Chondrocalcinosis (pseudodema) is a broad term used to describe the presence of calcium s alt deposits within the joints that have been detected by imaging or histology. This diagnosis is not necessarily related to the presence of clinical symptoms and may apply to any type of calcium deposit. What are the causes and symptoms of pseudogout? How is chondrocalcinosis treated?

Chondrocalcinosis( pseudo-gout , pseudodna, Latinchondrocalcinosis , English chondrocalcinosis, pseudogout) is a rheumatic disease in which calcium s alt deposits in the joints are detected. Sometimes, however, this term is usually used to describe diseases caused by calcium pyrophosphate crystals, i.e. CPPD (Calcium pyrophosphate dihydrate disease).

Pyrophosphate is the most common type of calcium s alt that is precipitated in the pond structures. Chondrocalcinosis, found on X-rays, can rarely be caused by hydroxyapatite or dicalcium phosphate crystals.

CPPD is a metabolic arthropathy caused by the deposition of calcium pyrophosphate crystals in articular cartilage and other surrounding tissues. Accumulation of deposits in the synovium and synovial fluid can cause inflammation, which causes troublesome symptoms and, consequently, even destruction of the affected joint. CPPD is usually found in patients over the age of 50, and its incidence increases with age. Despite the fact that the exact percentage of symptomatic forms is unknown, it is worth noting that radiological markers of joint calcification (chondrocalcinosis) are often observed, in as many as 50% of people over 85 years. CPPD is slightly more common in women.

Chondrocalcinosis: causes

The exact cause of the deposition of calcium pyrophosphate crystals remains unknown. CPPD may be primary and familial with autosomal dominant inheritance. This form is rare. We deal more often with secondary characters. CPPD can accompany diseases and conditions such as:

  • overactive or underactive thyroid gland
  • hyperparathyroidism
  • hemochromatosis
  • Wilson's disease
  • hypomagnesaemia
  • hypophosphatemia
  • chronic steroid therapy

In addition to the generalized course that may affect many joints, we can also deal with a local process related to, among others: joint instability, meniscus removal and amyloid deposits.

Pseudogout: symptoms and course

CPPD can be done in different ways. The deposition of calcium pyrophosphate crystals is usually asymptomatic. The only indicator of the disease is then isolated chondrocalcinosis found in radiological examination.

About 25% of the cases involve acute arthritis that is clinically similar to a gout attack. For this reason, the acute form of this condition is often referred to as "pseudogout". The main symptoms are sudden pain, swelling and redness of the skin around the joint. They are paroxysmal, but unlike gout, they increase more slowly and the pain is usually less intense. "Pseudo-seizures" usually affect one joint. The knee joint is most often involved.

In 5% of cases, calcium pyrophosphate deposition may present as chronic arthritis, which manifests itself confusingly similar to rheumatoid arthritis (RA). The joints are symmetrically involved (usually the interphalangeal and metacarpophalangeal joints) and patients complain of swelling and stiffness in the morning.

Nearly half of CPPD cases are associated with osteoarthritis, resulting from the progressive degeneration of the articular cartilage. The most common degenerative changes concern the knee joint. In addition to the peripheral joints, the lumbar spine can be affected, resulting in pain and limited mobility, which may be clinically similar to ankylosing spondylitis (AS).

Chondrocalcinosis: diagnosis

The most objective and unambiguous examination that can confirm the acute form of CPPD is the examination of the synovial fluid. If crystals are found in the direct specimen, the next element of the test is the observation of the fluid sediment with the use of polarized light. Characteristic for CPPD is the presence of diamond-shaped crystals, which are characterized by a weak positive birefringence. They can exist in free form or phagocytosed (absorbed) by "food cells" - macrophages or granulocytes. It is worth noting that the fluid collected during a pseudogout attack usually has the physical characteristics of an inflammatory fluid - it is cloudy ("milky") and may be slightly bloody.

Currently, more and more often the role of ultrasound examination (USG) is emphasized, which, unlike traditional radiographsperfectly illustrates soft tissues.

Imaging tests, in particular a basic X-ray image, are a very important element of diagnostics. It can highlight the features of the aforementioned chondrocalcinosis, i.e. the presence of calcium deposits (in this case calcium pyrophosphate - CPP) in cartilage, as well as in tendons, ligaments, joint capsules and menisci. Calcifications are either linear or point-like.

In the radiological examination, we can also observe features characteristic of osteoarthritis, which often accompanies CPPD. These features are, for example, the narrowing of the joint space or the presence of bone spurs, the so-called osteophytes. This allows you to monitor the progression of the chronic form of the disease.

Pseudodna: treatment

Currently, there is no effective therapy available that would prevent the formation of calcium pyrophosphate crystals. Treatment is usually symptomatic and depends on the clinical form. Asymptomatic, it does not require treatment, but its presence may be a secondary manifestation of another disease, thus prompting extended diagnostics.

In the treatment of acute arthritis, i.e. a pseudo-gout attack, the following are used, among others: aspiration of inflammatory synovial fluid and intra-articular injections of glucocorticosteroids. Oral treatment consists mainly of NSAIDs (non-steroidal anti-inflammatory drugs). In more severe cases, an alternative may be colchicine (used in gout attacks), but its use must be under strict medical supervision. Low doses of colchicine may prove effective in preventing frequent seizures.

Chronic arthritis is an indication for anti-inflammatory treatment - NSAIDs and GCS (glucocorticosteroids) in low doses. In more severe cases, attempts are made to treat with disease-modifying drugs, e.g. methotrexate, which is usually used in the treatment of RA.

Osteoarthritis associated with CPPD, like the primary disease, is a progressive and irreversible disease. In addition to analgesic and anti-inflammatory treatment, it is worth emphasizing the important role of physiotherapy. Solid rehabilitation with the use of kinesiotherapy or physical therapy may help to reduce joint ailments, slow down the progression of the disease and improve overall functioning.

Category:

Spine, bones, joints