Chondrocalcinosis and Chondroarthritis
Chondrocalcinosis is a condition that can cause knee pain. If you suffer from knee arthritis, you are at risk of developing this condition. Fortunately, there are treatments that you can pursue. Read on to learn more about the disease and the treatments available.
Synovial fluid analysis
If you have joint pain, your doctor may perform a synovial fluid analysis. The test will help identify the cause of your pain. This will allow your doctor to rule out diseases and conditions that can cause pain. It can also help to determine if your joint is swollen.
Crystal deposition disease is a condition in which crystals form in a fluid that circulates in joints. Several different types of crystals can form in the synovial fluid. These can include calcium pyrophosphate dihydrate (CPPD), monosodium urate, uric acid, and other crystals.
There are several tests that can be used to identify crystals in the synovial fluid. Some are non-invasive, while others require a more invasive approach.
Synovial fluid analysis is usually performed to assess whether there are signs of inflammation, infection, or bleeding in the joint. A special filter is used to detect crystals. In addition, crystals can be identified using a polarized light microscope.
The procedure is relatively safe. Ideally, it should be performed on freshly aspirated fluid. However, it is not always possible to do so.
In the future, more advanced diagnostic methods may be developed. However, there are some challenges with these ultrasensitive techniques.
When performing a synovial fluid analysis, it is important to use a high-quality microscope. Reliability depends on the quality of the microscope and the training of the examiner.
A positive Gram stain is one way to confirm the presence of CPPD crystals. Other tests, such as culture, can help to confirm the presence of certain microorganisms. Another method is to measure the concentration of the crystals in the fluid.
In addition, the presence of these crystals can be important in diagnosing infectious arthritis. However, if the infection is not present, the results can be misleading.
In contrast, the presence of CPPD crystals can be helpful in the diagnosis of pseudogout. It is known that they are associated with mild subclinical inflammation.
Compared to other diagnostic procedures, this test is inexpensive and shows some promise. Although it does not have the sensitivity of more invasive tests, it can confirm disease and provide additional diagnostic support.
Diagnosis
The diagnosis of crystal deposition disease is often challenging. Asymptomatic joint damage and pain can be associated with crystals that are not visible by imaging. This can lead to misdiagnosis and even false negative reports. While these conditions are not life-threatening, they can result in arthralgias and degenerative joint disease. There are some key diagnostic tools available.
Ultrasound has long been a diagnostic tool for detecting calcium deposition. For example, a high-frequency diagnostic ultrasound can penetrate body tissues to a depth of about a few centimetres. Stones that contain calcium – such as kidney stones – are radiolucent on plain radiographs, but have acoustic properties that allow them to be detected on ultrasound.
Ultrasound can also be used to detect the presence of crystal-induced arthritis. In this condition, the cartilage matrix is edematous, allowing crystals to migrate to the articular surface. Crystals in synovial fluid are a common cause of inflammatory arthropathies. They can incite acute inflammation.
Another useful diagnostic tool is high-resolution ultrasonography. This is an investigational modality that can provide detailed information on the tissue, subcutaneous structures, and superficial structures. It can be particularly helpful for evaluating the vascular structures of the soft tissues and can help determine whether a uric acid stone is present.
Other tests include a Gram stain and culture of synovial fluid. If crystals are detected in the synovial fluid, this may be enough to make the diagnosis. However, it is important to aspirate the joint in question to rule out infection. Also, the presence of a uric acid-containing stone can be seen on an ultrasound scan.
Finally, a serial ultrasound examination of the joint can be helpful in determining the status of a crystal deposition disease. It can also guide arthrocentesis and removal of the deposited crystals.
These diagnostic techniques have gained ground in recent years. But before completing a final diagnosis, it is always important to consider all the potential differentials. Some of these include infections, trauma, and other crystal-deposition diseases. Additionally, other inflammatory articular diseases may coexist with gout. Thus, a timely diagnosis is essential.
Although a plethora of tests can be performed, the presence of crystals in the synovial fluid is a technical standard for detecting the presence of gout. Fortunately, the acoustic properties of uric acid stones, combined with the acoustic properties of other crystal-deposition diseases, mean that they are detectable with ultrasound.
Treatment options
If you have CPPD crystal deposition disease, you may need to consider a number of treatment options. There are treatments available to alleviate pain, reduce inflammation, and protect the affected joints. These treatments depend on the severity of the condition and your doctor’s advice. You should always follow your doctor’s recommendations.
Some of the most common treatments for CPPD are rest, exercise, and joint aspiration. Other treatment options include surgery, medication, or a combination of these. The goal of CPPD treatment is to keep the joint functioning at full capacity.
Treatments for CPPD crystal deposition disease vary depending on the severity of the condition. For less severe cases, you can take a nonsteroidal anti-inflammatory, which can help relieve symptoms. Surgery may also be recommended for more severe cases.
Exercise is important because it helps you maintain muscle strength around the affected joints. A physical therapist can teach you how to do strengthening exercises. You can try doing a gentle range of motion exercises on a daily basis. Heat can make these exercises more comfortable.
The first step in CPPD crystal deposition disease treatment is to see your doctor. He or she will run a blood test to check your calcium and phosphorous levels, as well as your thyroid-stimulating hormone. Your doctor may also recommend taking a medication called corticosteroids.
If you have CPPD crystal deposition, you should consider visiting a physical therapist for a more comprehensive evaluation. They can help you determine the best exercises for your condition, and explain which types of exercises will work best during flare-ups.
It is important to note that CPPD is a chronic condition, and will likely continue to develop as you age. If you have the disease, you can expect to experience a flare-up every few years. In the meantime, you will need to follow your doctor’s advice and keep your joints well-protected.
The goal of CPPD crystal deposition disease treatment is not to eliminate the crystals, but to relieve inflammation and pain. This can be done with a variety of medications, including corticosteroids and painkillers.
A physical therapist can also suggest a splint to protect the sore joint. You can also wear artificial joints made of plastic or metal.
Prevalence of chondrocalcinosis in Arabs with knee arthritis
Chondrocalcinosis is a condition that is associated with knee osteoarthritis. The disease is a result of calcium pyrophosphate dehydrate crystals depositing in soft tissues. It may occur in the knee or other joints.
A recent study has characterized the prevalence of chondrocalcinosis among patients with knee arthritis in the Middle-Eastern Arab population. This research also investigated the occurrence of CPPD-CDD in these populations. Moreover, this study provides evidence that a high level of clinical awareness in these patients might make CPPD-CDD more prevalent.
In this study, chondrocalcinosis was present in two out of 100 adults in the Middle-Eastern Arab population. In addition, the prevalence was comparable to that observed in Western countries. Moreover, there was no significant difference between the age and gender of patients with chondrocalcinosis.
Among the participants, 24 patients had CC in the knees. However, in only 60% of the symptomatic patients, conventional radiographs were obtained. Therefore, it is not possible to determine the true prevalence of CC in the knees.
Approximately one-third of the CPPD patients had CC in the wrists. However, the presence of CC in the other joints was more common in the absence of chondral lesions in the knee.
Patients with CPPD were older than those with RA. Additionally, the RA patients had more symmetric arthritis and CC. Moreover, the presence of aggressive OA was more prevalent in the Saudi Arabian population.
Although the CPPD-CDD is not uncommon in the Middle-Eastern Arab population, it is underrecognized. Thus, it is important to assess joint aspirates in patients with OA carefully. Furthermore, patients with knee arthritis should be examined for CPPD crystals in the synovial fluid. Moreover, it is also essential to perform blood tests for comorbid conditions such as hyperparathyroidism, hypophosphatasia, and hemochromatosis.
A population-based survey can reveal the true prevalence of CPPD deposition disease. Moreover, it can also help in determining the location of the CC in the knees. Ultimately, the findings of this study will contribute to a better understanding of a rare joint condition in this part of the world.
The results of this study confirm the occurrence of chondrocalcinosis among adult Arabs in Kuwait. Further studies are needed to characterize the calcification in other joint sites.
Concurrence of rheumatoid arthritis and calcium pyrophosphate deposition disease: A case collection and review of the literature – PMC (nih.gov)
Chondrocalcinosis | Radiology Reference Article | Radiopaedia.org