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Calcium pyrophosphate (CPP) and basic calcium phosphate (BCP) crystals are the 2 main families of calcium-containing crystals that can form simultaneously in all joint structures, ligament, tendon, muscle, and soft tissue.
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BCP and CPP crystal deposition are 2 common multifaceted diseases that can mimic alarming clinical manifestations.
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Ultrasonography seems to be an excellent imaging technique for CPP crystal detection but lacks efficacy for deep locations.
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Computed tomography remains the gold
Diagnosis and Clinical Manifestations of Calcium Pyrophosphate and Basic Calcium Phosphate Crystal Deposition Diseases
Section snippets
Key points
Calcification formation
Mechanisms of ectopic calcifications remain unresolved and have been reviewed recently.3, 4, 5, 6, 7, 8 Multiple factors contribute to this cellular driven process, including genetics, aging, imbalance between inhibitors and stimulators of calcification, alteration of calcium, phosphate and pyrophosphate metabolisms, extracellular matrix lesions, cellular differentiation state, and cell death.
Two types of CPP crystals have been identified in synovial fluid, hyaline cartilage, and
Clinical manifestations related to BCP and CPPD
CPPD and BCP crystal deposition are often asymptomatic and identified as an incidental radiographic finding. However, both calcium crystals may be associated with several manifestations.25 Intra-articular CPP crystals may cause acute and relapsing CPP crystal arthritis attacks, chronic CPP crystal inflammatory arthritis, and OA with CPP crystal.1 Extra-articular CPP and BCP crystals can cause tenosynovitis, peripheral nerve and spinal cord compression, and pseudotumoral deposition.25 Both CPPD
Diagnosis
Diagnosis of BCP and CPP crystal–related diseases relies on clinical history, radiography, and synovial fluid analysis whenever possible. Although some radiographic and US characteristics (location of calcification, radiography patterns) may differentiate BCP crystal deposition from CPPD, only microscopic examination of synovial fluid permits correct identification of CPP crystals. Detection of BCP crystals by light microscopy is unusual, because these crystals are too small. Alizarin red
Summary
BCP and CPPD are 2 common multifaceted diseases that can mimic alarming clinical manifestations. Awareness of less common presentations is helpful and prevents misdiagnosis. Diagnosis is based on direct and indirect identification of calcium-containing crystals and deposits. US seems to be an excellent imaging technique for CPP crystal detection but lacks efficacy for deep locations. CT remains the gold standard imaging modality for detection of calcification in the axial skeleton, especially
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Imaging of Crystal Disorders:: Calcium Pyrophosphate Dihydrate Crystal Deposition Disease, Calcium Hydroxyapatite Crystal Deposition Disease and Gout Pathophysiology, Imaging, and Diagnosis
2022, Radiologic Clinics of North AmericaCitation Excerpt :Less commonly genetic or various metabolic disorders such as hereditary hemochromatosis, primary hyperparathyroidism, and hypomagnesemia are the cause,1,6 and this should be considered in case of CPP deposition when younger than 55 years or excessive polyarticular involvement.5 Its clinical expression is variable; patients may present with chondrocalcinosis, acute CPP crystal arthritis (also called pseudogout), or pyrophosphate arthropathy, as a result of chronic CPP arthritis7,8 (Fig. 1). There is no medical treatment of CPPD, and in case of progressive degenerative changes, joint replacement might be an option.1
Microcrystalline arthritis
2021, Medicine (Spain)Unusual localization of chondrocalcinosis: The sternoclavicular joint: Case report and review of the literature
2021, Egyptian RheumatologistWinds of change in imaging of calcium crystal deposition diseases
2020, Revue du Rhumatisme (Edition Francaise)A Fuzzy Cause of Hip Pain
2020, American Journal of MedicineAcute febrile torticollis
2019, Annales Francaises d'Oto-Rhino-Laryngologie et de Pathologie Cervico-Faciale
This work is supported by ANR grant 2013-2017 (CAPYROSIS), “Association Rhumatisme et Travail,” “Association ARPS.”