jkra The Journal of the Korean Rheumatism Association J Korean Rheum Assoc 1226-8070 2233-4718 The Korean Rheumatism Association 10.4078/jkra.2010.17.4.412 jkra-17-412 Original Article A Case of CPPD Crystal Deposition Disease in a Patient with Rheumatoid Arthritis and Systemic Sclerosis JeongJae Shik KimTae Wook JeongMin Jeong ImJun Young ParkMi Ran LeeChoong Won Department of Internal Medicine, Wallace Memorial Baptist Hospital, Busan, Korea 122010 23122010 17 4 412 416 20052010 15072010 19072010 Copyright © 2010 The Korean Rheumatism Association 2010 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 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.

 Rheumatoid arthritisCalcium pyrophosphate dihydrate crystal deposition disease REFERENCES Ryan LM McCarty DJ Calcium pyrophosphate crystal deposition disiease, pseudogout, and articular chondrocalcinosis. In: Koopman WJ ed. Athritis and allied conditions. 13th ed. 210325 Baltimore, Wiliams & Wikins 1997 Feldmann M Brennan FM Mainni RN Rheumatoid arthritis Cell 1996 85 30710 Menkes CJ Simon F Delrieu F Forrest M Delbarre F Destructive arthropathy in chondrocalcinosis articularis Arthritis Rheum 1976 19 32948 Gester JC Vischer TL Boussina I Fallet GH Joint destruction and chondrocalnosis Br Med J 1975 2 6845 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 10029 Gerster JC Varisco PA Kern J Dudler J So AKL CPPD crystal deposition disease in patients with rheumatoid arthritis Clin Rheumatol 2006 25 4689 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 71137 Rothschild B CPPD complicating other forms of inflammatory arthritis Clin Rheumatol 2007 26 11301 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 41822 Jones AC Chuck AJ Arie EA Green DJ Doherty M Diseases associated with calcium pyrophosphate deposition disease Semin Arthritis Rheum 1992 22 188202 Schumacher HR Jr Crystal deposition disease Curr Opin Rheumatol 1997 9 2512 Figures

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

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

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