Algorithm for Evaluation and Treatment of Calcium Pyrophosphate Dihydrate Disease
Algorithm for Evaluation and Treatment of Calcium Pyrophosphate Dihydrate Disease - Flowchart Basic Calcium Phosphate Deposition Basic Calcium Phosphate Deposition
Flowchart

Acute or chronic arthritis

Acute or chronic arthritis

Acute or chronic arthritis

Suspect CPPD:


Elderly
History of OA or trauma
Typical pseudogout or pseudo-OA
Hemarthrosis
Specific metabolic disorder
Family history of chondrocalcinosis

Suspect CPPD:


Elderly
History of OA or trauma
Typical pseudogout or pseudo-OA
Hemarthrosis
Specific metabolic disorder
Family history of chondrocalcinosis


Elderly
History of OA or trauma
Typical pseudogout or pseudo-OA
Hemarthrosis
Specific metabolic disorder
Family history of chondrocalcinosis Suspect CPPD

Another diagnosis established

Another diagnosis established

Another diagnosis established

End

End

End

Treat inflammatory arthritis:


NSAIDs
Systemic or intra-articular steroids
Alternative approach: ACTH
Prophylactic colchicine for recurrent pseudogout
For refractory chronic inflammatory arthritis, experimental use of:


Methotrexate
Hydroxychloroquine
IL-1 inhibition

Treat inflammatory arthritis:


NSAIDs
Systemic or intra-articular steroids
Alternative approach: ACTH
Prophylactic colchicine for recurrent pseudogout
For refractory chronic inflammatory arthritis, experimental use of:


Methotrexate
Hydroxychloroquine
IL-1 inhibition


NSAIDs
Systemic or intra-articular steroids
Alternative approach: ACTH
Prophylactic colchicine for recurrent pseudogout
For refractory chronic inflammatory arthritis, experimental use of:


Methotrexate
Hydroxychloroquine
IL-1 inhibition


Methotrexate
Hydroxychloroquine
IL-1 inhibition Treat inflammatory arthritis

Evaluate for primary metabolic disorder:


Serum Ca2+, PO4-, alkaline phosphatase
Serum Mg2+
Serum iron, TIBC, ferritin
Renal function

Evaluate for primary metabolic disorder:


Serum Ca2+, PO4-, alkaline phosphatase
Serum Mg2+
Serum iron, TIBC, ferritin
Renal function


Serum Ca2+, PO4-, alkaline phosphatase 2+ 4 -
Serum Mg2+ 2+
Serum iron, TIBC, ferritin
Renal function Evaluate for primary metabolic disorder


Aspirate affected joint
Synovial fluid analysis by compensated polarized light microscopy


Aspirate affected joint
Synovial fluid analysis by compensated polarized light microscopy


Aspirate affected joint
Synovial fluid analysis by compensated polarized light microscopy Aspirate affected joint


Plain radiographs of affected joint
Or
High resolution ultrasound of affected joint


Plain radiographs of affected joint
Or
High resolution ultrasound of affected joint


Plain radiographs of affected joint
Or

High resolution ultrasound of affected joint Plain radiographs


Crystal analysis positive for CPP, or radiographic evidence for CPPD
Gout excluded
Joint cultures negative


Crystal analysis positive for CPP, or radiographic evidence for CPPD
Gout excluded
Joint cultures negative


Crystal analysis positive for CPP, or radiographic evidence for CPPD
Gout excluded
Joint cultures negative Crystal analysis positive

Crystal analysis and radiographs or ultrasound negative: Assess for alternative diagnosis

Crystal analysis and radiographs or ultrasound negative: Assess for alternative diagnosis

Crystal analysis and radiograph negative