J Korean Rheum Assoc.  2010 Dec;17(4):412-416. 10.4078/jkra.2010.17.4.412.

A Case of CPPD Crystal Deposition Disease in a Patient with Rheumatoid Arthritis and Systemic Sclerosis

• Jeong JS
• Kim TW
• Jeong MJ
• Im JY
• Park MR
• Lee CW

• KMID: 2201900
• DOI: http://doi.org/10.4078/jkra.2010.17.4.412

Abstract

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is an inflammatory arthropathy that is defined by the deposition of CPPD crystals in articular and periarticular structures. CPPD crystal deposition disease has various clinical manifestation patterns ranging from an absence of symptoms to a severely destructive arthropathy. CPPD crystal deposition disease very rare with rheumatoid arthritis or systemic sclerosis. We report a case of CPPD crystal deposition disease combined in a patient with rheumatoid arthritis and systemic sclerosis.

Keyword

Rheumatoid arthritis; Calcium pyrophosphate dihydrate crystal deposition disease

MeSH Terms

Arthritis, Rheumatoid
Calcium Pyrophosphate
Diphosphates
Humans
Scleroderma, Systemic
Calcium Pyrophosphate
Diphosphates

Figure

• 

  Fig. 1. Plain radiographs show punctate and linear radiodense deposits in the fibrocartilaginous periarticular joint articular hyaline cartilage (chondrocalcinosis).

• 

  Fig. 2. Computed tomography scan showing nodular calcified deposit in the distal humerus and proximal ulnar and radius (arrow).

• 

  Fig. 3. Examination of synovial fluid under polarized microscopy shows rhomboid crystals with weakly positive birefringence (wet smear, compensator axis: A, x400, B, x1,000).

Reference

1). Ryan LM., McCarty DJ. Calcium pyrophosphate crystal deposition disiease, pseudogout, and articular chondrocalcinosis. In:. Koopman WJ, editor. ed.Athritis and allied conditions. 13th ed.p. 2103–25. Baltimore, Wiliams & Wikins;1997.

2). Feldmann M., Brennan FM., Mainni RN. Rheumatoid arthritis. Cell. 1996. 85:307–10.

3). Menkes CJ., Simon F., Delrieu F., Forrest M., Delbarre F. Destructive arthropathy in chondrocalcinosis articularis. Arthritis Rheum. 1976. 19:329–48.

4). Gester JC., Vischer TL., Boussina I., Fallet GH. Joint destruction and chondrocalnosis. Br Med J. 1975. 2:684–5.

5). Doherty M., Dieppe P., Watt I. Low incidence of calcium pyrophosphate dihydrate crystal deposition in rheumatoid arthritis, with modification of radiographic feature in coexistent disease. Arthritis Rheum. 1984. 27:1002–9.

6). Gerster JC., Varisco PA., Kern J., Dudler J., So AKL. CPPD crystal deposition disease in patients with rheumatoid arthritis. Clin Rheumatol. 2006. 25:468–9.

7). McCarty DJ., Kohn NN., Faires JS. The significance of calcium phosphate crystals in the synovial fluid of arthritis patients: The “pseudoout syndrome.” I. Clinical aspects. Ann Intern Med. 1962. 56:711–37.

8). Rothschild B. CPPD complicating other forms of inflammatory arthritis. Clin Rheumatol. 2007. 26:1130–1.

9). Sanmarti R., Panella D., Brancos MA., Canela J., Collado A., Brugues J. Prevalence of articular chondrocalcinosis in elderly subjects in a rural area of catalonia. Ann Rheum Dis. 1993. 52:418–22.

10). Jones AC., Chuck AJ., Arie EA., Green DJ., Doherty M. Diseases associated with calcium pyrophosphate deposition disease. Semin Arthritis Rheum. 1992. 22:188–202.

11). Schumacher HR Jr. Crystal deposition disease. Curr Opin Rheumatol. 1997. 9:251–2.