Journal List > J Korean Rheum Assoc > v.17(4) > 1003762

J Korean Rheum Assoc. 2010 Dec;17(4):412-416. Korean.
Published online December 31, 2010.  https://doi.org/10.4078/jkra.2010.17.4.412
Copyright © 2010 The Korean Rheumatism Association
A Case of CPPD Crystal Deposition Disease in a Patient with Rheumatoid Arthritis and Systemic Sclerosis
Jae Shik Jeong, Tae Wook Kim, Min Jeong Jeong, Jun Young Im, Mi Ran Park and Choong Won Lee
Department of Internal Medicine, Wallace Memorial Baptist Hospital, Busan, Korea.

Corresponding author (Email: choong@wmbh.co.kr )
Received May 20, 2010; Revised July 15, 2010; Accepted July 19, 2010.

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.

Keywords: Rheumatoid arthritis; Calcium pyrophosphate dihydrate crystal deposition disease

Figures


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


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


Fig. 3
Examination of synovial fluid under polarized microscopy shows rhomboid crystals with weakly positive birefringence (wet smear, compensator axis: ↗, A, ×400, B, ×1,000).
Click for larger image

References
1. Ryan LM, McCarty DJ. Calcium pyrophosphate crystal deposition disiease, pseudogout, and articular chondrocalcinosis. In: Koopman WJ, editor. Athritis and allied conditions. 13th ed. Baltimore: Wiliams & Wikins; 1997. pp. 2103-2125.
2. Feldmann M, Brennan FM, Mainni RN. Rheumatoid arthritis. Cell 1996;85:307–310.
3. Menkes CJ, Simon F, Delrieu F, Forrest M, Delbarre F. Destructive arthropathy in chondrocalcinosis articularis. Arthritis Rheum 1976;19:329–348.
4. Gester JC, Vischer TL, Boussina I, Fallet GH. Joint destruction and chondrocalnosis. Br Med J 1975;2:684–685.
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;27:1002–1009.
6. Gerster JC, Varisco PA, Kern J, Dudler J, So AKL. CPPD crystal deposition disease in patients with rheumatoid arthritis. Clin Rheumatol 2006;25:468–469.
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;56:711–737.
8. Rothschild B. CPPD complicating other forms of inflammatory arthritis. Clin Rheumatol 2007;26:1130–1131.
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;52:418–422.
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;9:251–252.