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What Is Chondrocalcinosis Of The Knee

Lab Tests To Diagnose Chondrocalcinosis

Chondrocalcinosis, Tumoral Calcinosis, – Everything You Need To Know – Dr. Nabil Ebraheim

Lab tests are primary used to diagnose chondrocalcinosis. Blood tests can check for problems with your thyroid and parathyroid glands, as well as for a variety of mineral imbalances that have been linked to chondrocalcinosis. Your doctor may withdraw a sample of the fluid from your affected joint with a needle to test for the presence of crystals.

How Is Calcium Pyrophosphate Dihydrate Crystal Deposition Disease Treated

The treatment of CPPD is similar to the treatment of acute gout attacks with anti-inflammatory medication. Uric acid-lowering drugs are not prescribed. Symptoms are often relieved within 24 hours after beginning treatment with anti-inflammatory medications.

The goals of treatment are to relieve pain and inflammation, and prevent recurrent attacks that could lead to significant pain and joint damage.

The type of treatment prescribed will depend on several factors, including the person’s age, type of other medicines they’re taking, overall health, medical history and the severity of the attack.

Anti-inflammatory drugs

Anti-inflammatory drugs are usually continued until the CPPD attack completely resolves. If side effects from the therapy occur, treatment may be changed to a different medicine. Your healthcare provider will discuss the potential side effects with you.

Side effects of medicines

Not all patients will develop side effects from these medicines. How often any side effect occurs varies from patient to patient. The occurrence of side effects depends on the dose, type of medicine, length of treatment, concurrent illnesses and other medications the patient may be taking.

Some side effects are more serious than others. Before any medicine is prescribed, your healthcare provider will discuss with you the potential benefits and risks of taking the medications.

What Happens To Patients With Calcium Pyrophosphate Dihydrate Crystal Deposition Disease

Prevalence of chondrocalcinosis varies from 7-10% in people aged 60 years, and shows equal sex distribution. Chondrocalcinosis is strongly associated with age; the prevalence is low below 50 years old, and increasing from 10%-15% in those aged 65-75, and 30%-60% in those older than 85. Chondrocalcinosis is reported from most countries and racial groups.

Genetic associations include mutations of the ANKH gene on chromosome 5p and unknown genes on chromosome 8 . The ANKH gene functions to transport inorganic pyrophosphate out of the cells. Familial mutations result in a gain of function of the ANKH that increases extracellular PPi and leads to onset of CPPD disease in the third or fourth decade of life.

There have been numerous associations suggested with metabolic diseases, but many reflect chance concurrence of common age-related conditions. The strongest evidence for association is with hyperparathyroidism, hemochromatosis, and hypomagnesemia and hypophosphatasia .

There is strong overlap with OA, however its relationship is complex, but with convincing evidence for a strong positive association, at least in the knee.

Occasional development of rapidly progressive arthropathy is well recognized, particularly at the knee, shoulder, or hip. This destructive pyrophosphate arthropathy is mainly confined to elderly women, associated with a poor outcome.

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What Triggers A Painful Episode Of Acute Cpp Crystal Arthritis

The pain and swelling of acute CPP crystal arthritis happens when the crystals shed from cartilage into a joint. Often, its not clear why the crystals have shed.

Sometimes though it will be obvious what has caused the crystals to shake loose.

For example, an injury to your knee may shake the crystals loose, causing pain and swelling a day or two afterwards.

Another common trigger of crystal shedding is an illness that causes a fever, such as having the flu or a chest infection.

A major stress to your body such as having an operation or a heart attack can cause the crystals to shed.

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Acute Knee Pain

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What Are The Symptoms Of Chondrocalcinosis

Normally chondrocalcinosis does not cause any symptoms or discomfort for patients and for that reason it is only diagnosed by means of an X-ray. Evidence of chondrocalcinosis is the presence of a white line in the cavities at the ends bones.

However, many patients may experience the following symptoms:

  • Osteoarthritis: the degeneration of specific joints, sometimes more advanced on one side of the body that may lead to deformities later on.
  • Pseudo gout arthritis: joint becomes swollen, stiff and a fever might develop. This happens especially in the wrist, knee or ankle and is similar to symptoms of gout.
  • Symptoms similar to;rheumatoid arthritis: stiffness and inflammation of joints, affecting joints on both sides of the body.

Joint Drainage For Treating Chondrocalcinosis

Joint drainage treatment for chondrocalcinosis is administered to reduce the pain. The affected joint is operated upon as the doctors use syringe to extract the fluid partially from the affected joint. It will also remove some crystals and release the pressure on the joints. Later on the corticosteroid injection is administered to reduce the instances of inflammation.

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Lifestyle Changes For Chondrocalcinosis


Lifestyle changes can be of great help if there are any sudden chondrocalcinosis flare-ups.

  • If there is a sudden flare-up of chondrocalcinosis, the patients can use over the counter non-steroidal anti-inflammatory drugs . The medicines that do not require prescriptions can be good option for the patients. Some of them include ibuprofen along with naproxen sodium.
  • Relaxing the affected joint is a good lifestyle change. Do not try to do lots of activities with the knees which are affected by chondrocalcinosis.
  • One of the best lifestyle changes to eliminate inflammation caused by chondrocalcinosis is to apply ice cold pack in the affected area.

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What Are The Causes Of Chondrocalcinosis

Injuries that deteriorate collagen and other cartilage proteins, such as repetitive micro trauma can lead to excess calcium crystal deposition.

Older people are those who have a genetic predisposition for developing the condition are more at risk.

Other causes can be a lack of magnesium or excess calcium or iron. The disease can also be related to metabolic or endocrine disorders, such as hyperparathyroidism,;hypothyroidism, hypomagnesemia,;hypophosphatasia;and;hemochromatosis.

Are There Clinical Practice Guidelines To Inform Decision Making

EULAR Expert Guidelines for Management of Clinical Manifestations of CPPD Crystal Deposition. In: EULAR recommendations for calcium pyrophosphate deposition. Part II: management.

European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis.

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How Should Patients With Calcium Pyrophosphate Dihydrate Crystal Deposition Disease Be Managed

There is no current treatment for CPPD deposition disease. Unlike in gout, there is no practical way to remove or dissolve CPP crystals from the joints articular cartilage or soft tissues. No treatment can modify the progression of structural changes.

Treatment of associated metabolic diseases does not result in resorption of CPP crystal deposits and does not influence the outcome of CPPD deposition disease, except possibly for the correction of hypomagnesemia.

General principles

All patients should receive: education about their arthritis, prescription for local strengthening and aerobic exercise, advice on reduction of adverse mechanical factors , and simple analgesia.

Goals of treatment include control of symptoms, early mobilization to avert effects of prolonged immobility, and maintenance or improvement of function. Local therapy is preferred over systemic therapy, if possible.

The treatment of acute attacks of CPP crystal arthritis are predominantly expert opinion-based and modeled on the treatment of acute gout.


Non-pharmacologic treatment with ice and temporary rest are beneficial adjuncts to pharmacologic modalities, which should be tailored to individual patients and their comorbidities.

Aspiration alone may be the only treatment needed, which greatly improves symptoms in majority of cases. However, fluid re-accumulation is common.

Simple analgesics or NSAIDs are beneficial.

Systemic corticosteroids are considered for severe, polyarticular attacks.

Home Remedies For Chondrocalcinosis

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There is no guaranteed diet that can help as a home remedy for chondrocalcinosis. The patient of chondrocalcinosis should change the diet and maintain a balanced weight so that the pressure on the knee does not increase. It will provide pain relief to the joints. Supplements which are used as home remedies for chondrocalcinosis are used to remove the crystals from the joints. It is vital for the patients to avoid diet that can aid in inflammation of the joints and bones.

One should refrain from the diet which is rich in Omega 6 fatty acids and also trans-fatty acid. There are many supplements in the market that tend to aid inflammation. One needs to have complete dietary information in an easy and hassle free manner.

Some of the food ingredients such as corn along with peanuts should not be part of the menu. Omega 3 fatty acids are essential to get relief from pain and inflammation of the joints. Flax seeds along with fish oil and salmon are very popular home remedies among the patients of chondrocalcinosis. Fruits contain lots of antioxidants that prevent the formation of crystals in the joints. Vitamin A along with C and E helps to boost the immune system and inhibit the production of the free radicals in the blood. Radicals always focus on healthy molecules and try to infect them by robbing a single electron. As a result, the immune system deteriorates and leads to an increase in the intensity of chondrocalcinosis inflammation.

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Cartilage Icing And Chondrocalcinosis On Knee Radiographs In The Differentiation Between Gout And Calcium Pyrophosphate Deposition

  • * E-mail:

    Affiliations Department of Radiology, University of Michigan, Ann Arbor, Michigan, United States of America, Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland

  • Roles Conceptualization, Methodology, Supervision, Validation, Visualization, Writing review & editing

    Affiliation Department of Radiology, University of Michigan, Ann Arbor, Michigan, United States of America

  • Affiliation Department of Radiology, University of Michigan, Ann Arbor, Michigan, United States of America

  • Affiliation Department of Radiology, University of Michigan, Ann Arbor, Michigan, United States of America

  • Affiliation Department of Radiology, University of Michigan, Ann Arbor, Michigan, United States of America

  • Roles Formal analysis, Methodology, Validation, Writing review & editing

    Affiliation Michigan Institute for Clinical & Health Research , Ann Arbor, MI, United States of America

Causes And Risk Factors Of Chondrocalcinosis Or Pseudogout Or Cppd Disease

Chondrocalcinosis or pseudogout or CPPD disease is caused due to deposition of crystals present in the calcium pyrophosphate dehydrate in the joints. Chondrocalcinosis or pseudogout or CPPD disease usually may affect many of the joints at a single time resulting in damage and pain. Wrists, pubic symphysis and knees are the joints that most often get affected with chondrocalcinosis. The exact cause of the Chondrocalcinosis or pseudogout or CPPD disease is unknown. However, some of the risk factors may include:

  • Advancing age.
  • Hyperparathyroidism resulting in high volume of calcium in the blood.
  • Dehydration.

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Other Prescription Drug Options

For some people, NSAIDs, corticosteroids, and colchicine dont offer symptom or preventative relief from chondrocalcinosis. In these instances, your doctor might prescribe disease-modifying antirheumatic drugs , such as methotrexate and hydroxychloroquine:

  • Methotrexate:;No large randomized controlled trials support the use of methotrexate in CPPD, though smaller trials and case studies have shown promise.
  • Hydroxychloroquine: Hydroxychloroquine can help reduce inflammation. It works by blocking the activity of certain inflammatory-producing substances.

Strengthening Exercises For Chondrocalcinosis

CPPD… a common arthritis with an uncommon name

The strengthening exercises for chondrocalcinosis is instrumental in enhancing the durability of the muscles by many notches. If the muscle is strong, it can easily absorb the pain radiating from the joints. Initially, you should keep the frequency of the exercise to minimum, however later on it could be increased as the muscle gain strength. The strengthening exercises for chondrocalcinosis are carried out 4 times within one week and addition 2 times to ensure the maintenance of the muscles. If you want to add more power to the muscle use high weight exercise with lower frequency. To enhance durability low weight with higher frequency is the best bet to go. If you are comfortable with the increasing load of the workout, consult the physiotherapist to increase the weight or make the activities more complex.

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Chondrocalcinosis Of The Menisci

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What Other Conditions Can Accompany Chondrocalcinosis

Chondrocalcinosis can affect the people as they age or it may be caused due to genetic issues. There are many other diseases such as hemophilia along with hemochromatosis that could be the possible reasons for the occurrence of chondrocalcinosis. The above mentioned issues also incorporate hormonal disorders. You need to undergo detailed checkup before consulting the specialists for treatment.

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What Is Chondrocalcinosis

Chondrocalcinosis, also known as calcium pyrophosphate deposition disease, is a rheumatic disease characterized by the excessive accumulation of calcium crystals in the cartilage of joints. The knee is the area that is most often affected by this disease, although it is also common in other joints and bone areas. It also typically occurs more in older people.

What Is The Evidence

Figure 1 from Chondrocalcinosis and Gitelman syndrome ...

Zhang, W, Doherty, M, Bardin, T. European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann Rheum Dis. vol. 70. 2011 Apr. pp. 563-70.

Zhang, W, Doherty, M, Pascual, E. EULAR recommendations for calcium pyrophosphate deposition. Part II: management. Ann Rheum Dis. vol. 70. 2011 Apr. pp. 571-5.

Felson, DT, Anderson, JJ, Naimark, A. The prevalence of chondrocalcinosis in the elderly and its association with knee osteoarthritis: the Framingham Study. J Rheumatol. vol. 16. 1989 Sep. pp. 1241-5.

Doherty, M, Abhishek, A, Hochberg, M, Silman, A, Smolen, J. Calcium pyrophosphate crystal-associated arthropathy. Rheumatology. 2011. pp. 1875-1887.

Guerne, P, Terkeltaub, R, Terkeltaub, R. Calcium Pyrophosphate Dihydrate Crystal Deposition: Epidemiology, Clinical Features, Diagnosis, and Treatment. Gout and Other Crystal Arthropathies. 2012. pp. 249-265.

Richette, P, Bardin, T, Doherty, M. An update on the epidemiology of calcium pyrophosphate dihydrate crystal deposition disease. Rheumatology . vol. 48. 2009. pp. 711-715.

Zhang, W, Doherty, M, Pascual, E. EULAR Expert Guidelines for Management of Clinical Manifestations of CPPD Crystal Deposition. Ann Rheum Dis. vol. 70. 2011 Apr. pp. 571-5.

Zhang, W, Doherty, M, Bardin, T. European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann Rheum Dis. vol. 70. 2011 Apr. pp. 563-70.

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For A Complete Report

This is an abstract of a report from the National Organization for Rare Disorders . For a full-text version of this report, go to and click on Rare Disease Database under “Rare Disease Information”.

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This disease entry is based upon medical information available through the date at the end of the topic. Since NORD’s resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder.

What Is Acute Cpp Crystal Arthritis

Acute calcium pyrophosphate crystal arthritis is a condition that can cause pain and swelling in joints.

Its known as a calcium crystal disease because the pain is caused by crystals of the mineral calcium rubbing against soft tissue.

It most commonly affects the knees, but can affect other joints too.

Calcium crystals are normally in bones and teeth to help make them strong. However, people can have too much of these crystals and in the wrong place in the body, and this can cause problems.

In acute CPP crystal arthritis they can form in the cartilage at the ends of bones.

Many people can have calcium crystals in their cartilage for years without them causing any problems.

However, these crystals can move from their protected site within the cartilage into the space between the bones in a joint. This area is called the joint cavity. This can cause pain and swelling as the sharp, hard crystals rub against soft tissue.

The process of the crystals shaking loose and leaving the cartilage is called crystal shedding.

The name of the condition comes from the substance which forms into crystals, calcium pyrophosphate.

An old name for acute CPP crystal arthritis is pseudo-gout, or false gout, because the symptoms look like a condition called gout. However, gout is caused by crystals of the waste product urate rather than calcium crystals.

Its rare for acute CPP crystal arthritis to affect people under the age of 60.

Men and women are affected in equal numbers.

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