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CPPD metabolic associations — SCE Rheumatology MCQ

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ModerateCrystal ArthropathiesCPPD metabolic associationsSCE Rheumatology

A 56-year-old man presents with recurrent acute CPP crystal arthritis of the wrist and knee. Radiographs show widespread chondrocalcinosis. He is younger than expected for idiopathic CPPD and has fatigue. Calcium is mildly high. What is the most appropriate investigation?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Screen for haemochromatosis, hyperparathyroidism and metabolic causes

Explanation lettering: B = shown as A · D = shown as B · A = shown as D

Screen for haemochromatosis, hyperparathyroidism and metabolic causes is best because early or recurrent CPPD should prompt assessment for associated metabolic disorders including haemochromatosis and hyperparathyroidism. A is less suitable because anti-dsDNA assesses lupus rather than CPPD associations; C is less suitable because biologic therapy is not first-line and should not precede metabolic evaluation; D is less suitable because HLA-B27 is not the key CPPD test; E is less suitable because temporal artery biopsy is unrelated. Clinical pearl: CPPD in a relatively young patient is a clue to look for secondary causes.

Reference: Oxford Textbook of Rheumatology; BSR gout guideline