{"id":10766,"date":"2023-09-11T06:00:27","date_gmt":"2023-09-11T05:00:27","guid":{"rendered":"https:\/\/blogs.bmj.com\/bjsm\/?p=10766"},"modified":"2023-09-14T10:45:51","modified_gmt":"2023-09-14T09:45:51","slug":"the-msk-playbook-chondrocalcinosis-pathway","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bjsm\/2023\/09\/11\/the-msk-playbook-chondrocalcinosis-pathway\/","title":{"rendered":"The MSK Playbook: Chondrocalcinosis Pathway"},"content":{"rendered":"<p><span style=\"font-weight: 400\">The forgotten crystal arthropathy; Metabolically driven or just an incidental finding?<\/span><\/p>\n<p><span style=\"font-weight: 400\">Key words: #MSKplaybook #Chondrocalcinosis #CrystalArthropathy #Pseudogout #CPPD<\/span><\/p>\n<p><b>Introduction\u00a0<\/b><\/p>\n<p><span style=\"font-weight: 400\">Chondrocalcinosis is a common imaging finding encountered in community MSK clinics. In some patients, it may be considered normal for age, but in others, it can be a sign of a crystal arthropathy (CPPD arthropathy\/pseudogout) or be associated with an underlying metabolic, genetic, or medical condition. Early recognition of the condition can help to preserve joint health or alert clinicians to patients that need a full medical and metabolic workup. We discuss the key clinical tests, blood tests and history for MSK clinicians to consider as part of their playbook.<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-10767\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/MSK-chondro-1-300x131.png\" alt=\"\" width=\"463\" height=\"202\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/MSK-chondro-1-300x131.png 300w, https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/MSK-chondro-1.png 512w\" sizes=\"auto, (max-width: 463px) 100vw, 463px\" \/><\/p>\n<p>&nbsp;<\/p>\n<p><b>Chondrocalcinosis: incidental finding or evidence of destructive joint disease?<\/b><\/p>\n<p><span style=\"font-weight: 400\">The presence of chondrocalcinosis (deposits of calcium pyrophosphate within joints) increases with age and is often reported on plain radiographs of the hands, wrists, shoulders, ankles, elbows, or hands. For clinicians in a community MSK setting, the question is often if this finding is expected for the patient&#8217;s age\/medical history or does this need further medical and metabolic workup?<\/span><\/p>\n<p><span style=\"font-weight: 400\">Chondrocalcinosis within joints can go on to cause symptomatic flares of pseudogout or calcium pyrophosphate deposition (CPPD) arthropathy. This is a painful arthropathy, often thought of as the forgotten crystal arthropathy \u2013 as in primary care routine imaging X-ray or joint aspiration is not performed to confirm the diagnosis.\u00a0<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-10788\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/History-CPPD-120x300.jpg\" alt=\"\" width=\"258\" height=\"645\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/History-CPPD-120x300.jpg 120w, https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/History-CPPD-768x1920.jpg 768w, https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/History-CPPD-614x1536.jpg 614w, https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/History-CPPD-640x1600.jpg 640w, https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/History-CPPD.jpg 800w\" sizes=\"auto, (max-width: 258px) 100vw, 258px\" \/><\/p>\n<p><span style=\"font-weight: 400\">Figure 1: Focused clinical history questions In chondrocalcinosis patients\u00a0<\/span><\/p>\n<p><b>How common is it?<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">CPPD has an estimated prevalence of between 4% and 7% in the general population (1,2).\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">It is the most common cause of an acutely swollen joint in the elderly, however, it is often overlooked and treated as gout or osteoarthritis.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Among 100 consecutive patients admitted to an acute geriatric ward, the prevalence of radiological CPP deposition increases with age from 15% for those aged 65-74 to almost 50% for those &gt;84 years (3).\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">There is no clear gender predominance (3).<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Early onset chondrocalcinosis is associated with an increased risk of an underlying genetic or metabolic condition at age&lt;50.<\/span><\/li>\n<\/ul>\n<table style=\"height: 170px\" width=\"497\">\n<tbody>\n<tr>\n<td colspan=\"3\"><span style=\"font-weight: 400\">Risk factors for chondrocalcinosis<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">Patient-related<\/span><\/td>\n<td><span style=\"font-weight: 400\">Medical\/metabolic<\/span><\/td>\n<td><span style=\"font-weight: 400\">Genetic<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">Trauma<\/span><\/td>\n<td><span style=\"font-weight: 400\">Rheumatoid arthritis<\/span><\/td>\n<td><span style=\"font-weight: 400\">Hemochromatosis<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">Osteoarthritis<\/span><\/td>\n<td><span style=\"font-weight: 400\">Gout<\/span><\/td>\n<td><span style=\"font-weight: 400\">Wilsons disease<\/span><\/td>\n<\/tr>\n<tr>\n<td><\/td>\n<td><span style=\"font-weight: 400\">Hyperparathyroidism<\/span><\/td>\n<td><span style=\"font-weight: 400\">Ochronosis syndrome<\/span><\/td>\n<\/tr>\n<tr>\n<td><\/td>\n<td><span style=\"font-weight: 400\">Loop diuretics<\/span><\/td>\n<td><span style=\"font-weight: 400\">Gitelman&#8217;s syndrome<\/span><\/td>\n<\/tr>\n<tr>\n<td><\/td>\n<td><span style=\"font-weight: 400\">Bisphosphonates<\/span><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td><\/td>\n<td><span style=\"font-weight: 400\">Hypothyroidism<\/span><\/td>\n<td><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><span style=\"font-weight: 400\">Table 1: Risk factors for CPPD arthropathy\/Pseudogout<\/span><\/p>\n<p><span style=\"font-weight: 400\">CPPD arthropathy is often diagnosed after imaging has been performed in a symptomatic joint. Diagnostic workups for chondrocalcinosis can vary according to the skills mix and resources available in community MSK clinics, and whether this is done in-house or referred to secondary care. A focussed clinical history and typical X-ray findings (chondrocalcinosis) are usually enough to confirm a suspected diagnosis, but in cases of uncertainty, aspiration of fluid and crystal analysis may be performed (4).<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-10769\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/MSK-chondro-3-300x268.png\" alt=\"\" width=\"378\" height=\"338\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/MSK-chondro-3-300x268.png 300w, https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/MSK-chondro-3.png 512w\" sizes=\"auto, (max-width: 378px) 100vw, 378px\" \/><\/p>\n<p><span style=\"font-weight: 400\">Figure 2: X-ray 1 \u2013 Chondrocalcinosis (knee)<\/span><\/p>\n<p><span style=\"font-weight: 400\">Risk factors for CPPD, include medical conditions, metabolic triggers, bone health, or underlying joint disease (osteoarthritis\/ rheumatoid arthritis\/ gout). Identifying these risk factors and addressing them early can reduce the risk of destruction of joint disease in the long term and can influence the onset and progression of the conditions (5). Age is by far the biggest risk factor and when the condition is present &lt;50 or if there is a family history of hemochromatosis, we recommend further medical workup (Figure 1).<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-10770\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/MSK-chondro-4-257x300.png\" alt=\"\" width=\"350\" height=\"409\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/MSK-chondro-4-257x300.png 257w, https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/MSK-chondro-4.png 438w\" sizes=\"auto, (max-width: 350px) 100vw, 350px\" \/><\/p>\n<p><span style=\"font-weight: 400\">Figure 3: X-ray 2 \u2013 chondrocalcinosis (wrist)<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><b>Clinical History <\/b><\/p>\n<p><span style=\"font-weight: 400\">Assessment of an acutely swollen joint, suspicious for calcium pyrophosphate dihydrate disease (CPPD) or pseudogout, should begin with a comprehensive history to screen for relevant risk factors. This includes questions regarding medication history, alcohol, and smoking. The evaluation should continue with a meticulous physical examination, scrutinising not only the affected joint but also other peripheral joints, looking for any signs indicative of more systemic features of rheumatic disease, such as skin or eye involvement, associated with other inflammatory rheumatic diseases. An important distinction to bear in mind during the examination is that, unlike other types of inflammatory arthritis that predominantly affect small joints \u2014 such as rheumatoid arthritis (RA) involving metacarpophalangeal joints (MCPJs) and metatarsophalangeal joints (MTPJs), and connective tissue diseases (CTDs) affecting wrists \u2014 CPPD\/pseudogout tends to impact larger joints. Additionally, gout, another differential diagnosis, typically affects the 1st MTPJ in about 75% of cases.<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-10789\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/Examination-CPPD-300x225.jpg\" alt=\"\" width=\"428\" height=\"321\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/Examination-CPPD-300x225.jpg 300w, https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/Examination-CPPD-768x576.jpg 768w, https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/Examination-CPPD-640x480.jpg 640w, https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/Examination-CPPD.jpg 1024w\" sizes=\"auto, (max-width: 428px) 100vw, 428px\" \/><\/p>\n<p><span style=\"font-weight: 400\">Figure 4: Focused examination in suspected CPPD patients<\/span><\/p>\n<p><b>Blood Tests<\/b><\/p>\n<p><span style=\"font-weight: 400\">Several blood tests can be considered when investigating underlying, genetic, or medical conditions. These include:\u00a0\u00a0<\/span><\/p>\n<table style=\"font-size: 1rem;background-color: #ffffff;height: 389px\" width=\"783\">\n<tbody>\n<tr>\n<td><b>Blood tests to order<\/b><\/td>\n<td><b>Diagnosis to rule out\/in<\/b><\/td>\n<\/tr>\n<tr>\n<td><b>Full Blood Count (FBC)<\/b><\/p>\n<p><b>Erythrocyte Sedimentation Rate (ESR) and C-reactive protein (CRP)<\/b><\/td>\n<td>To evaluate the presence of inflammation and differentiate between inflammatory and non-inflammatory conditions.<\/td>\n<\/tr>\n<tr>\n<td><b>Urea and Electrolytes<\/b><\/td>\n<td>CKD is a risk factor for chondrocalcinosis<\/td>\n<\/tr>\n<tr>\n<td><b>Bone profile (Calcium, phosphate, and ALP)<\/b><\/td>\n<td>If high Calcium: think hyperparathyroidism, or hypocalciuric hypercalcaemia (rare) as a cause of chondrocalcinosis.<\/p>\n<p>If low calcium: chronic kidney disease, and magnesium deficiency should be considered.<\/p>\n<p>If low Phosphate and ALP: think about hypophosphatasia (rare)<\/td>\n<\/tr>\n<tr>\n<td><b>Serum Magnesium<\/b><\/td>\n<td>Hypomagnesaemia<\/td>\n<\/tr>\n<tr>\n<td><b>Thyroid function tests<\/b><\/td>\n<td>Hypothyroidism is associated with chondrocalcinosis<\/td>\n<\/tr>\n<tr>\n<td><b>Parathyroid hormone (PTH)<\/b><\/td>\n<td>Hyperparathyroidism can cause chondrocalcinosis.<\/td>\n<\/tr>\n<tr>\n<td><b>Serum uric acid level<\/b><\/td>\n<td>To rule out gout as a cause of the joint pain<\/td>\n<\/tr>\n<tr>\n<td><b>Iron profile<\/b><\/td>\n<td>Hemochromatosis can cause chondrocalcinosis<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><span style=\"font-weight: 400\">Table 2: blood tests to consider in patients with chondrocalcinosis.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">These should be focussed based on the clinical and family history of the patient. Community MSK services with direct access to rheumatology should be considered for those with diagnostic uncertainty.<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-10790\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/Figure-3-188x300.jpg\" alt=\"\" width=\"327\" height=\"522\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/Figure-3-188x300.jpg 188w, https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/Figure-3-768x1225.jpg 768w, https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/Figure-3-640x1021.jpg 640w, https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/Figure-3.jpg 800w\" sizes=\"auto, (max-width: 327px) 100vw, 327px\" \/><\/p>\n<p><span style=\"font-weight: 400\">Figure 5: Chondrocalcinosis; a risk factor-based approach of when to consider further investigation.<\/span><\/p>\n<p><b>Treatments<\/b><\/p>\n<p><span style=\"font-weight: 400\">Treatment for CPPD primarily involves addressing acute attacks as well as identifying and managing underlying reversible causes, to prevent future joint damage (7).\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Regular ice packs, relative rest, and aspiration of the joint for symptom relief are often used first line (8). Range of motion exercises should also be included.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Oral nonsteroidal anti-inflammatory drugs (NSAIDs) can be used for acute episodes of CPPD, providing effective relief from pain and inflammation (9).<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Intra-articular corticosteroid injections can also be used for single-joint involvement, often relieving symptoms rapidly (10).\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">If CPPD is multi-joint involvement, sometimes oral corticosteroids can be considered, but this is often reserved for more severe diseases.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Oral colchicine can also be used and is moderately beneficial in both acute attacks and preventing future attacks (8).\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Physiotherapy and strengthening exercises can help to maintain joint function and reduce stiffness.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Regular physical activity is recommended for patients with chondrocalcinosis.\u00a0<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400\">There are no disease-modifying drugs to treat or prevent CPPD from occurring (8). Importantly, identifying and managing reversible causes, such as metabolic disorders or endocrine abnormalities, are crucial in limiting disease progression and preventing the onset of more widespread arthropathy (11). In the case of genetic causes such as haemochromatosis, onward referral for treatment or genetic counselling may be advised.\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400\"><strong>Conclusions<\/strong>\u00a0<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Chondrocalcinosis is a common imaging finding reported in community MSK services.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">The early identification of genetic, metabolic, and medical risk factors can be based on the patient&#8217;s age, and a focused clinical history.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Where risk factors are present, for an underlying reversible cause referral to an MSK service with (rheumatology or musculoskeletal medicine) should be considered.\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p><b>Authors and Affiliations: Dr Mohammed Subhi, Dr Irfan Ahmed, Dr Imran Lasker, Dr Raj Amarnani, Mr Jack March, Dr Nicholas Shenker\u00a0<\/b><\/p>\n<p>&nbsp;<\/p>\n<p><b>Dr Mohammed Subhi<\/b><\/p>\n<p><b>GP Specialty Registrar<\/b><\/p>\n<p><b>NHS England \u2013 East of England<\/b><\/p>\n<p><b>@Moh_irak<\/b><\/p>\n<p>&nbsp;<\/p>\n<p><b>Dr Irfan Ahmed\u00a0<\/b><\/p>\n<p><b>Locum Consultant in Musculoskeletal, Sport &amp; Exercise Medicine<\/b><\/p>\n<p><b>Addenbrookes Hospital<\/b><\/p>\n<p><b>@ExerciseIrfan<\/b><\/p>\n<p>&nbsp;<\/p>\n<p><b>Dr Imran Lasker<\/b><\/p>\n<p><b>Consultant Radiologist with Specialist interest in MSK<\/b><\/p>\n<p><b>Mid &amp; South Essex Foundation Trust<\/b><\/p>\n<p><b>@DocLasker<\/b><\/p>\n<p><b>Links to MSK\/MRI courses: imranlasker.com, radiologyseminars.com. emergencyimaging.co.uk<\/b><\/p>\n<p>&nbsp;<\/p>\n<p><b>Dr Raj Amarnani\u00a0<\/b><\/p>\n<p><b>Sport and Exercise Medicine Registrar\u00a0<\/b><\/p>\n<p><b>Barts Health NHS Trust<\/b><\/p>\n<p><b>@DrRajAmar<\/b><\/p>\n<p>&nbsp;<\/p>\n<p><b>Mr Jack March<\/b><\/p>\n<p><b>Rheumatology Physiotherapist \/ Rheumatology Clinical Lead<\/b><\/p>\n<p><b>Chews Health<\/b><\/p>\n<p><b>@physiojack<\/b><\/p>\n<p>&nbsp;<\/p>\n<p><b>Dr Ncholas Shenker<\/b><\/p>\n<p><b>Consultant Rheumatologist<\/b><\/p>\n<p><b>Addenbrooke\u2019s Hospital<\/b><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400\"><strong>References<\/strong>:<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Neame RL, Carr AJ, Muir K, Doherty M. UK community prevalence of knee chondrocalcinosis: evidence that correlation with osteoarthritis is through a shared association with osteophyte. Ann Rheum Dis. 2003 Jun;62(6):513-8. doi: 10.1136\/ard.62.6.513. PMID: 12759286; PMCID: PMC1754579.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Felson DT, Naimark A, Anderson J, Kazis L, Castelli W, Meenan RF. The prevalence of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis Rheum. 1987 Aug;30(8):914-8. doi 10.1002\/art.1780300811. PMID: 3632732.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Rosenthal, A.K. (2023) Clinical manifestations and diagnosis of calcium pyrophosphate crystal deposition (CPPD) disease, UpToDate. Available at: https:\/\/www.uptodate.com\/contents\/clinical-manifestations-and-diagnosis-of-calcium-pyrophosphate-crystal-deposition-cppd-disease?search=prevalence+CPPD+disease&amp;amp;source=search_result&amp;amp;selectedTitle=1~87&amp;amp;usage_type=default&amp;amp;display_rank=1 (Accessed: 13 May 2023).<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Rosenthal AK, Ryan LM. Calcium Pyrophosphate Deposition Disease. N Engl J Med. 2016;374(26):2575-2584.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Abhishek A, Doherty M. Pathophysiology of articular chondrocalcinosis\u2014the role of ANKH. Nat Rev Rheumatol. 2011;7(2):96-104.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Ryan LM, McCarty DJ. Calcium pyrophosphate crystal deposition disease, pseudogout, and articular chondrocalcinosis. In: Koopman WJ, Moreland LW, eds. Arthritis and Allied Conditions: A Textbook of Rheumatology. 15th ed. Philadelphia, Pa: Lippincott Williams and Wilkins; 2005:2103-2125.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Zhang W, Doherty M, Pascual E, et al. EULAR recommendations for calcium pyrophosphate deposition. Part II: management. Ann Rheum Dis. 2011;70(4):571-575.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Iqbal SM, Qadir S, Aslam HM, Qadir MA. Updated Treatment for Calcium Pyrophosphate Deposition Disease: An Insight. Cureus. 2019 Jan 7;11(1): e3840. doi: 10.7759\/cureus.3840. PMID: 30891381; PMCID: PMC6411330.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Rosenthal AK, Ryan LM. Calcium Pyrophosphate Deposition Disease. N Engl J Med. 2016;374(26):2575-2584.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Richette P, Doherty M, Pascual E, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2017;76(1):29-42.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Abhishek A, Doherty M. Pathophysiology of articular chondrocalcinosis&#8211;role of ANKH. Nat Rev Rheumatol. 2011;7(2):96-104.<\/span><\/li>\n<\/ol>\n<p><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The forgotten crystal arthropathy; Metabolically driven or just an incidental finding? Key words: #MSKplaybook #Chondrocalcinosis #CrystalArthropathy #Pseudogout #CPPD Introduction\u00a0 Chondrocalcinosis is a common imaging finding encountered in community MSK clinics. In some patients, it may be considered normal for age, but in others, it can be a sign of a crystal arthropathy (CPPD arthropathy\/pseudogout) or [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bjsm\/2023\/09\/11\/the-msk-playbook-chondrocalcinosis-pathway\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":463,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[16207,16068,16206],"class_list":["post-10766","post","type-post","status-publish","format-standard","hentry","category-uncategorized","tag-chondrocalcinosis","tag-featured","tag-swollen-joints"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>The MSK Playbook: Chondrocalcinosis Pathway - BJSM blog - social media&#039;s leading SEM voice<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bjsm\/2023\/09\/11\/the-msk-playbook-chondrocalcinosis-pathway\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The MSK Playbook: Chondrocalcinosis Pathway - BJSM blog - social media&#039;s leading SEM voice\" \/>\n<meta property=\"og:description\" content=\"The forgotten crystal arthropathy; Metabolically driven or just an incidental finding? Key words: #MSKplaybook #Chondrocalcinosis #CrystalArthropathy #Pseudogout #CPPD Introduction\u00a0 Chondrocalcinosis is a common imaging finding encountered in community MSK clinics. In some patients, it may be considered normal for age, but in others, it can be a sign of a crystal arthropathy (CPPD arthropathy\/pseudogout) or [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/bjsm\/2023\/09\/11\/the-msk-playbook-chondrocalcinosis-pathway\/\" \/>\n<meta property=\"og:site_name\" content=\"BJSM blog - social media&#039;s leading SEM voice\" \/>\n<meta property=\"article:published_time\" content=\"2023-09-11T05:00:27+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-09-14T09:45:51+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/MSK-chondro-1-300x131.png\" \/>\n<meta name=\"author\" content=\"bjsm\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"bjsm\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"8 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/2023\\\/09\\\/11\\\/the-msk-playbook-chondrocalcinosis-pathway\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/2023\\\/09\\\/11\\\/the-msk-playbook-chondrocalcinosis-pathway\\\/\"},\"author\":{\"name\":\"bjsm\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/#\\\/schema\\\/person\\\/02b7ae2dae6231c8629aa4da74bb9e6b\"},\"headline\":\"The MSK Playbook: Chondrocalcinosis Pathway\",\"datePublished\":\"2023-09-11T05:00:27+00:00\",\"dateModified\":\"2023-09-14T09:45:51+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/2023\\\/09\\\/11\\\/the-msk-playbook-chondrocalcinosis-pathway\\\/\"},\"wordCount\":1529,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/2023\\\/09\\\/11\\\/the-msk-playbook-chondrocalcinosis-pathway\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/files\\\/2023\\\/09\\\/MSK-chondro-1-300x131.png\",\"keywords\":[\"Chondrocalcinosis\",\"featured\",\"swollen joints\"],\"articleSection\":[\"General\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/2023\\\/09\\\/11\\\/the-msk-playbook-chondrocalcinosis-pathway\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/2023\\\/09\\\/11\\\/the-msk-playbook-chondrocalcinosis-pathway\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/2023\\\/09\\\/11\\\/the-msk-playbook-chondrocalcinosis-pathway\\\/\",\"name\":\"The MSK Playbook: Chondrocalcinosis Pathway - BJSM blog - social media&#039;s leading SEM voice\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/2023\\\/09\\\/11\\\/the-msk-playbook-chondrocalcinosis-pathway\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/2023\\\/09\\\/11\\\/the-msk-playbook-chondrocalcinosis-pathway\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/files\\\/2023\\\/09\\\/MSK-chondro-1-300x131.png\",\"datePublished\":\"2023-09-11T05:00:27+00:00\",\"dateModified\":\"2023-09-14T09:45:51+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/2023\\\/09\\\/11\\\/the-msk-playbook-chondrocalcinosis-pathway\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/2023\\\/09\\\/11\\\/the-msk-playbook-chondrocalcinosis-pathway\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/2023\\\/09\\\/11\\\/the-msk-playbook-chondrocalcinosis-pathway\\\/#primaryimage\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/files\\\/2023\\\/09\\\/MSK-chondro-1.png\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/files\\\/2023\\\/09\\\/MSK-chondro-1.png\",\"width\":512,\"height\":224},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/2023\\\/09\\\/11\\\/the-msk-playbook-chondrocalcinosis-pathway\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"The MSK Playbook: Chondrocalcinosis Pathway\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/#website\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/\",\"name\":\"BJSM blog - social media&#039;s leading SEM voice\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/#organization\",\"name\":\"BJSM blog - social media&#039;s leading SEM voice\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/files\\\/2017\\\/11\\\/blog-logo-bjsm.png\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/files\\\/2017\\\/11\\\/blog-logo-bjsm.png\",\"width\":222,\"height\":34,\"caption\":\"BJSM blog -  social media&#039;s leading SEM voice\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/#\\\/schema\\\/logo\\\/image\\\/\"}},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/#\\\/schema\\\/person\\\/02b7ae2dae6231c8629aa4da74bb9e6b\",\"name\":\"bjsm\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/30b5dcc2c7ad0129ee9634e2076ef25234e9fb69a4fb39547fad1d7cb6612fb8?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/30b5dcc2c7ad0129ee9634e2076ef25234e9fb69a4fb39547fad1d7cb6612fb8?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/30b5dcc2c7ad0129ee9634e2076ef25234e9fb69a4fb39547fad1d7cb6612fb8?s=96&d=mm&r=g\",\"caption\":\"bjsm\"},\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/author\\\/nifferco\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"The MSK Playbook: Chondrocalcinosis Pathway - BJSM blog - social media&#039;s leading SEM voice","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.bmj.com\/bjsm\/2023\/09\/11\/the-msk-playbook-chondrocalcinosis-pathway\/","og_locale":"en_US","og_type":"article","og_title":"The MSK Playbook: Chondrocalcinosis Pathway - BJSM blog - social media&#039;s leading SEM voice","og_description":"The forgotten crystal arthropathy; Metabolically driven or just an incidental finding? Key words: #MSKplaybook #Chondrocalcinosis #CrystalArthropathy #Pseudogout #CPPD Introduction\u00a0 Chondrocalcinosis is a common imaging finding encountered in community MSK clinics. In some patients, it may be considered normal for age, but in others, it can be a sign of a crystal arthropathy (CPPD arthropathy\/pseudogout) or [...]Read More...","og_url":"https:\/\/blogs.bmj.com\/bjsm\/2023\/09\/11\/the-msk-playbook-chondrocalcinosis-pathway\/","og_site_name":"BJSM blog - social media&#039;s leading SEM voice","article_published_time":"2023-09-11T05:00:27+00:00","article_modified_time":"2023-09-14T09:45:51+00:00","og_image":[{"url":"https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/MSK-chondro-1-300x131.png","type":"","width":"","height":""}],"author":"bjsm","twitter_card":"summary_large_image","twitter_misc":{"Written by":"bjsm","Est. reading time":"8 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/bjsm\/2023\/09\/11\/the-msk-playbook-chondrocalcinosis-pathway\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bjsm\/2023\/09\/11\/the-msk-playbook-chondrocalcinosis-pathway\/"},"author":{"name":"bjsm","@id":"https:\/\/blogs.bmj.com\/bjsm\/#\/schema\/person\/02b7ae2dae6231c8629aa4da74bb9e6b"},"headline":"The MSK Playbook: Chondrocalcinosis Pathway","datePublished":"2023-09-11T05:00:27+00:00","dateModified":"2023-09-14T09:45:51+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/bjsm\/2023\/09\/11\/the-msk-playbook-chondrocalcinosis-pathway\/"},"wordCount":1529,"commentCount":0,"publisher":{"@id":"https:\/\/blogs.bmj.com\/bjsm\/#organization"},"image":{"@id":"https:\/\/blogs.bmj.com\/bjsm\/2023\/09\/11\/the-msk-playbook-chondrocalcinosis-pathway\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/MSK-chondro-1-300x131.png","keywords":["Chondrocalcinosis","featured","swollen joints"],"articleSection":["General"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/blogs.bmj.com\/bjsm\/2023\/09\/11\/the-msk-playbook-chondrocalcinosis-pathway\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/bjsm\/2023\/09\/11\/the-msk-playbook-chondrocalcinosis-pathway\/","url":"https:\/\/blogs.bmj.com\/bjsm\/2023\/09\/11\/the-msk-playbook-chondrocalcinosis-pathway\/","name":"The MSK Playbook: Chondrocalcinosis Pathway - BJSM blog - social media&#039;s leading SEM voice","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bjsm\/#website"},"primaryImageOfPage":{"@id":"https:\/\/blogs.bmj.com\/bjsm\/2023\/09\/11\/the-msk-playbook-chondrocalcinosis-pathway\/#primaryimage"},"image":{"@id":"https:\/\/blogs.bmj.com\/bjsm\/2023\/09\/11\/the-msk-playbook-chondrocalcinosis-pathway\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/MSK-chondro-1-300x131.png","datePublished":"2023-09-11T05:00:27+00:00","dateModified":"2023-09-14T09:45:51+00:00","breadcrumb":{"@id":"https:\/\/blogs.bmj.com\/bjsm\/2023\/09\/11\/the-msk-playbook-chondrocalcinosis-pathway\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.bmj.com\/bjsm\/2023\/09\/11\/the-msk-playbook-chondrocalcinosis-pathway\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bjsm\/2023\/09\/11\/the-msk-playbook-chondrocalcinosis-pathway\/#primaryimage","url":"https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/MSK-chondro-1.png","contentUrl":"https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/09\/MSK-chondro-1.png","width":512,"height":224},{"@type":"BreadcrumbList","@id":"https:\/\/blogs.bmj.com\/bjsm\/2023\/09\/11\/the-msk-playbook-chondrocalcinosis-pathway\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blogs.bmj.com\/bjsm\/"},{"@type":"ListItem","position":2,"name":"The MSK Playbook: Chondrocalcinosis Pathway"}]},{"@type":"WebSite","@id":"https:\/\/blogs.bmj.com\/bjsm\/#website","url":"https:\/\/blogs.bmj.com\/bjsm\/","name":"BJSM blog - social media&#039;s leading SEM voice","description":"","publisher":{"@id":"https:\/\/blogs.bmj.com\/bjsm\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.bmj.com\/bjsm\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/blogs.bmj.com\/bjsm\/#organization","name":"BJSM blog - social media&#039;s leading SEM voice","url":"https:\/\/blogs.bmj.com\/bjsm\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bjsm\/#\/schema\/logo\/image\/","url":"https:\/\/blogs.bmj.com\/bjsm\/files\/2017\/11\/blog-logo-bjsm.png","contentUrl":"https:\/\/blogs.bmj.com\/bjsm\/files\/2017\/11\/blog-logo-bjsm.png","width":222,"height":34,"caption":"BJSM blog -  social media&#039;s leading SEM voice"},"image":{"@id":"https:\/\/blogs.bmj.com\/bjsm\/#\/schema\/logo\/image\/"}},{"@type":"Person","@id":"https:\/\/blogs.bmj.com\/bjsm\/#\/schema\/person\/02b7ae2dae6231c8629aa4da74bb9e6b","name":"bjsm","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/30b5dcc2c7ad0129ee9634e2076ef25234e9fb69a4fb39547fad1d7cb6612fb8?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/30b5dcc2c7ad0129ee9634e2076ef25234e9fb69a4fb39547fad1d7cb6612fb8?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/30b5dcc2c7ad0129ee9634e2076ef25234e9fb69a4fb39547fad1d7cb6612fb8?s=96&d=mm&r=g","caption":"bjsm"},"url":"https:\/\/blogs.bmj.com\/bjsm\/author\/nifferco\/"}]}},"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/posts\/10766","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/users\/463"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/comments?post=10766"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/posts\/10766\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/media?parent=10766"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/categories?post=10766"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/tags?post=10766"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}