2023 ACR/EULAR Classification Criteria for Calcium Pyrophosphate Deposition Disease (CPPD)
Classifies symptomatic CPPD disease using ordered entry, exclusion, sufficient, and weighted criteria.
INSTRUCTIONS
Use in patients with at least one episode of joint pain, swelling, or tenderness when considering the research classification of symptomatic CPPD disease. Apply the criteria in order: entry criterion, exclusion criterion, sufficient criteria, then weighted scoring only if sufficient criteria are absent.
Ever had at least one episode of joint pain, swelling, or tenderness*
All symptoms are more likely explained by an alternative condition*
Presence of crowned dens syndrome*
Synovial fluid analysis demonstrates CPP crystals in a joint with swelling, tenderness, or pain*
CPP crystals demonstrated on histopathologic analysis of joint tissue*
Imaging of at least one symptomatic peripheral joint by CR, US, CT, or DECT has been performed*
Age at onset of joint symptoms*
≤60 years0
>60 years+4
Time course and symptoms of inflammatory arthritis*
No persistent or typical inflammatory arthritis0
Persistent inflammatory arthritis+9
One typical acute arthritis episode+12
More than one typical acute arthritis episode+16
Site of typical episode(s) of inflammatory arthritis*
First MTP joint-6
No typical episode(s)0
Joint(s) other than wrist, knee, or first MTP joint+5
Wrist+8
Knee+9
Related metabolic diseases*
None0
Present+6
Synovial fluid crystal analysis from a symptomatic joint*
CPP crystals absent on ≥2 occasions-7
CPP crystals absent on 1 occasion-1
Not performed0
OA of hand/wrist on imaging*
None of the below findings or no wrist/hand imaging performed0
OA of radiocarpal joints bilaterally+2
≥2 of the following: STT joint OA without first CMC joint OA; second MCP joint OA; third MCP joint OA+7
Imaging evidence of CPPD in symptomatic peripheral joint(s)*
None on US, CT, or DECT (and absent on CR or CR not performed)-4
None on CR (and US, CT, DECT not performed)0
Present on either CR, US, CT, or DECT+16
Number of peripheral joints with evidence of CPPD on any imaging modality regardless of symptoms*
