Re-conceptualizing structural damage in chronic calcium pyrophosphate crystal inflammatory arthritis through ultrasonography: a pictorial essay

Abstract

Calcium pyrophosphate deposition (CPPD) disease is the most prevalent crystal related arthropathy in the older-aged population. The clinical spectrum of CPPD arthropathy can include asymptomatic, acute, and chronic inflammatory disease that primarily results in irreversible structural joint damage. The manifestations and impact of structural damage that result from other inflammatory non-degenerative features of chronic CPP crystal inflammatory arthritis are often underrecognized and may lead to an inaccurate perception of disease severity. This pictorial essay sought to display the disease burden and various presentations of chronic inflammatory CPP crystal arthritis. Sonographic imaging of cases with chronic CPP arthritis was presented for diagnostic considerations and to demonstrate the extent of irreversible articular and peri-articular damage occurring at a structural level. Evolving understanding of the imaging characteristics of CPPD disease will provide a better appreciation of disease morbidity caused by this condition and stress the need to expand efforts to find effective treatments to dissolve crystal deposition and targeted therapies that will contain the inflammatory response to crystals. Recognizing the anatomic consequences of tissue damage that arise from CPPD disease should also help reflect on potential surgical alternatives to mitigate the progression of structural complications until effective disease modifying agents for this condition emerge.

Keywords

Calcium pyrophosphate deposition disease / chronic calcium pyrophosphate arthritis / pseudogout / pseudorheumatoid arthritis / ultrasound

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