Chondrocalcinosis - Symptoms, Causes, Diagnosis, Treatment, Pictures
What is Chondrocalcinosis?
Chondrocalcinosis is a variant of arthritis characterized by the presence of calcification within the connective tissue most commonly in the knee joint. It is also known as "Calcium pyrophosphate dihyradte deposition" marked by the accumulation of calcium pyrophosphate dihydrate crystals.
Chondrocalcinosis can involve one or more joints that can subsequently result in damages of the affected joint or joints. The condition can affect the joints in the wrist, the knee and the pubic symphysis but it is more common in the knee joints. The acute form of Chondrocalcinosis is called "Pseudogout" and in rare cases can involve the spinal canal that can cause damage to the spinal cord.
Chondrocalcinosis is a rheumatologic condition that can equally affect both men and women although women are more at risk than in men. The condition is known to affect all people without racial predilection. The onset is by the age 50 years and the incidence increases while the age is advancing or increasing.
Chemical irregularity describes the condition of Chondrocalcinosis in which it manifests in four separate diseases that are interrelated. Most Chondrocalcinosis is asymptomatic and the attack usually develops in 12 to 36 hours and which may persist for over a week or 2 weeks. The onset can be sudden with symptom that is similar to gout and was therefore termed pseudogout. Some Chondrocalcinosis may go on to progressive degeneration of the joint and may also lead to poly-articular osteoarthritis.
The knee is the most common site in Chondrocalcinosis although it can also affect the larger joints and seldom involves the big toe. One or several joints may be affected with inflammation with less severity as compared with gout. The inflammation is characterized by redness, swelling and warmth over the affected area. The pain may also come suddenly and which may be severe and affect the joints in the knee, wrist and thumb. The inflammation and pain may bring on a limited range of motion and a decreased strength in the affected joint.
The symptom of Chondrocalcinosis can also manifest as acute or chronic inflammatory arthritis where the symptom of pain can involve one or several joints.
On pseudogout presentation of Chondrocalcinosis, the onset is often aggressive that usually peaks in a matter of several hours. Pain is usually felt accompanied with swelling, redness and warmth of the affected joint usually on the knee. The metatarsophalangeal joint, ankle, shoulder and elbow are also often affected. The pseudogout spontaneously resolves over a few days or weeks at the most and with treatment that hastens recovery.
Patients suffering from Chondrocalcinosis may also experience symptoms similar to Wilson’s disease or hepatolenticular degeneration. The patient may experience difficulty in walking, joint pain, clumsiness and fatigue and may also have swelling in the arms and the legs.
The large accumulation of calcium pyrophosphate deposit can create a pseudotumor which can be massive and are often painful.
Osteoarthritis is the most similar symptom in Chondrocalcinosis except for the presence of calcium pyrophosphate crystals that is much more apparent during diagnostic imaging procedure. The incidence of Chondrocalcinosis increases in frequency as an individual is increasing with age.
The progressive joint destruction associated with Chondrocalcinosis may bring instability to the function of the affected joint such as instability in the carpal brought by the destruction of its ligaments. The destruction may also result in physical changes in the appearance or a deformity of the affected site.
The exact etiology of Chondrocalcinosis remains unclear although a genetic link has been suspected. Chondrocalcinosis occur when calcium pyrophosphate dihydrate deposit accumulates in the connective tissues. Initially, the crystals of calcium pyrophosphate accumulate in the cartilage leading to its damage. The crystals will later accumulate in the synovial fluid and later leading to inflammation and swelling of the affected joint. Pain can also be experienced which can be sudden and debilitating and linger for several weeks. The onset of Chondrocalcinosis is believed to be hereditary or runs in the family. Chondrocalcinosis is seen in an autosomal dominant pattern and the ANKH gene is being involved in the transport of inorganic phosphate.
Chondrocalcinosis is also being associated with some metabolic disorders. Hyperparathyroidism, hemochromatosis, hypophosphatemia and hypothyroidism are among the metabolic disorders that are being associated with Chondrocalcinosis.
Advancing age is being linked to the onset of Chondrocalcinosis where the increase in crystal deposition is often seen in people over the age of fifty regardless of gender as the condition equally affects both men and women.
Chondrocalcinosis can be diagnosed with radiology and analysis of the joint fluid. Radiology plays a key role in identifying Chondrocalcinosis whether the signs and symptoms are mild or absent. The plain X-ray films proved to be successful in identifying Chondrocalcinosis and in so far the most valuable diagnostic tool in confirming the condition.
Joint fluid analysis is being done to test the synovial fluid for the existence of calcium pyrophosphate crystals. The analysis of joint fluid also proved to be dependable in recognizing crystals under the microscope although the method has drawbacks that can give inaccurate results.
Chondrocalcinosis that does not cause pain and discomfort or remains asymptomatic generally does not require treatment.
Chondrocalcinosis manifesting with acute pseudogout may be treated medically with systemic corticosteroid or with intra-articular corticosteroid injection. The low dosage of "nonsteroidal anti-inflammatory drugs" is generally given to avert the onset of Chondrocalcinosis while high dosage is given to Chondrocalcinosis that already occurred or attacked acutely. Colchicine in high dose may also be given although on rare occasion only.
Surgery is indicated for Chondrocalcinosis that causes carpal instability due to destruction of the ligament. Surgery is necessary to restore the stability and function and restore the cartilage in good condition. Surgery is also indicated for Chondrocalcinosis that causes significant pain with the rotation of the forearm.