CPPD chronic arthropathy — SCE Rheumatology MCQ

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ModerateCrystal ArthropathiesCPPD chronic arthropathySCE Rheumatology

A 73-year-old woman has chronic wrist and MCP pain with intermittent flares. Hand radiographs show chondrocalcinosis at the triangular fibrocartilage and hook-like osteophytes at the MCP joints. RF and anti-CCP are negative. Ferritin is mildly raised. What is the most likely diagnosis?

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Correct answer: C — Chronic CPP crystal inflammatory arthritis

Explanation lettering: E = shown as A · A = shown as C · C = shown as E

Chronic CPP crystal inflammatory arthritis is best because chondrocalcinosis with wrist/MCP involvement and hook-like osteophytes suggests chronic CPPD arthropathy. B is less suitable because primary hand OA usually affects DIP/PIP and thumb base; C is less suitable because seronegative RA can mimic but would not explain chondrocalcinosis and hook osteophytes; D is less suitable because PsA would have psoriasis, nail disease or dactylitis; E is less suitable because SLE arthritis is usually non-erosive and not linked to chondrocalcinosis. Clinical pearl: CPPD can mimic RA, especially when wrists and MCPs are involved.

Reference: Oxford Textbook of Rheumatology