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<v ->So let's look at pyrophosphate arthropathy.

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It involves joints or parts of joints

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not commonly involved in osteoarthrosis.

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The radiocarpal compartment of the wrist,

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the metacarpal phalangeal joints of the hand.

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In men, the patellarofemoral compartment in the knee.

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Second, it can be severe and progressive,

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looking a bit more neuropathic than it does degenerate.

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And then finally, the osteophytes may or may not be present.

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I show you two examples from an article we wrote years ago

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on pyrophosphate arthropathy.

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Bilateral symmetrical changes in the second and third

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metacarpal phalangeal joints

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with calcification or without it.

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Calcification may not be there to help you class it.

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And the involvement of the wrist,

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consisting of narrowing between the radius and scaphoid,

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excavation of scaphoid fascia of the distal radius,

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narrowing between the lunate and capitate,

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and here in this case, again, helping you,

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calcification within the triangular fibrocartilage.

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So this is classic pyrophosphate.

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Another example here shown by CT.

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Note this involvement

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between the radius and the scaphoid.

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A lot of cysts certainly can be seen,

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and malalignment, dorsal intercalated carpal instability

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is a manifestation of pyrophosphate arthropathy.

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Now it's important that you realize

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that although radiocarpal and mid-carpal involvement

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is characteristic of pyrophosphate arthropathy,

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seen typically in middle-aged and elderly persons,

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that's where this disease occurs,

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that if you have a similar appearance

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in a unilateral distribution

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there are two post-traumatic articular problems

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that may arise and give a similar appearance.

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The first is known as

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Post-Traumatic Scapholunate Advanced Collapse

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or the SLAC wrist.

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I show you an example here in the center

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at the bottom of this slide.

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And here I show you another condition.

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Scaphoid Nonunion Advanced Collapse, SNAC,

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a chronic fracture of the scaphoid

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with avascular necrosis

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and note the narrowing of the space

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between the radial styloid and scaphoid.

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So these can be seen in patients of all ages,

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including young patients

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and the findings are often unilateral,

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as opposed to the bilateral nature

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of pyrophosphate arthropathy.

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With regard to phosphate arthropathy in men,

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isolated or predominant involvement

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of the patellofemoral compartment is a key rule.