Morning Report

1
Morning Report 4 Lets get out of this joint
2

• A 60 y/o male with known history of
  hemochromatosis presents with acute swelling,
  erythema, and pain of the right big toe.
  Aspirate of the joint reveals a crystal
  arthropathy.

3

• 1. Name the type of crystal that would likely be
  found in this acute arthropathy.
• 2. Name 2 other causes for this type of
  arthropathy

4
Calcium Pyrophosphate Dihydrate Deposition Disease

• Acute or recurrent monoarticular inflammatory
  athropathy that mimics gout
• Positive birefringent rhomboid-shaped crystals
• Onset after age 60
• Suspect in any patient that presents with
  accelerated or unusual distribution of DJD

5
CPPD crystal (positively birefringent) blue
when parallel / yellow when perpendicular to the
axis of the first order filter in a polarizing
microscope)
6
Associated conditions

• Hemochromatosis
• hypophosphatemia
• Thyroid (hypothyroid)
• Parathyroid (hyperparathyroid)
• Gitelmans syndrome
• Gout
• X-linked hypophosphatemic rickets
• Familial hypocalciuric hypercalcemia
• Hemosiderosis
• Trauma
• Joint injections

7
Clinical Manifestations

• Asymptomatic or incidental finding
• Recurrent acute inflammatory monoarticular
  arthritis
• acute hemarthrosis
• Chronic degenerative arthritis
• Chronic symmetric inflammatory polyarthritis
• Systemic illness ("pseudopolymyalgia rheumatica,"
  fever of unknown origin)
• Carpal tunnel syndrome

8
Chondrocalcinosis