Authors: Oliveira Sílvia, Ribeirinho Soares João, Barroso António.
Calcium pyrophosphate dihydrate crystal deposition disease (CPPD) is an inflammatory arthritis produced by the deposition of calcium pyrophosphate crystals. His pathogenesis is not fully understood, but some risk factors were associated such as aging, previous trauma or some metabolic conditions. The involvement of joints like the metacarpophalangeal, which are not typically affected by osteoarthritis, should raise the suspicion of CPPD. Diagnosis is based on the clinical manifestations, radiographic and laboratory findings.
The authors present a case report in which occupational exposure, through the contribution of chronic microtrauma, appears to be the main etiological factor for CPPD, an association never reported before. This case refers to a 63-year-old man, who worked as a medical pathologist for 30 years, specialized in cellular microscopy. His daily
tasks consisted of using the microscope about 8 hours per day and involved highly repetitive precision movements of fingers and hands at high rate with insufficient recovery time.
After 25 years in this job, he gradually developed complaints of bony enlargement, tenderness, warmth, erythema and swelling referred to the metacarpophalangeal and 1st interphalangeal joints of the 2nd and 3rd right fingers. Secondary causes of CPPD were excluded and the immunological study was normal, but the radiographic images showed intra-articular calcifications and arthrosis in the metacarpophalangeal joint of the 3rd finger of the right hand and marginal osteophytosis in this topography in the likely context of deposition of calcium pyrophosphate crystals. This case opens the possibility of a new etiology for CPPD as well as his classification as a work-related disease.
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