From the Guidelines
The management of a patient with hydroxyapatite deposition in the hands on X-rays and joint pain should focus on symptom control and preventing flares, with initial treatment including topical NSAIDs as the first pharmacological topical treatment of choice, as recommended by the 2019 EULAR guidelines 1. The treatment approach for hydroxyapatite deposition disease involves a combination of non-pharmacological and pharmacological modalities, individualized to the patient's requirements, as suggested by the 2007 EULAR recommendations 1.
Key Considerations
- Topical NSAIDs are preferred over systemic treatments due to safety reasons, with oral analgesics, particularly NSAIDs, considered for a limited duration for relief of symptoms 1.
- Exercises to improve function and muscle strength, as well as to reduce pain, should be considered for every patient, along with education and training in ergonomic principles, pacing of activity, and use of assistive devices 1.
- Orthoses should be considered for symptom relief in patients with thumb base OA, and intra-articular injections of glucocorticoids may be considered in patients with painful interphalangeal joints 1.
- Chondroitin sulfate may be used in patients with hand OA for pain relief and improvement in functioning, although the effect sizes are small 1.
Treatment Approach
- Initial treatment: topical NSAIDs (e.g., diclofenac, ibuprofen) for acute pain and inflammation.
- For patients with contraindications to NSAIDs: acetaminophen (up to 3000mg daily) can be used.
- For severe or persistent symptoms: corticosteroid injections into affected joints provide targeted relief.
- Physical therapy focusing on joint protection, range of motion exercises, and strengthening should be incorporated.
- Patients should be advised to rest affected joints during acute flares but maintain gentle movement to prevent stiffness. The goal of treatment is to manage symptoms, prevent flares, and improve quality of life, as there are no specific medications to dissolve hydroxyapatite deposits, and the body gradually resorbs the deposits naturally 1.
From the Research
Management Approach for Hydroxyapatite Deposition in Hands
The management approach for a patient with hydroxyapatite deposition in the hands on X-rays and joint pain typically involves conservative treatment.
- The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is a common approach to manage pain and inflammation, as seen in patients with hydroxyapatite deposition disease (HADD) 2, 3, 4.
- Local heat and physical therapy may also be recommended to help reduce pain and improve joint mobility.
- In some cases, steroid injections may be used to reduce inflammation and relieve pain 5, 6.
- Needling with or without aspiration of the calcific deposits may also be considered as a treatment option 5.
Diagnostic Considerations
- It is essential to make an accurate diagnosis to avoid misdiagnosis and inappropriate treatment, such as iatrogenic surgical management 3.
- Radiographs may show calcifications of varying size and shape in the para-articular tendons, bursae, and capsule, which can help confirm the diagnosis of HADD 5, 4.
- Computed tomography (CT) scans or other imaging modalities may be used to confirm the diagnosis if plain radiographs are negative 2.
Treatment Outcomes
- Conservative treatment is usually effective in managing HADD, with over 90% of cases experiencing symptom relief 4.
- In some cases, surgery may be necessary to relieve pain and improve joint function, especially if there is significant joint destruction or if conservative treatment is ineffective 2, 5, 3.
- Long-term management and prevention of recurrences may involve controlling underlying disorders, such as hyperphosphatemia, and monitoring for signs of degenerative disease 6.