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CPPD Metabolic Screen Tests — SCE Rheumatology MCQ

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EasyCrystal ArthropathyCPPD Metabolic Screen TestsSCE Rheumatology

A 45-year-old woman develops an acutely swollen, painful wrist after a minor fall. Radiography shows triangular fibrocartilage complex chondrocalcinosis, and synovial fluid microscopy identifies calcium pyrophosphate crystals. Which initial blood-test panel is most appropriate to investigate associated metabolic disease?

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Correct answer: D — Adjusted calcium, parathyroid hormone, magnesium, alkaline phosphatase, ferritin and transferrin saturation

The correct answer is D. CPPD presenting before 60 years of age should prompt investigation for an associated metabolic disorder. Adjusted calcium and parathyroid hormone assess for hyperparathyroidism; ferritin and transferrin saturation screen for haemochromatosis; magnesium detects hypomagnesaemia; and a low alkaline phosphatase may suggest hypophosphatasia. Option B assesses only haemochromatosis, while option A focuses mainly on calcium and vitamin D metabolism and omits other important associations. Thyroid testing alone is not the recommended core metabolic screen, making E inadequate. Option E is incorrect because this patient's young age warrants investigation after a confirmed presentation rather than waiting for recurrence.

Reference: BMJ Best Practice. Calcium pyrophosphate deposition, Diagnostic investigations, updated 15 February 2024; evidence reviewed 26 July 2026. https://bestpractice.bmj.com/topics/en-gb/370