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Calcium pyrophosphate arthritis


Calcium pyrophosphate dihydrate deposition disease; CPPD disease; Acute CPPD arthritis; Pseudogout

Calcium pyrophosphate arthritis (CPPD) is a joint disease that can cause attacks of arthritis. Like with gout, crystals form in the joints. But in calcium pyrophosphate arthritis, the crystals are not formed from uric acid.

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  • Causes

    Calcium pyrophosphate arthritis is caused by the collection of salt called calcium pyrophosphate dihydrate (CPPD). The buildup of this salt forms crystals in the joints. This leads to attacks of joint swelling and pain in the knees, wrists, ankles, and other joints.

    Among older adults, calcium pyrophosphate arthritis is a common cause of sudden (acute) arthritis in one joint.

    Calcium pyrophosphate arthritis mainly affects the elderly because joint degeneration and osteoarthritis increases with age. However, it can sometimes affect younger people who have conditions such as:

    • Hemochromatosis
    • Parathyroid disease
    • Thyroid disease

    Because the symptoms are similar, calcium pyrophosphate arthritis can be misdiagnosed as:

    • Gouty arthritis (gout)
    • Osteoarthritis
    • Rheumatoid arthritis
  • Symptoms

    • Attacks of joint pain and fluid buildup in the joint, leading to joint pain, swelling, warmth and redness
    • Chronic (long-term) arthritis

    There may be no symptoms between attacks.

  • Exams and Tests

    • An exam of joint fluid to detect white blood cells and calcium pyrophosphate crystals
    • Joint x-rays to look for joint damage and calcium deposits in joint spaces
    • Blood tests to screen for conditions that are linked to calcium pyrophosphate arthritis 

    Carefully testing the joint fluid for crystals can help the doctor diagnose the condition. Because most conditions involving joint pain are treated with the same medicines (such as steroids and nonsteroidal anti-inflammatory drugs), you may still get the right treatment, even if your diagnosis was incorrect at first.

  • Treatment

    Treatment may involve removing fluid to relieve pressure in the joint. A needle is placed into the joint and fluid is removed (aspirated).

    Steroid injections may help treat severely swollen joints. Oral steroids are sometimes used when many joints are swollen.

    Nonsteroidal anti-inflammatory medications (NSAIDS) may help ease painful attacks. Colchicine may be useful in some people.

  • Outlook (Prognosis)

    Most people do well with treatment to reduce the acute joint pain. A medicine such as colchicine may help prevent repeat attacks. There is no treatment to remove the CPPD crystals.

  • Possible Complications

    Permanent joint damage can occur without treatment.

  • When to Contact a Medical Professional

    Call for an appointment with your health care provider if you have attacks of joint swelling and joint pain.

  • Prevention

    There is no known way to prevent this disorder. However, treating other problems that may cause pseudogout may make the condition less severe, and may help prevent it from developing in patients who don't already have it.


Related Information

  ArthritisJoint swellingAcromegalyAlkaptonuriaHemochromatosisWilson diseaseRheumatoid arthrit...Osteoarthritis     OsteoarthritisGoutRheumatoid arthrit...


Goldman L, Ausiello DA. Goldman's Cecil Medicine. 23rd ed. Philadelphia, PA: Elsevier Saunders; 2007.



Review Date: 4/18/2014  

Reviewed By: Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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