焦磷酸鈣沈積疾病：一個常被忽略的關節炎

Calcium Pyrophosphate Deposition Disease - An Underdiagnosed Arthritis

黃正皓(Zheng-Hao Huang) ； 陳相成(Hsiang-Cheng Chen) ； 朱士傑(Shi-Jye Chu)

《內科學誌》 29卷3期 (2018/06) Pp. 160-168

https://doi.org/10.6314/JIMT.201806_29(3).06

摘要

焦磷酸鈣沈積(calcium pyrophosphate deposition，CPPD)疾病是由焦磷酸鈣(calcium pyrophosphate，CPP)的結晶沈積在關節組織所引起的。CPPD疾病雖然常見，但大部病患是老年人且合併許多疾病，在臨床上治療上要特別小心。CPPD疾病病患可能無症狀或表現類似痛風的急性關節腫痛，也可能類似其他發炎性關節炎，使臨床上要正確診斷有些困難。CPPD疾病與老化、退化性關節炎、代謝疾病及progressive ankylosis protein homolog基因突變有相關性。CPPD可以經由X光片、超音波檢查及關節液分析發現。不像痛風被研究的比較深入，CPPD疾病缺乏實證醫學的研究，目前也尚無藥物可以移除CPP結晶。治療目標主要是減輕症狀及預防再次發作。在此我們回顧CPPD疾病最新的文獻，使內科醫師能夠更加了解此疾病，希望對於日後診斷CPPD疾病及治療上能有所幫助。

關鍵字

焦磷酸鈣沈積疾病(Calcium pyrophosphate deposition disease) ； 退化性關節炎(Osteoarthritis) ； 軟骨鈣化症(Chondrocalcinosis)

並列摘要

Calcium pyrophosphate deposition (CPPD) disease is an arthropathy caused by the presence of CPP crystals in articular tissues. CPPD diseases are common and presenting particular management problems in clinical practice because they often influence older patients with multiple medical illnesses. Clinical presentations may be asymptomatic, most dramatically, acute attacks of joint pain and swelling similar to gout, or other forms of inflammatory arthropathy, making an accurate clinical diagnosis difficult. CPPD disease closely related with aging, osteoarthritis, metabolic disease, and ANKH gene mutation. CPPD can be identified by X-rays, ultrasonography or by synovial fluid examination. Unlike for gout, there is lack of evidence-based studies on the CPPD disease and no available therapy to remove the CPP crystals. The goal of treatment is therefore targeted at symptomatic relief and preventing further episodes. In this article, we review recent advances in CPPD disease and allow clinical physicians to further understand the disease. This may help clinical physicians to make correct diagnosis and appropriate treatments.