From the Guidelines
Chondrocalcinosis, a condition characterized by calcium crystal deposits in joint cartilage, is often associated with hemochromatosis, and its management should focus on treating the underlying condition and alleviating symptoms. In the context of hemochromatosis, chondrocalcinosis is a common finding, present in approximately 50% of cases, and is characterized by degenerative changes, joint space narrowing, osteophytes, and subchondral cysts on radiographs 1. The condition can significantly affect quality of life, with symptoms including joint pain, stiffness, and limited mobility. Treatment options for chondrocalcinosis in hemochromatosis are limited, and focus on managing symptoms, with analgesics and non-steroidal anti-inflammatory agents being commonly used 1. In some cases, physiotherapy and orthopedic procedures, including joint replacement, may be necessary to alleviate symptoms and improve quality of life. It is essential to identify and treat underlying conditions that predispose to chondrocalcinosis, such as hemochromatosis, to prevent further progression of the disease. According to the EASL clinical practice guidelines on haemochromatosis, treatment of hemochromatosis-related arthropathy is limited to symptomatic relief, and phlebotomy does not improve joint symptoms 1. In contrast, the EULAR recommendations for calcium pyrophosphate deposition suggest that treatment should focus on managing symptoms, with NSAIDs, colchicine, and corticosteroids being effective options for acute attacks 1. However, in the context of hemochromatosis, the primary focus should be on treating the underlying condition, and managing symptoms to improve quality of life. Key considerations in managing chondrocalcinosis in hemochromatosis include:
- Identifying and treating underlying hemochromatosis
- Managing symptoms with analgesics and non-steroidal anti-inflammatory agents
- Considering physiotherapy and orthopedic procedures for severe cases
- Focusing on improving quality of life and alleviating symptoms.
From the Research
Definition and Classification of Chondrocalcinosis
- Chondrocalcinosis is categorized into radiographic chondrocalcinosis, acute calcium pyrophosphate arthritis, chronic calcium pyrophosphate arthritis, and osteoarthritis with calcium pyrophosphate deposition 2
- These entities are characterized by the deposition of calcium into joints, resulting in pain and swelling in the affected joints
Clinical Presentation and Diagnosis
- Radiographic chondrocalcinosis is asymptomatic, while acute calcium pyrophosphate arthritis results in self-limited periods of joint pain and swelling 2
- Chronic calcium pyrophosphate arthritis results in periods of quiescence interrupted by flares, and osteoarthritis associated calcium pyrophosphate arthritis presents with chronic pain and periods of acute flares 2
- Diagnosis is made if there is proof of either crowned dens syndrome or synovial fluid analysis demonstrating calcium pyrophosphate crystals, or when more than 56 points are summed utilizing the criteria described in the guidelines 2
Treatment Options
- Radiographic chondrocalcinosis requires no therapy, while acute calcium pyrophosphate arthritis is treated with the goal of aborting the flare using nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, oral corticosteroids, and other options 2
- Chronic calcium pyrophosphate arthritis is treated with the goal of suppressing acute flares using maintenance therapy with NSAIDs, colchicine, and other options, as well as methotrexate and hydroxychloroquine 2
- Intra-articular injections of corticosteroid and hyaluronic acid have been shown to reduce pain compared to hyaluronic acid alone in the treatment of knee osteoarthritis 3