Case history

Case history #1

A 72-year-old woman presents with polyarticular joint pain. She has long-standing mild joint pain, but over the last 10 years notes increasing discomfort in her wrists, shoulders, knees, and ankles. She has had several recent episodes of severe pain in one or two joints, with swelling and warmth of the affected areas. These episodes often last 3-4 weeks. Her examination shows severe bony changes consistent with osteoarthritis in many joints, and slight swelling, warmth, and tenderness without erythema in the second and third metacarpophalangeal joints, left shoulder, and the right wrist.

Case history #2

An 80-year-old man presents with a swollen red wrist, fever, and chills. He recalls falling out of his wheelchair several days ago but seemed well until 24 hours before admission, when he developed pain in his right wrist. His daughter noted fever and some confusion and brought him to the hospital. On examination, he appears ill and has a fever of 39ºC (102ºF). There is swelling, tenderness, and redness around the right wrist with oedema over the dorsum of the hand.

Other presentations

Arthritis associated with CPP crystals is often called the great mimic and can have a wide variety of presentations.[1] Although acute mono-articular arthritis resembling gout is perhaps the most commonly recognised form of CPP arthritis, it is not the most common form of the disease. The most common form of CPP arthritis presents as a chronic degenerative arthritis that resembles osteoarthritis and may occur with or without inflammatory episodes. CPP arthritis typically affects joints not commonly affected by osteoarthritis, such as the wrists or shoulders.

In addition to its presentation as an acute mono-articular or oligo-articular arthritis, it can present with a polyarticular, symmetrical inflammatory arthritis similar to rheumatoid arthritis; or, less commonly, with the diffuse aching similar to that seen in polymyalgia rheumatica.

CPPD is associated with an increased risk of vascular calcification, and low bone mineral density.[6][7] The neuropathic form is rare but is characterised by severe destructive arthritis with bone fragmentation and loose bodies.

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