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Rheumatology207 papers

Calcium pyrophosphate arthritis and periarthritis

Last edited: 4/14/2026

Overview

Calcium pyrophosphate deposition disease (CPPD) encompasses conditions characterized by the deposition of calcium pyrophosphate dihydrate crystals in cartilage and soft tissues, leading to acute and chronic inflammatory arthritis, often referred to as pseudogout. The disease presents with diverse clinical manifestations, including acute crystal arthritis and osteoarthritis with crystal deposition 12328.

Diagnosis

  • Clinical Presentation: Joint pain, swelling, and stiffness, often mimicking gout or osteoarthritis 23.
  • Imaging: Radiographic findings of chondrocalcinosis (calcified deposits in cartilage) and ultrasound for detecting cartilage calcification 254.
  • Laboratory Tests: Synovial fluid analysis showing calcium pyrophosphate crystals under polarized microscopy 20.
  • Classification Criteria: The 2023 ACR/EULAR classification criteria provide validated tools for diagnosing CPPD 1011.
  • Advanced Imaging: Dual-energy computed tomography (DECT) can differentiate CPPD from other calcifications 18.

    • Management

  • First-Line Treatments:
    • - Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): For pain and inflammation 17. - Colchicine: Shown to be safe and equivalent to prednisone in older patients 9.
  • Adjunctive Treatments:
    • - Corticosteroids: Intra-articular or systemic for acute flares 17. - Physical Therapy: To maintain joint function and mobility 17.

    Special Populations

  • Elderly: Prevalence increases with age; management focuses on symptom control and minimizing complications 223.
  • Comorbidities: CPPD often coexists with other metabolic conditions; management should consider these comorbidities 29.

    • Key Recommendations

  • Use the 2023 ACR/EULAR classification criteria for diagnosing CPPD (Evidence: Strong 1011).
  • Employ NSAIDs or colchicine for acute management, with colchicine being a safe alternative to prednisone in older adults (Evidence: Moderate 9).
  • Consider dual-energy computed tomography for distinguishing CPPD from other calcifications in complex cases (Evidence: Moderate 18).
  • Tailor management strategies to address comorbidities prevalent in elderly patients (Evidence: Expert opinion 29).
  • Regularly assess patient-reported outcomes to monitor disease impact and treatment efficacy (Evidence: Moderate 12).

    • References

    1 Zhang Y, Tedeschi SK, Abhishek A, Hensey O, Grossberg D, Cai K et al.. Core domain set for chronic and/or recurrent manifestations of calcium pyrophosphate deposition disease: OMERACT delphi survey to establish consensus. Seminars in arthritis and rheumatism 2025. link 2 Zhang Y, Tedeschi SK, Abhishek A, Hensey O, Grossberg D, Cai K et al.. Core domain set for studies of acute calcium pyrophosphate crystal arthritis: OMERACT delphi survey to establish consensus. Seminars in arthritis and rheumatism 2025. link 3 Sirotti S, Jauffret C, Adinolfi A, Cipolletta E, Cirillo D, Ingrao L et al.. Pseudogout, chondrocalcinosis, CPPD et al: crystal clear… or clear as mud?-The time has come to reconsider the nomenclature of calcium pyrophosphate deposition. Annals of the rheumatic diseases 2025. link 4 Chen L, Chen J, Kong Y, Xiong X, Ying T, Hu B et al.. Ultrasonographic findings and differential diagnosis of acute calcific periarthritis in hands. Clinical rheumatology 2025. link 5 Jauffret C, Adinolfi A, Sirotti S, Cirillo D, Ingrao L, Lucia A et al.. Systematic literature review on Calcium Pyrophosphate Deposition (CPPD) nomenclature: condition elements and clinical states- A Gout, Hyperuricaemia and Crystal-Associated Disease Network (G-CAN) consensus project. RMD open 2025. link 6 Sirotti S, Terkeltaub R, Filippou G. Describing calcium pyrophosphate deposition: undoing the tower of Babel!. Current opinion in rheumatology 2024. link 7 Akella DS, Ghezavati A, Siddiqui HA, Erbele ID. Middle Ear Tophi: A Case Series of Two Unusual Lesions and a Report of Facial Weakness and Review of the Literature. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 2024. link 8 Lee SH, Lee JS, Chung SW, Lim SD, Oh KS. Calcium pyrophosphate crystal deposition with rotator cuff tear-A case report. Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 2024. link 9 Pascart T, Robinet P, Ottaviani S, Leroy R, Segaud N, Pacaud A et al.. Evaluating the safety and short-term equivalence of colchicine versus prednisone in older patients with acute calcium pyrophosphate crystal arthritis (COLCHICORT): an open-label, multicentre, randomised trial. The Lancet. Rheumatology 2023. link00165-0) 10 Abhishek A, Tedeschi SK, Pascart T, Latourte A, Dalbeth N, Neogi T et al.. The 2023 ACR/EULAR classification criteria for calcium pyrophosphate deposition disease. Annals of the rheumatic diseases 2023. link 11 Abhishek A, Tedeschi SK, Pascart T, Latourte A, Dalbeth N, Neogi T et al.. The 2023 ACR/EULAR Classification Criteria for Calcium Pyrophosphate Deposition Disease. Arthritis & rheumatology (Hoboken, N.J.) 2023. link 12 Whelan MG, Hayashi K, Altwies H, Tedeschi SK. Patient-Reported Outcomes in Calcium Pyrophosphate Deposition Disease Compared to Gout and Osteoarthritis. The Journal of rheumatology 2023. link 13 Tedeschi SK, Yoshida K, Huang W, Solomon DH. Confirming Prior and Identifying Novel Correlates of Acute Calcium Pyrophosphate Crystal Arthritis. Arthritis care & research 2023. link 14 Parperis K, Papachristodoulou E, Kakoullis L, Rosenthal AK. Management of calcium pyrophosphate crystal deposition disease: A systematic review. Seminars in arthritis and rheumatism 2021. link 15 Cai K, Fuller A, Zhang Y, Hensey O, Grossberg D, Christensen R et al.. Towards development of core domain sets for short term and long term studies of calcium pyrophosphate crystal deposition (CPPD) disease: A framework paper by the OMERACT CPPD working group. Seminars in arthritis and rheumatism 2021. link 16 Fuller A, Cai K, Diaz-Torne C, Filippou G, Pascart T, Hensey O et al.. Outcome domains reported by patients, caregivers, healthcare professionals and stakeholders for calcium pyrophosphate deposition (CPPD): A content analysis based on semi-structured qualitative interviews from the OMERACT CPPD working group. Seminars in arthritis and rheumatism 2021. link 17 Stack J, McCarthy G. Calcium pyrophosphate deposition (CPPD) disease - Treatment options. Best practice & research. Clinical rheumatology 2021. link 18 Pascart T, Norberciak L, Legrand J, Becce F, Budzik JF. Dual-energy computed tomography in calcium pyrophosphate deposition: initial clinical experience. Osteoarthritis and cartilage 2019. link 19 Lee JS, Hong S, Kwon OC, Ghang B, Kim YG, Lee CK et al.. Clinical features and risk of recurrence of acute calcium pyrophosphate crystal arthritis. Clinical and experimental rheumatology 2019. link 20 Subramanian H, Gochhait D, Ganesh RN, Govindarajalou R, Siddaraju N. Diagnosis of pseudo-gout (calcium pyrophosphate deposition disease) clinched on cytology. Diagnostic cytopathology 2018. link 21 Abhishek A, Neogi T, Choi H, Doherty M, Rosenthal AK, Terkeltaub R. Review: Unmet Needs and the Path Forward in Joint Disease Associated With Calcium Pyrophosphate Crystal Deposition. Arthritis & rheumatology (Hoboken, N.J.) 2018. link 22 Kleiber Balderrama C, Rosenthal AK, Lans D, Singh JA, Bartels CM. Calcium Pyrophosphate Deposition Disease and Associated Medical Comorbidities: A National Cross-Sectional Study of US Veterans. Arthritis care & research 2017. link 23 Rosen T, Furman J. Acute calcium pyrophosphate deposition arthropathy. JAAPA : official journal of the American Academy of Physician Assistants 2016. link 24 Ward IM, Scott JN, Mansfield LT, Battafarano DF. Dual-Energy Computed Tomography Demonstrating Destructive Calcium Pyrophosphate Deposition Disease of the Distal Radioulnar Joint Mimicking Tophaceous Gout. Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases 2015. link 25 Gutierrez M, Di Geso L, Salaffi F, Carotti M, Girolimetti R, De Angelis R et al.. Ultrasound detection of cartilage calcification at knee level in calcium pyrophosphate deposition disease. Arthritis care & research 2014. link 26 Zhang W, Doherty M, Pascual E, Barskova V, Guerne PA, Jansen TL et al.. EULAR recommendations for calcium pyrophosphate deposition. Part II: management. Annals of the rheumatic diseases 2011. link 27 Doherty M. Calcium pyrophosphate in joint disease. Hospital practice (Office ed.) 1994. link 28 Pritzker KP. Calcium pyrophosphate dihydrate crystal deposition and other crystal deposition diseases. Current opinion in rheumatology 1994. link 29 Jones AC, Chuck AJ, Arie EA, Green DJ, Doherty M. Diseases associated with calcium pyrophosphate deposition disease. Seminars in arthritis and rheumatism 1992. link90019-a) 30 Fam AG. Calcium pyrophosphate crystal deposition disease and other crystal deposition diseases. Current opinion in rheumatology 1992. link 31 Ryan PF. Calcific periarthritis. Australian family physician 1989. link 32 Mandel GS, Halverson PB, Mandel NS. Calcium pyrophosphate crystal deposition: the effect of monosodium urate and apatite crystals in a kinetic study using a gelatin matrix model. Scanning microscopy 1988. link 33 Hajiroussou VJ, Webley M. Familial calcific periarthritis. Annals of the rheumatic diseases 1983. link

    Original source

    1. [1]
      Core domain set for chronic and/or recurrent manifestations of calcium pyrophosphate deposition disease: OMERACT delphi survey to establish consensus. — Zhang Y, Tedeschi SK, Abhishek A, Hensey O, Grossberg D, Cai K et al. Seminars in arthritis and rheumatism (2025)
    2. [2]
      Core domain set for studies of acute calcium pyrophosphate crystal arthritis: OMERACT delphi survey to establish consensus. — Zhang Y, Tedeschi SK, Abhishek A, Hensey O, Grossberg D, Cai K et al. Seminars in arthritis and rheumatism (2025)
    3. [3]
      Pseudogout, chondrocalcinosis, CPPD et al: crystal clear… or clear as mud?-The time has come to reconsider the nomenclature of calcium pyrophosphate deposition. — Sirotti S, Jauffret C, Adinolfi A, Cipolletta E, Cirillo D, Ingrao L et al. Annals of the rheumatic diseases (2025)
    4. [4]
      Ultrasonographic findings and differential diagnosis of acute calcific periarthritis in hands. — Chen L, Chen J, Kong Y, Xiong X, Ying T, Hu B et al. Clinical rheumatology (2025)
    5. [5]
      Systematic literature review on Calcium Pyrophosphate Deposition (CPPD) nomenclature: condition elements and clinical states- A Gout, Hyperuricaemia and Crystal-Associated Disease Network (G-CAN) consensus project. — Jauffret C, Adinolfi A, Sirotti S, Cirillo D, Ingrao L, Lucia A et al. RMD open (2025)
    6. [6]
      Describing calcium pyrophosphate deposition: undoing the tower of Babel! — Sirotti S, Terkeltaub R, Filippou G Current opinion in rheumatology (2024)
    7. [7]
      Middle Ear Tophi: A Case Series of Two Unusual Lesions and a Report of Facial Weakness and Review of the Literature. — Akella DS, Ghezavati A, Siddiqui HA, Erbele ID Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology (2024)
    8. [8]
      Calcium pyrophosphate crystal deposition with rotator cuff tear-A case report. — Lee SH, Lee JS, Chung SW, Lim SD, Oh KS Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association (2024)
    9. [9]
      Evaluating the safety and short-term equivalence of colchicine versus prednisone in older patients with acute calcium pyrophosphate crystal arthritis (COLCHICORT): an open-label, multicentre, randomised trial. — Pascart T, Robinet P, Ottaviani S, Leroy R, Segaud N, Pacaud A et al. The Lancet. Rheumatology (2023)
    10. [10]
      The 2023 ACR/EULAR classification criteria for calcium pyrophosphate deposition disease. — Abhishek A, Tedeschi SK, Pascart T, Latourte A, Dalbeth N, Neogi T et al. Annals of the rheumatic diseases (2023)
    11. [11]
      The 2023 ACR/EULAR Classification Criteria for Calcium Pyrophosphate Deposition Disease. — Abhishek A, Tedeschi SK, Pascart T, Latourte A, Dalbeth N, Neogi T et al. Arthritis & rheumatology (Hoboken, N.J.) (2023)
    12. [12]
      Patient-Reported Outcomes in Calcium Pyrophosphate Deposition Disease Compared to Gout and Osteoarthritis. — Whelan MG, Hayashi K, Altwies H, Tedeschi SK The Journal of rheumatology (2023)
    13. [13]
      Confirming Prior and Identifying Novel Correlates of Acute Calcium Pyrophosphate Crystal Arthritis. — Tedeschi SK, Yoshida K, Huang W, Solomon DH Arthritis care & research (2023)
    14. [14]
      Management of calcium pyrophosphate crystal deposition disease: A systematic review. — Parperis K, Papachristodoulou E, Kakoullis L, Rosenthal AK Seminars in arthritis and rheumatism (2021)
    15. [15]
      Towards development of core domain sets for short term and long term studies of calcium pyrophosphate crystal deposition (CPPD) disease: A framework paper by the OMERACT CPPD working group. — Cai K, Fuller A, Zhang Y, Hensey O, Grossberg D, Christensen R et al. Seminars in arthritis and rheumatism (2021)
    16. [16]
      Outcome domains reported by patients, caregivers, healthcare professionals and stakeholders for calcium pyrophosphate deposition (CPPD): A content analysis based on semi-structured qualitative interviews from the OMERACT CPPD working group. — Fuller A, Cai K, Diaz-Torne C, Filippou G, Pascart T, Hensey O et al. Seminars in arthritis and rheumatism (2021)
    17. [17]
      Calcium pyrophosphate deposition (CPPD) disease - Treatment options. — Stack J, McCarthy G Best practice & research. Clinical rheumatology (2021)
    18. [18]
      Dual-energy computed tomography in calcium pyrophosphate deposition: initial clinical experience. — Pascart T, Norberciak L, Legrand J, Becce F, Budzik JF Osteoarthritis and cartilage (2019)
    19. [19]
      Clinical features and risk of recurrence of acute calcium pyrophosphate crystal arthritis. — Lee JS, Hong S, Kwon OC, Ghang B, Kim YG, Lee CK et al. Clinical and experimental rheumatology (2019)
    20. [20]
      Diagnosis of pseudo-gout (calcium pyrophosphate deposition disease) clinched on cytology. — Subramanian H, Gochhait D, Ganesh RN, Govindarajalou R, Siddaraju N Diagnostic cytopathology (2018)
    21. [21]
      Review: Unmet Needs and the Path Forward in Joint Disease Associated With Calcium Pyrophosphate Crystal Deposition. — Abhishek A, Neogi T, Choi H, Doherty M, Rosenthal AK, Terkeltaub R Arthritis & rheumatology (Hoboken, N.J.) (2018)
    22. [22]
      Calcium Pyrophosphate Deposition Disease and Associated Medical Comorbidities: A National Cross-Sectional Study of US Veterans. — Kleiber Balderrama C, Rosenthal AK, Lans D, Singh JA, Bartels CM Arthritis care & research (2017)
    23. [23]
      Acute calcium pyrophosphate deposition arthropathy. — Rosen T, Furman J JAAPA : official journal of the American Academy of Physician Assistants (2016)
    24. [24]
      Dual-Energy Computed Tomography Demonstrating Destructive Calcium Pyrophosphate Deposition Disease of the Distal Radioulnar Joint Mimicking Tophaceous Gout. — Ward IM, Scott JN, Mansfield LT, Battafarano DF Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases (2015)
    25. [25]
      Ultrasound detection of cartilage calcification at knee level in calcium pyrophosphate deposition disease. — Gutierrez M, Di Geso L, Salaffi F, Carotti M, Girolimetti R, De Angelis R et al. Arthritis care & research (2014)
    26. [26]
      EULAR recommendations for calcium pyrophosphate deposition. Part II: management. — Zhang W, Doherty M, Pascual E, Barskova V, Guerne PA, Jansen TL et al. Annals of the rheumatic diseases (2011)
    27. [27]
      Calcium pyrophosphate in joint disease. — Doherty M Hospital practice (Office ed.) (1994)
    28. [28]
      Calcium pyrophosphate dihydrate crystal deposition and other crystal deposition diseases. — Pritzker KP Current opinion in rheumatology (1994)
    29. [29]
      Diseases associated with calcium pyrophosphate deposition disease. — Jones AC, Chuck AJ, Arie EA, Green DJ, Doherty M Seminars in arthritis and rheumatism (1992)
    30. [30]
      Calcium pyrophosphate crystal deposition disease and other crystal deposition diseases. — Fam AG Current opinion in rheumatology (1992)
    31. [31]
      Calcific periarthritis. — Ryan PF Australian family physician (1989)
    32. [32]
      Calcium pyrophosphate crystal deposition: the effect of monosodium urate and apatite crystals in a kinetic study using a gelatin matrix model. — Mandel GS, Halverson PB, Mandel NS Scanning microscopy (1988)
    33. [33]
      Familial calcific periarthritis. — Hajiroussou VJ, Webley M Annals of the rheumatic diseases (1983)
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