US has also been shown to be helpful in assessment of tophus resolution in response to treatment [64,65]. Variant 4: Chronic extremity joint pain. Suspect calcium pyrophosphate deposition disease (pseudogout). Radiographs normal or inconclusive. Next imaging study. The EULAR defines CPPD as a general term encompassing variable phenotypes, including asymptomatic involvement, acute CPP crystal arthritis, osteoarthritis with CPPD, and chronic CPP crystal inflammatory arthritis [66]. CPPD is thought to have high prevalence in the elderly [67] but is underdiagnosed. CPPD joint involvement as defined by EULAR is when CPP is detected in the synovial fluid from affected joints [66]. Diagnosis is often challenging; however, because the reference standard of synovial fluid analysis has been shown to have a high specificity (100%) but a lower sensitivity (75%) [68]. Chondrocalcinosis is defined as cartilage calcification detected by imaging or histological examination and is most commonly due to CPPD. However, the relationship between chondrocalcinosis and commonly coexisting conditions like osteoarthritis and hemochromatosis is poorly understood. The area of interest for this variant include: the ankle, elbow, foot, hand, hip, knee, shoulder, and wrist. Bone Scan Whole Body There is no relevant literature supporting the use of bone scan whole body for the evaluation of CPPD in the extremities following initial radiographs. CT Area of Interest With IV Contrast There is no relevant literature supporting the use of CT area of interest with IV contrast for the evaluation of CPPD in the extremities following initial radiographs. CT Area of Interest Without and With IV Contrast There is no relevant literature supporting the use of CT area of interest without and with IV for the evaluation of CPPD in the extremities following initial radiographs.
Chronic Extremity Joint Pain Suspected Inflammatory Arthritis Crystalline Arthritis or Erosive Osteoarthritis PCAs. US has also been shown to be helpful in assessment of tophus resolution in response to treatment [64,65]. Variant 4: Chronic extremity joint pain. Suspect calcium pyrophosphate deposition disease (pseudogout). Radiographs normal or inconclusive. Next imaging study. The EULAR defines CPPD as a general term encompassing variable phenotypes, including asymptomatic involvement, acute CPP crystal arthritis, osteoarthritis with CPPD, and chronic CPP crystal inflammatory arthritis [66]. CPPD is thought to have high prevalence in the elderly [67] but is underdiagnosed. CPPD joint involvement as defined by EULAR is when CPP is detected in the synovial fluid from affected joints [66]. Diagnosis is often challenging; however, because the reference standard of synovial fluid analysis has been shown to have a high specificity (100%) but a lower sensitivity (75%) [68]. Chondrocalcinosis is defined as cartilage calcification detected by imaging or histological examination and is most commonly due to CPPD. However, the relationship between chondrocalcinosis and commonly coexisting conditions like osteoarthritis and hemochromatosis is poorly understood. The area of interest for this variant include: the ankle, elbow, foot, hand, hip, knee, shoulder, and wrist. Bone Scan Whole Body There is no relevant literature supporting the use of bone scan whole body for the evaluation of CPPD in the extremities following initial radiographs. CT Area of Interest With IV Contrast There is no relevant literature supporting the use of CT area of interest with IV contrast for the evaluation of CPPD in the extremities following initial radiographs. CT Area of Interest Without and With IV Contrast There is no relevant literature supporting the use of CT area of interest without and with IV for the evaluation of CPPD in the extremities following initial radiographs.