How to Manage Chondrocalcinosis

Chondrocalcinosis, also known as calcium pyrophosphate deposition disease (CPPD), is a type of arthritis in which calcium crystals accumulate in joints, most commonly in the knee. The deposits cause irritation that leads to inflammation, joint degeneration, and cartilage damage.

Symptoms of chondrocalcinosis are similar to gout and other types of arthritis. The condition can be diagnosed by examining joint fluid. Treatments include oral painkillers, joint fluid extraction, and injected steroid drugs.

This article describes the symptoms and causes of chondrocalcinosis, including how this inflammatory joint disorder is diagnosed and treated.

Chondrocalcinosis Symptoms

Not everyone with chondrocalcinosis has symptoms. When symptoms occur, they most commonly impact the knees but can also affect the shoulders, wrists, elbows, ankles, or hands.

Chondrocalcinosis is characterized by painful flare-ups (attacks) that develop suddenly and can last for days or weeks.

Chondrocalcinosis is sometimes called pseudogout because the symptoms are similar to gout. However, gout is caused by the build-up of uric acid crystals rather than calcium pyrophosphate crystals.

In addition to gout, chondrocalcinosis can also mimic osteoarthritis (wear-and-tear arthritis) and rheumatoid arthritis (a form of autoimmune arthritis).

Symptoms of chondrocalcinosis include:

• Pain and swelling in the joints
• Warm joints
• Joint stiffness, especially in the morning
• Joint tenderness
• Joint redness
• Crackling or popping sounds (crepitus)
• Mild fever
• Fatigue
  

Chondrocalcinosis Causes

According to the Arthritis Foundation, almost half of people 85 and older have varying degrees of chondrocalcinosis. Most of the time, the cause is unknown, although the risk increases substantially with age. The condition also tends to run in families, so genetics may play a role.

Chondrocalcinosis is commonly seen in people with an underlying metabolic disease. These are diseases in which chemical processes go awry due to problems with organs (like the pancreas or liver).

These include:

• Hyperparathyroidism: An overactive parathyroid gland, caused by organ malfunction or external causes like chronic kidney disease or vitamin D deficiency
• Hypothyroidism: An underactive thyroid gland, often caused by an autoimmune disease called Hashimoto's thyroiditis
• Hypomagnesemia: Low blood magnesium associated with diabetes, inflammatory bowel disease, pancreatitis, starvation, and celiac disease
• Hypercalcemia: High blood calcium associated with medications and supplements, severe dehydration, hyperparathyroidism, and certain infections
• Hemochromatosis: An overload of iron in tissues and organs, most often caused by an inherited genetic disease called hereditary hemochromatosis

Other risk factors for chondrocalcinosis include obesity, hypertension (high blood pressure), and chronic gout.

Diagnosing Chondrocalcinosis

The gold standard for the diagnosis of chondrocalcinosis is joint fluid aspiration, also known as arthrocentesis. This involves the insertion of a needle into a joint space to extract a sample of lubricating fluid known as synovial fluid.

The fluid sample is taken to the lab for evaluation under the microscope to see if it contains any calcium crystals (recognized by their crystallized structure).

Imaging studies may also be ordered to check for calcium deposits inside joints. They can also see if there is any sign of joint and/or cartilage deterioration.

The three imaging tools commonly used for diagnosis include:

• Conventional X-ray: A plain film image created with low-dose radiation
• Computed tomography (CT): An imaging technique that composites multiple X-ray images
• Ultrasound: A non-invasive imaging study that visualizes tissues with reflected sound waves

Blood tests may be performed to rule out other conditions with similar symptoms.

Differential Diagnoses

To confirm the diagnosis, healthcare providers will investigate and exclude other conditions with symptoms similar to chondrocalcinosis.

The differential diagnosis would include:

• Gout: Chondrocalcinosis and gout both involve joint crystals and are characterized by acute (sudden, severe) flare-ups. But gout mainly affects the big toe, while chondrocalcinosis primarily affects larger joints. An evaluation of joint fluid can differentiate the two.
  
• Osteoarthritis; Chondrocalcinosis is an inflammatory condition characterized by acute flare-ups, while osteoarthritis tends to cause chronic (persistent), non-inflammatory stiffness and pain. The two can be differentiated with blood tests that detect generalized inflammation.
• Rheumatoid arthritis: Chondrocalcinosis is unilateral (affecting one joint on one side of the body), while rheumatoid arthritis is typically bilateral (affecting the same joint on both sides). Blood tests can also detect autoimmune antibodies associated with rheumatoid arthritis.

Chondrocalcinosis Treatment

There are no medical treatments that can dissolve, destroy, or remove calcium crystal deposits in joint spaces. However, there are ways to manage symptoms of chondrocalcinosis and improve joint function.

• Cold application: Applying a cold compress or ice pack for 10 to 15 minutes can help ease joint inflammation and pain.
• Heat application: Applying a heating pad or moist, warm towel to a joint can help ease joint stiffness and improve mobility.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): These include over-the-counter NSAIDs like Advil (ibuprofen) and Aleve (naproxen) or prescription NSAIDs like Indocin (indomethacin).
• Arthrocentesis: The same procedure used for diagnostic purposes can drain excess fluid from joints, thereby relieving pressure and pain.
• Cortisone injections: Cortisone is a type of steroid delivered by intra-articular injection (into a joint space). The shots provide longer-lasting relief from inflammation and pain.
• Colcrys (colchicine): This is a medication used to prevent gout flare-ups that may help some people with chondrocalcinosis.
• Methotrexate: This is a drug used to treat rheumatoid arthritis that may help some people with chronic, unremitting chondrocalcinosis.
• Surgery: This includes arthroscopic debridement to scrape away damaged tissues that impede joint movement or a total knee replacement (total knee arthroplasty) for severe cases.

Maintaining a healthy weight can also minimize stress on joints and reduce inflammation.

Summary

Chondrocalcinosis, also known as pseudogout, is a type of inflammatory arthritis caused by calcium crystal deposits in joint space, such as the knee. It causes episodic attacks that can last for days or weeks, resulting in joint pain, redness, swelling, and stiffness.

Chondrocalcinosis can be diagnosed with the evaluation of synovial fluids taken from the joint space and imaging studies like ultrasound or a CT scan. The treatment is focused on easing symptoms and reducing inflammation with ice or heat application, nonsteroidal painkillers, joint aspiration, cortisone shots, and possibly surgery in severe cases.