Joint chondrocalcinosis: what are the treatments?

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Joint chondrocalcinosis: what exactly are we talking about?

Joint chondrocalcinosis is a disease characterized by the deposition of calcium pyrophosphate crystals on the joints, and in particular on the fibrous cartilages that make them up: the menisci (fibro-cartilages found in particular in the joints knees), tendons, joint capsules (those fibrous envelopes that surround movable joints), entheses (these are the areas where tendons and ligaments attach to the bone) and bursae (these are the folds of the articular membrane which surround the joints and which are responsible for making synovial fluid).

To know. Joint chondrocalcinosis is a disease that can affect any joint in the body, but mainly develops in the knee, hip, and back joints (spine).

And also. The exact origins of articular chondrocalcinosis are not yet known. This pathology could be linked to genetic factors and / or traumatic causes – falls, shocks, blows … in the joints.

It should be noted that articular chondrocalcinosis is more common in men; rather, symptoms appear between the ages of 40 and 50. About 4% of adults aged 50 to 59 and 20% of adults aged 80 to 84 are thought to have it.

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What are the symptoms of joint chondrocalcinosis?

In fact, there are 4 forms of articular chondrocalcinosis:

  • The asymptomatic articular chondrocalcinosis. The discovery of the pathology is most often fortuitous, during an X-ray of the joint: deposits of calcium pyrophosphate crystals are not responsible for any symptoms. This form is more common in the elderly.
  • The Recurrent acute inflammatory joint chondrocalcinosis. It is also called “pseudo-gout”: calcium deposits are concentrated on a single joint (we speak of “mono-arthritis”) and cause very intense pain as well as redness. Painful episodes last from a few days to a few weeks; the most commonly affected joints are those of the knees and wrists.
  • The chronic inflammatory joint chondrocalcinosis. Its symptoms are reminiscent of those of rheumatoid arthritis: painful joints, especially at the end of the night, stiffness and joint numbness in the morning … The joints most frequently affected are those of the knees, wrists and fingers (joints metacarpophalangeal).
  • L’osteoarthritis with deposits of chondrocalcinosis. The inflammatory pains of chondrocalcinosis are added to the mechanical pains caused by osteoarthritis.

Joint chondrocalcinosis: what are the risk factors? If the precise causes of articular chondrocalcinosis have not yet been identified, experts know that there are several risk factors favoring the development of the disease:

  • L’hemochromatosis : this genetic disease is characterized by an accumulation of iron in the blood and organs,
  • The deficiency in magnesium (hypomagnésémie) : this deficiency is more frequent in stressed individuals, high-level athletes, in the event of alcoholism, and especially after the age of 60,
  • L’hyperparathyroïdie : this endocrine disease is characterized by an overproduction of parathyroid hormone,
  • L’Familial hypocalciuric hypercalcemia (HFF) : this genetic disease corresponds to an excess of calcium in the blood, associated with a poor evacuation of calcium in the urine.
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Diagnosis and treatment: what treatment for articular chondrocalcinosis?

Diagnostic. The diagnosis of articular chondrocalcinosis involves medical imaging examinations: x-ray, joint ultrasound, CT scan and / or MRI. Analysis of the synovial fluid (this is the fluid that “lubricates” the joint) can also show the presence of calcium pyrophosphate crystal deposits.

Treatments. As a first step, it is necessary to identify the contributing factors of the disease and to set up an adequate treatment: bloodletting against hemochromatosis, magnesium supplementation in case of hypomagnesemia …

To date, unfortunately, there is no treatment to prevent the formation and / or deposition of calcium pyrophosphate crystals. When joint chondrocalcinosis is chronic, your doctor may prescribe non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroid infiltrations to relieve the pain. When it is acute with severe pain (pseudo-gout), methotrexate may also be offered.

Thanks to Dr. Alexandre di Iorio, orthopedic surgeon at the Montagard Surgical Center in Avignon (ELSAN group).

Source : Chondrocalcinosis and arthropathies with deposits of calcium pyrophosphate crystals: news 2010 (Swiss medical journal)

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