Chondrocalcinosis

Chondrocalcinosis is a painful form of arthritis caused by calcium crystals building up in the joints, leading to sudden episodes of intense pain and swelling that can significantly affect daily life.

Table of contents

• What is Chondrocalcinosis?
• Other Names for This Condition
• What Causes Chondrocalcinosis?
• Who Is at Risk?
• Signs and Symptoms
• How Is It Diagnosed?
• Treatment Options
• Living with Chondrocalcinosis
• Difference from Gout

What is Chondrocalcinosis?

Chondrocalcinosis is a type of arthritis that develops when tiny crystals made of calcium pyrophosphate (CPP) build up in the joints and surrounding tissues^[1]. These crystals settle in the cartilage—the firm, rubbery material that cushions the ends of bones—and in the fluid-filled membranes that protect joints^[1].

The condition most commonly affects the knees, but it can also involve the wrists, shoulders, ankles, elbows, hands, and hips^[1][2]. In some cases, calcium pyrophosphate crystal deposits occur without causing any symptoms at all^[2].

Pseudogout, Calcium pyrophosphate deposition disease (CPPD), Calcium pyrophosphate deposition (CPPD), Calcium pyrophosphate arthritis

Other Names for This Condition

Healthcare providers use several different names to describe this condition. The term pseudogout is frequently used because the symptoms are similar to gout, another type of arthritis^[1]. The prefix “pseudo” means false, so pseudogout is sometimes called “false” gout^[1].

Other medical names include calcium pyrophosphate deposition disease (CPPD) and calcium pyrophosphate arthritis^[1][4]. The term chondrocalcinosis specifically describes the characteristic appearance of calcium deposits in joint cartilage that can be seen on imaging tests like X-rays^[3].

• Knees
• Wrists
• Hands
• Shoulders
• Hips
• Ankles
• Elbows

What Causes Chondrocalcinosis?

Chondrocalcinosis develops when calcium pyrophosphate crystals form in the joints. The extra calcium pyrophosphate forms small crystals that build up in the cartilage and the fluid-filled membranes cushioning the joints. Eventually, these crystals clump together and trigger inflammation^[1].

Most of the time, doctors don’t know exactly why these crystals form^[2]. Experts believe the condition may be hereditary, meaning parents can pass the risk of developing it to their biological children^[1][2]. Some people develop the condition after experiencing trauma or an injury that damages a joint^[1].

Research suggests that certain metabolic or endocrine conditions may cause chondrocalcinosis^[1][3]. These include conditions that affect the body’s processing of minerals like calcium, iron, phosphorus, and magnesium^[3].

Who Is at Risk?

Anyone can develop chondrocalcinosis, but it is much more common among people older than 60 or 65^[1][2]. The risk increases with age—almost half of people over 85 have calcium crystals in their joints, although many of them don’t have symptoms^[7].

Certain health conditions can increase the risk of developing chondrocalcinosis. These include^[1][3]:

• Hypomagnesemia (low magnesium levels in the blood)
• Hyperparathyroidism (overactive parathyroid glands)
• Thyroid disease
• Hemochromatosis (excess iron in the body)
• Hypophosphatasia (a condition affecting bone and teeth mineralization)
• Chronic kidney disease

People with other types of arthritis may also be more likely to develop chondrocalcinosis, including those with gout, osteoarthritis, rheumatoid arthritis, or post-traumatic arthritis^[1].

Signs and Symptoms

Chondrocalcinosis causes sudden episodes of symptoms called flares or attacks. These attacks can happen without warning, and you’ll usually notice symptoms all at once rather than feeling them slowly building up over time^[1].

The most common symptoms during an attack include^[1][2]:

• Sudden, intense joint pain
• Skin redness or discoloration around the joint
• Swelling
• Stiffness
• A feeling of heat or warmth in or around the joint
• Joint tenderness

An inflammatory flare-up can last anywhere from a few days to a few weeks, or sometimes even longer^[1][2]. The pain and swelling can be severe enough to cause limitations in daily activities^[2]. People may not experience any symptoms between episodes^[2].

Over time, repeated crystal deposits can lead to chronic inflammation and permanent joint damage. This can cause symptoms similar to osteoarthritis or rheumatoid arthritis, including^[2]:

• Ongoing joint pain and stiffness
• Low-grade inflammation
• Swollen, “knobby” joints
• Limited range of motion
• Morning joint stiffness and fatigue

Some people with untreated chondrocalcinosis experience more frequent and severe flares^[1].

How Is It Diagnosed?

Chondrocalcinosis symptoms can look similar to those of gout and other types of arthritis, so laboratory and imaging tests are usually necessary to confirm the diagnosis^[10].

A healthcare provider may use a needle to withdraw fluid from the affected joint. This procedure is called joint aspiration or arthrocentesis^[1][10]. The fluid sample is then examined under a special microscope to look for calcium pyrophosphate crystals. These crystals have a distinctive rhomboid shape and appear different from the needle-shaped crystals seen in gout^[8].

X-rays of the affected joint can often reveal calcium crystal deposits in the joint’s cartilage^[1][10]. These deposits typically appear as a white line in the cavities at the ends of bones^[6]. Other imaging techniques used to visualize calcium crystals in the joints include musculoskeletal ultrasound and, in some cases, CT scans^[4].

Blood tests may be ordered to check for mineral imbalances and problems with the thyroid or parathyroid glands that have been linked to chondrocalcinosis^[10]. These tests can also help rule out other conditions with similar symptoms^[2].

Treatment Options

There is currently no treatment available to dissolve or remove calcium pyrophosphate crystals from the joints^[4][7]. Instead, treatment focuses on reducing inflammation and relieving pain. A typical attack may last between 7 to 14 days^[4].

During acute episodes, a healthcare professional may drain fluid from the affected joint using a needle and then inject a corticosteroid (a medication that reduces inflammation) along with a numbing medication into the joint^[1][4]. This procedure can provide significant relief from pain and swelling.

Medications commonly used to manage symptoms include^[4][10]:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or indomethacin to reduce pain and inflammation
• Oral corticosteroids like prednisone to reduce inflammation
• Colchicine, a medication also used to treat gout, which can be effective for managing acute attacks

For people experiencing frequent attacks, preventive treatment may be helpful. Low-dose colchicine taken daily can help prevent flare-ups^[10][14]. Other medications that may be considered for chronic inflammation include hydroxychloroquine and methotrexate^[14].

In severe cases where the condition doesn’t respond to standard treatments, medications that target the immune system’s inflammatory response may be used. These include anakinra, an interleukin-1 beta antagonist that has shown promise in treating refractory cases^[4][14].

Surgery to replace severely damaged joints may be an option for people with advanced joint damage^[7].

Living with Chondrocalcinosis

Prompt diagnosis and treatment can help ease symptoms and may prevent further joint damage^[4]. It’s important to see a healthcare professional as soon as symptoms appear to rule out other possible causes like infection and start appropriate treatment^[4].

Healthcare professionals may refer people with chondrocalcinosis to physical and occupational therapists^[4]. These specialists can guide therapy to improve flexibility, ease joint pain, and help adapt movements for better function.

Simple measures at home can also help manage symptoms during a flare-up. These include^[6]:

• Resting the affected joint
• Applying cold packs to help relieve swelling and inflammation
• Using light compression wraps to reduce swelling
• Keeping the joint elevated
• Starting gentle movement as soon as pain permits to improve swelling

Regular moderate exercise to increase muscle strength and maintaining a healthy weight can help reduce the risk of joint wear and tear^[6].

Difference from Gout

Chondrocalcinosis is often called pseudogout because it causes similar symptoms to gout, but these are two different conditions^[1].

Gout happens when there’s too much uric acid in the blood, and sharp uric acid crystals clump together in the joints and cause inflammation^[1]. In contrast, calcium pyrophosphate crystals cause chondrocalcinosis^[1].

Gout most commonly affects the joint where the big toe connects to the rest of the foot. Chondrocalcinosis doesn’t usually develop in this location and instead more commonly affects larger joints like the knees, wrists, and shoulders^[1].

Under a microscope, the crystals look different. Gout crystals are needle-shaped, while calcium pyrophosphate crystals are rhomboid-shaped^[8]. Unlike gout, chondrocalcinosis is not influenced by dietary factors such as consumption of red meat or certain types of alcohol^[5].