Noninfective arthritis
Calcium pyrophosphate crystal deposition disease

Author: Vijay Shankar, M.D. (see Authors page)

Revised: 28 August 2017, last major update April 2013

Copyright: (c) 2002-2017,, Inc.

PubMed Search: Calcium pyrophosphate crystal deposition disease [title]

Cite this page: Shankar, V. Calcium pyrophosphate crystal deposition disease. website. Accessed August 19th, 2018.
Definition / general
  • Also called pseudogout, chondrocalcinosis
  • Common finding in arthritic joints
  • Calcium pyrophosphate dehydrate (CPPD) crystals develop first in menisci and intervertebral discs, may seed the joint and elicit neutrophilic response (Hum Path 1995;26:587)
  • 50% get significant joint damage
  • CPPD deposition may also cause symptoms similar to septic arthritis, polyarticular inflammatory arthritis or degenerative osteoarthritis
Diagrams / tables

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  • Knee is common site; 50% have involvement of several joints at diagnosis
Clinical features
  • Age 50+ years, 30% of patients are at least 85 years old
  • Hereditary variant: symptoms early in life, associated with severe osteoarthritis
  • Secondary: associated with prior joint damage, hyperparathyroidism, hemochromatosis, hypomagnesemia, hypothyroidism, ochronosis, diabetes mellitus
  • Synovial fluid has high white count (2000 - 8000 cells/mm³), 80% neutrophils with intracellular crystals; later mononuclear cells with intracellular or extracellular crystals
Radiology images

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Pyrophosphate arthropathy

Meniscal chondrocalcinosis

Case reports
Gross description
  • Chalky white deposits in articular tissue
Microscopic (histologic) description
  • Small rectangular (rhomboid) crystals that are weakly positive birefringent; may have histiocytic and giant cell reaction around these crystals
  • CPPD crystals have rhomboid or parallelelipedic morphology
Microscopic (histologic) images

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H&E (A - C), Shiddam staining (figure 2)

High magnification

Compensated polarized light microscopy

H&E, polarized light

Differential diagnosis
  • Crystal deposition: gout, deposition of calcium phosphate, talc, methyl methacrylate (prosthetic joints)