Rheumatoid arthritis and pseudo-rheumatoid arthritis in calcium pyrophosphate dihydrate crystal deposition disease.

Abstract

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease can lead to many clinical syndromes. One syndrome simulates rheumatoid arthritis and is thus called "pseudo-rheumatoid arthritis." Since some patients have true rheumatoid arthritis with CPPD crystal deposition disease, the clinician may have difficulty differentiating those patients from others who have the pseudo-rheumatoid syndrome. Such a diagnostic problem can be solved radiographically. Eleven patients with CPPD crystal deposition disease were studied; five had true rheumatoid arthritis and six had pseudo-rheumatoid arthritis. Because osseous erosions were not apparent in the arthropathy of uncomplicated CPPD crystal deposition disease, the detection of skeletal erosive changes indicated a true rheumatoid arthritis process.

Low incidence of calcium pyrophosphate dihydrate crystal deposition in rheumatoid arthritis, with modification of radiographic features in coexistent disease

“…The 10 patients with coexistent RA and CPPD deposition had definite evidence of both conditions and thus differed fundamentally from "pseudorheumatoid" patients with CPPD deposition alone (1,36). The striking feature of the group was the frequency of atypical radiographic changes.…”

The crowned dens syndrome. Evaluation with CT imaging

“…Bennet, in particular, noted the presence of "chalky", rhomboid-shaped crystals [16] during the autopsy of a patient in Ireland with polyarticular chondrocalcinosis. The several studies by Steinbach and Resnick and Resnick et al [12,17] reviewed the nomenclature of the disease, putting an end to the confusion caused by the use of different synonyms. The term "chondrocalcinosis" is very general, as it suggests apparent radiological and pathological calcification of the cartilage (which could be due to CPPD, HA, tricalcium phosphate or a combination of the three).…”

“…Quest'ultimo, in Irlanda, durante l'autopsia di un paziente affetto da condrocalcinosi poliarticolare, evidenziò la presenza di cristalli romboidali, di aspetto "gessoso" [16]. I numerosi studi di Resnick et al [12,17] hanno messo ordine nelle svariate nomenclature con cui la malattia era conosciuta, in quanto diversi sinonimi sono stati usati in maniera intercambiabile tra di loro, causando in passato una certa confusione. In effetti, il termine "condrocalcinosi" è molto generico, in quanto indica una evidente calcificazione -radiologica ed anatomopatologica -della cartilagine (che può riferirsi alla presenza di cristalli di CPPD, di HA, di fosfato tricalcico o alla combinazione dei tre suddetti).…”

A Case of Calcium Pyrophosphate Dihydrate Crystal Deposition Disease Presenting as an Acute Polyarthritis

“…Such a diagnostic problem can be solved by radiologic evaluations. The patients with CPPD usually show chondrocalcinosis and bony erosions are not apparent in uncomplicated CPDD, while the patients with rheumatoid arthritis show bony erosions and destructive joint changes (12).…”