Chondrocalcinosis 4.63/5 (8)

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Chondrocalcinosis of the knee

Chondrocalcinosis of the knee with calcification in meniscus (a) and meniscus injury (b). Bolog NV, Andreisek G - Insights Imaging (2016), Open

Definition

Chondrocalcinosis is also called pyrophosphate crystallite and is characterized by the fact that calcium pyrophosphate forms calcifications in articular cartilage, meniscuses and intervertebral discs. Attack with arthritis (Arthritis) that reminds of gout is typical, but chondrocalcinosis can also be detected without symptoms or in chronic joint disease.

  • Due to the similarity of gout attacks, the condition was previously called pseudo gout.

Occurrence

The incidence of chondrocalcinosis increases with age and is rare before 40 years of age. Among people over 85 years, chondrocalcinosis can be detected in even 50%. However, there is a rare, hereditary form that attacks people already at the age of 3040. Women and men become chondrocalcinosis approximately as frequently.

Disease Causes

The cause of the disease is the precipitation of calcium pyrophosphate dihydrate and calcification, as opposed to the gout where uric acid crystals precipitate. Both conditions are called crystal arthritis or crystal gout.

  • Chondrocalcinosis is frequent in people who have Osteoarthrtitis and can be triggered by injuries, surgeries and acute illnesses

Symptoms

It is primarily large and medium-sized joints that are attacked, in particular kneejoints and wrists.

  1. Acute Arthritis is most common
    1. The symptoms may be acute swollen, red, hot and tender joints. During such severe attacks, unwellness and mild fever may occur. Blood samples then usually show elevated CRP and Sedimentation rate. Such attacks are similar to gout, but high levels of uric acid in blood and uric acid crystals in joint fluid are not expected in chondrocalcinosis.
  2. The disease can also occur without symptoms and is then detected randomly by imaging, such as X-rays or ultrasound. In other cases, at the same time, osteoarthritis occurs.
  3. Osteoarthritis without prior damage or other explanatory causes may be due to chondrocalcinosis, especially where unusual joints such as shoulders and wrists are attacked.
  4. Arthritis (Rheumatoid Arthritis) Similar disease course occur in that small joints of the fingers, wrists, ankles and toes are attacked on both sides of the body. However, there is no elevated anti-CCP antibody in the blood such as is most common in arthritis. For imaging and joint fluid examinations, chondrocalcinosis is detected.
  5. Other forms that are more rare can look like polymyalgia revmatika (PMR) with muscle stiffness and muscle aches especially in the morning. Often, codrocalcinosis of the knee joints is detected. Chronic injuries over time may look like neuropathic joint damage / Charcot joint.

Blood tests for chondrocalcinosis

  • In case of acute attacks of chondrocalcinosis, CRP and the Sedimentation rate increase at least as markedly as at a gout attack.
  • The number of white blood cells may be elevated, but most often lower than with infection
  • Uric acid is not expected to be particularly high

Diagnosis

The diagnosis of chondrocalcinosis is based on typical symptoms, imaging and detecting the typical rhomboidal crystals of calcium pyrophosphate dihydrate in the joint fluid (by microscopy in polarized light).

Incorrect diagnosis (similar conditions, differential diagnoses)

Treatment

In case of attack, relief and cooling of hot joints is necessary. Inflammatory drugs can often be used and relieved well. Tapping of joint fluid and injection with corticosteroids is effective treatment. NSAIDs have palliative effects, but in elderly people, particular attention must be paid to the risk of side effects. Colchicine or prednisolone are alternatives, of which colchicine can also prevent attacks. Experimental treatment with interleukin-1 inhibitors (anakinra).

Prognosis

The acute attacks are very troublesome, but not dangerous. The chronic form can lead to joint damage such as osteoarthritis or arthritis.

Literature


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