Calcium Pyrophosphate Deposition (CPPD) Disease Differential Diagnoses

Updated: Apr 07, 2023
  • Author: Constantine K Saadeh, MD; Chief Editor: Herbert S Diamond, MD  more...
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Diagnostic Considerations

Gitelman syndrome

Gitelman syndrome is associated with hypokalemic metabolic acidosis and hypomagnesemia. Patients with Gitelman syndrome may have renal tubular acidosis and a history of pseudogout. Consequently, this diagnosis should be considered in patients with such findings.

Gitelman syndrome has been shown to be associated with a mutation in the gene solute carrier family 12, member 3 (SLC12A3). The cause may be related to the thiazide-sensitive sodium chloride cotransporter, which is found in a variant form in most patients with the syndrome.

Gitelman syndrome can mimic several other manifestations of calcium pyrophosphate deposition (CPPD) disease , including osteoarthritis, carpal tunnel syndrome, and tenosynovitis with calcifications along the tendon sheath itself. [23]

Septic arthritis

Septic arthritis can present as monoarticular arthritis and, therefore, can mimic acute pseudogout. Therefore, a Gram stain of the fluid should be performed. The results of the Gram stain will be negative unless a concomitant infection is present.

If septic arthritis is suggested clinically, even if crystals are seen on compensated polarized microscopy, it must be evaluated and, possibly, treated.

Other differentials

The differential diagnosis for pseudo-osteoarthritis includes hemochromatosis, hyperparathyroidism, hypothyroidism, and traumatic arthritis (as occurs in heavy-equipment machinery operators).

Basic calcium phosphate deposition disease and Lyme arthritis are also included in the differential diagnosis of CPPD.

See also The Approach to the Painful Joint.

Differential Diagnoses