X-linked hypophosphatemic rickets
- Acromegaly
There's more to see -- the rest of this topic is available only to subscribers.
Citation
Domino, Frank J., et al., editors. "Pseudogout (Calcium Pyrophosphate Dihydrate)." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688650/all/Pseudogout__Calcium_Pyrophosphate_Dihydrate_.
Pseudogout (Calcium Pyrophosphate Dihydrate). In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688650/all/Pseudogout__Calcium_Pyrophosphate_Dihydrate_. Accessed November 8, 2024.
Pseudogout (Calcium Pyrophosphate Dihydrate). (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688650/all/Pseudogout__Calcium_Pyrophosphate_Dihydrate_
Pseudogout (Calcium Pyrophosphate Dihydrate) [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 November 08]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688650/all/Pseudogout__Calcium_Pyrophosphate_Dihydrate_.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Pseudogout (Calcium Pyrophosphate Dihydrate)
ID - 1688650
ED - Domino,Frank J,
ED - Baldor,Robert A,
ED - Golding,Jeremy,
ED - Stephens,Mark B,
BT - 5-Minute Clinical Consult, Updating
UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688650/all/Pseudogout__Calcium_Pyrophosphate_Dihydrate_
PB - Wolters Kluwer
ET - 33
DB - Medicine Central
DP - Unbound Medicine
ER -