Lesson of the month
Calcium pyrophosphate crystal deposition is not always `wear and tear' or aging
Rheumatology Department, City Hospital,
Nottingham
Correspondence to: Dr G D Wright, Department of Rheumatology, City Hospital, Hucknall Road, Nottingham NG5 1PB.
Accepted for publication 18 June 1997
| The first 150 words of the full text of this article appear below. |
 |
Case 1 |
|---|
A 54 year old man gave a two year history of a painful right hip,
fingers, and wrists. There was no past medical history of note. On
examination there were bilateral, bony, metacarpophalangeal (MCP) joint
swellings and painful restriction of movement in his right hip. The
remainder of the examination was unremarkable. It was thought, at the
initial presentation, that the clinical and radiographic features (fig
1) were consistent with osteoarthritis and he was treated
symptomatically. A further rheumatology opinion was sought two years
later as his symptoms were progressive. Because of the history and
radiographic features further investigations were requested.
Radiographs of his knees confirmed chondrocalcinosis and calcium
pyrophosphate dihydrate (CPPD) crystals were identified in synovial
fluid aspirate by compensated polarised light microscopy. The serum
ferritin concentration was found to be increased at 1200 µg/l. The
-glutamyltransferase was 65 (10-50 U/l) and the alanine
aminotransferase 65 (5-40 U/l), the remainder of the
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