From the Guidelines
Crystal deposition disease is a group of conditions characterized by the formation of crystals in and around joints, leading to inflammation, pain, and damage, with the most common types being gout and calcium pyrophosphate deposition disease (CPPD). The formation of these crystals is often due to metabolic abnormalities, genetic factors, or aging that alter the balance of substances in body fluids, leading to crystal formation when saturation points are exceeded 1.
Types of Crystal Deposition Disease
- Gout: caused by uric acid crystals, typically affecting the big toe, ankles, and knees with sudden, severe pain and swelling.
- Calcium pyrophosphate deposition disease (CPPD): also known as pseudogout, involves calcium pyrophosphate crystals and often affects larger joints like knees and wrists.
- Other crystal deposition diseases: include basic calcium phosphate crystal deposition and oxalate crystal deposition.
Diagnosis and Treatment
Proper diagnosis often requires joint fluid analysis to identify the specific crystals present 1. Treatment for acute attacks of CPPD may include cool packs, temporary rest, and joint aspiration combined with steroid injection, while prophylaxis or chronic inflammatory arthritis with CPPD may be managed with oral non-steroidal anti-inflammatory drugs with gastroprotective treatment and/or low-dose colchicine 0.5–1.0 mg daily 1. The management of CPP-associated arthritis is challenging, and optimal treatment requires both non-pharmacological and pharmacological treatments. Asymptomatic CPPD requires no treatment, and the strength of recommendations for treatment varies from 79% to 95% 1.
From the Research
Definition of Crystal Deposition Disease
Crystal deposition disease refers to a group of joint disorders caused by the deposition of crystals in and around joints, leading to joint destruction and soft tissue masses.
Types of Crystal Deposition Diseases
- Gout: caused by the deposition of monosodium urate crystals within synovium of joints, leading to severe pain and reducing quality of life for patients with this condition 2, 3
- Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease: characterized by the accumulation of pyrophosphate dihydrate crystals in articular and periarticular tissues, with various clinical presentations including pseudogout and pyrophosphate arthropathy 4, 5, 6
- Hydroxyapatite crystal deposition disease: characterized by calcific tendinitis and periarthritis, as well as a more recently described arthropathy 5, 6
Clinical Presentation and Diagnosis
The clinical presentation of crystal deposition diseases is variable, and diagnosis might be challenging. Diagnosis can be made using several validated clinical prediction rules, arthrocentesis, and synovial fluid or tophus analysis 3. Imaging findings, including radiologic features such as articular and periarticular calcification, joint space narrowing, and bone sclerosis, can also aid in diagnosis 4, 5, 6.
Treatment and Management
Treatment for crystal deposition diseases includes pharmacotherapies such as colchicine, nonsteroidal anti-inflammatory drugs, and corticosteroids to relieve pain in acute episodes, as well as urate-lowering therapies to prevent flare-ups 2, 3. Awareness of the distinctive roentgenographic appearance of these diseases should allow a specific diagnosis to be made, and an understanding of their pathologic features should aid in appropriate therapy and guide future investigation of possible etiologic factors 6.