Evaluate for underlying metabolic disorders if appropriate : e.g., obtain serum levels of iron, transferrin, ferritin, calcium, magnesium, PTH, and alkaline phosphatase.Tests to rule out differential diagnoses of inflammatory arthritis: e.g., CBC, rheumatoid factor, anti-CCP antibodies.Obtain in patients with acute CPP crystal arthritis to differentiate it from gout.Dual-energy CT shows promise, but is not yet widely in use.MRI: not a sensitive/specific modality for diagnosing CPPD.CT: can be used to identify chondrocalcinosis not typically used to evaluate joint pain.Operator-dependent good sensitivity and specificity if performed by experienced sonographers.Hyperechoic deposits within cartilage.Sensitivity: ∼ 40% (i.e., x-ray may appear normal).Fibrocartilage ( meniscus, annulus fibrosus of intervertebral disk).Appears as radiodense shadows within the cartilage.Chondrocalcinosis : calcification of cartilage in the affected joints.A negative SFA does not rule out CPPD disease. ![]() SFA can be falsely negative, as CPPD crystals are small and weakly birefringent.
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