What is Chondrocalcinosis?
Chondrocalcinosis is a rheumatologic condition that is characterized by accumulation of calcium pyrophosphate dihydrate crystals or CPPD crystals in connective tissues or the joint cartilages.
The disease is often associated with similar conditions such as osteoarthritis, pseudogout and pseudo-osteoarthritis. It is also considered to be a variant of Calcium pyrophosphate dihydrate disease that is known by several of its alternative names, although neither of which is synonymous with Calcium pyrophosphate dihydrate disease or CPPD. The condition mostly affects the wrist, the hip, the knee joint and the pubic symphysis and gives rise to painful sensations in these areas.
Chondrocalcinosis is known to affect people from all cultural and ethnic backgrounds. In United States, nearly 50% of people over the age of 85 are estimated to be suffering from the disorder. Women are more prone to be affected by this disorder than men. The approximate occurrence ratio of the condition between women and men is 1.4:1.
Although the exact cause of the disorder is not known, evidence suggests that it might have a hereditary association. Chondrocalcinosis often runs in families and so a genetic link can be suspected. Calcium pyrophosphate crystals accumulate in the joint, firstly in the cartilage and then in the synovial fluid. This makes the joint swollen and inflamed. Episodes of the disease might recur over time and develop into a permanent form of arthritic pain.
Picture 1 – Chondrocalcinosis
Chondrocalcinosis is mostly seen in aged patients as an increased accumulation of CPPD crystals occurs in the joints with advancing age. The disorder has been found to affect patients of both sexes over 50 years of age. Around 3% people develop it around their 60s.
Apart from the deposition of calcium pyrophosphate dihydrate crystals of CPPD, the following factors may lead to the development of this ailment:
- Wilson disease
Chondrocalcinosis Risk Factors
According to Arthritis Foundation, certain risk factors predispose some individuals to this disease. These include an injury, dehydration or a joint surgery. Hyperparathyroidism leads to increased circulation of calcium in the bloodstream, which is also a potential risk factor. Patients of Hemochromatosis are also vulnerable to the development of Chondrocalcinosis, due to high levels of iron in their tissues. Three other conditions, which can make one prone to the disorder, include:
However, a patient of Chondrocalcinosis might not display any of the above mentioned conditions.
The various symptoms of this disorder are listed below:
- Joint pain
- Carpal tunnel syndrome
A patient may also experience symptoms similar to that of:
- Wilson's disease
- Renal osteodystrophy
Chondrocalcinosis is diagnosed by various medical processes, such as:
- MRI scans
- CT scans
- Nuclear medicine
MRI scans and CT scans show calcific masses generally within joint capsule or ligamentum flavum. Arthrocentesis, which involves removal of synovial fluid from an affected joint for studying the calcium pyrophosphate crystals present in the fluid, is another important test performed for diagnosing the condition. Blood work is done to check if the count of white blood cells has been raised.
Chondrocalcinosis Differential Diagnosis
The differential diagnosis for this disease include distinguishing its symptoms from those of similar conditions, such as:
Picture 2 – Chondrocalcinosis Image
- Septic arthritis
- Milwaukee Shoulder
- Ankylosing spondylitis
- Paget's disease
Chondrocalcinosis is not treated if it does not causeany pain. This is because any medications that can reduce inflammation related to this disorder also bear with it the risk of causing damage of organs. Acute pseudogout symptoms are treated with:
- Intra-articular corticosteroid injection
- NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
- Systemic corticosteroids
- High-dose colchicine (occasionally)
NSAIDs are commonly administered in low amounts to prevent this disorder. If, however, an acute attack of Chondrocalcinosis is occurring already, higher doses of NSAIDs are recommended. When nothing else works, methotrexate or hydroxychloroquine may provide some relief. Research is being currently held on the surgical removal of associated calcifications. This is still at an experimental stage.
As aforesaid, Chondrocalcinosis is often left untreated if there is no pain. In case a patient is experiencing pain, certain medications are used to relieve painful sensations. This may, however, cause damage to organs. The disease often exists along with Osteoarthritis or eventually leads to it.
Chondrocalcinosis is a rheumatologic disorder of the joints that causes considerable pain, even though it is not fatal. Although treatment is not always required, proper medical attention allows keeping a close watch on the symptoms of the disorder.