Orthopedics - Oleksa A.P. 2006

Neurogenic arthropathies
Chondrocalcinosis

Articular Cartilage calcification is most commonly detected during autopsies or via radiography, which reveals focal areas of calcification.

Chondrocalcinosis is most frequently observed in the knee and metacarpal joints, and less commonly in the symphysis pubis and spine. The menisci also undergo calcification, which is clearly visible on radiographs.

Clinically, chondrocalcinosis may manifest as transient, vague joint pain and stiffness in the affected joint, unaccompanied by destructive changes. Occasionally, it must be differentiated from Gout. In typical cases of gout, the first metatarsophalangeal joint is affected, whereas in chondrocalcinosis, this joint is never involved.

When symmetrical involvement of the metacarpophalangeal joints is accompanied by stiffness and synovitis, Differential Diagnosis with Rheumatoid Polyarthritis is necessary. However, the progressive course of rheumatoid Arthritis—marked by severe pain, altered Blood parameters, and specific laboratory reactions—consistently confirms the diagnosis of rheumatoid polyarthritis.

The arthrosic form of chondrocalcinosis is diagnosed based on joint aspiration with synovial fluid analysis and radiographic examination, as the clinical signs (joint pain, stiffness, and occasional lower back pain) are neither characteristic nor specific.

The detection of calcium pyrophosphate microcrystals in the synovial fluid—which vary in shape and size (1-15 microns) and are located within or adjacent to leukocytes—makes the diagnosis of chondrocalcinosis straightforward. Indeed, this analysis serves as the primary diagnostic test.

It is believed that these crystals appear in the synovial fluid As a result of shedding from calcifications in the synovial membrane, or due to the fragmentation of intra-cartilaginous calcifications and their subsequent penetration into the synovium. Histological examination of the synovial membrane may also reveal calcific incrustation. Tissue samples for histological analysis can be obtained using arthroscopic forceps.

Unlike the uric acid crystals present in gout, calcium pyrophosphate crystals lack birefringence.

Radiographic findings include calcification of the cartilage and menisci, as well as calcification of the triangular ligament in the wrist, appearing as a narrow band. Similar vertical calcifications may also occur in the Pubic Symphysis. In the vertebral bodies, they are typically located horizontally beneath the superior endplate and above the inferior endplate, or appear as horizontal lamellar inclusions within the intervertebral discs.

Chondrocalcinosis requires no specific Treatment, but if the patient is troubled by pain, long-term corticosteroid therapy may lead to the resolution of the condition.