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Artículos Destacados

Título: "Calcium Pyrophosphate Deposition Disease"

Autores: Ann K. Rosenthal, M.D., and Lawrence M. Ryan, M.D.

N Engl J Med 2016;374:2575-84.
DOI: 10.1056/NEJMra1511117

Calcium pyrophosphate deposition (CPPD) disease is arthritis caused by calcium pyrophosphate (CPP) crystals (Fig. 1). Until recently, CPPD disease has been referred to as pseudogout. This term stems from an early description of this disease in patients with an acute goutlike arthritis whose synovial-f luid crystals were resistant to digestion by uricase and who thus did not have gout. Almost simultaneously, a case series was published of 27 patients in Hungary who had chronic episodic inf lammatory oligoarthritis affecting primar - ily the knee. These patients shared a radiographic finding that was characterized by a “dense narrow band following the contour of the epiphysis” in the articular cartilage, a finding that was termed chondrocalcinosis articularis (Fig. 2A and 2B). These two early descriptions foreshadowed the broad range of clinical presenta - tions that currently constitute CPPD disease.

Nomenclature issues have plagued CPPD disease since its original description. Various cumbersome terms such as “calcium pyrophosphate dihydrate deposition disease” achieved common use. In 2011, a group from the European League against Rheumatism recommended that calcium pyrophosphate crystals be referred to as CPP crystals, that the term “acute CPP crystal arthritis” refer to the acute inf lamma - tory arthritis that was formerly known as pseudogout, and that the term “chronic CPP crystal arthritis” be used to denote other types of arthritis associated with CPP crystals. The term “chondrocalcinosis” refers to the common radiographic correlate of CPPD disease and does not imply clinical arthritis. We use the term “CPP deposi - tion” (CPPD) to refer to the presence of CPP crystals and the term “CPPD disease” to include all the related clinical presentations.

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