Dr Philippe SAFFAR/F.I.H.S


What is chondrocalcinosis ?

Chrondocalcinosis is a precipitate deposition arthropathy, that is, a disease in the joints which is usually confused with arthrosis. Calcium pyrophosphate crystals in the articular fluid are formed, and they locate over the ligaments and joint cartilage, destroying them.
This destruction is compared to gout which is also precipitate deposition arthropathy by uric acid crystals.
This affection usually occurs in the knee and wrist. Acute attacks occur: the joint presents heat, swelling and pain at motion. These crisis last several days or weeks, and they sometimes deform the joint.



Evolution can also be progressive, with pains and deformations of joints.
This disease appears after the age of 50, but it frequently presents after 70. As longevity increases, so does the affection. Familial patterns of early affection have been recorded.

Which are the clinical signs ?

When a crisis occurs, signs involve pain at the wrist or thumb, with swelling. Sometimes awareness of the existence of the disease is accidental, when there is trauma, there is no pain; but during the examinations, reduction of motion and strength occurs.
Age is relatively advanced: 70 is the average. The affection occurs in both wrists and sometimes knees.
Sometimes the disease can be revealed by the carpal tunnel syndrome which can be acute.

Which are the complimentary examinations ?

Radiological findings are often helpful, even when the clinical signs are mild or absent (asymptomatic)
Typical signs involve decalcification, local or generalised joint impingement, osseous sclerosis, bony geodes, sometimes of significant size. There are neither osteophytes, nor bony spurs, this differentiates this disease from arthrosis.
The three most typical findings are: calcifications of the triangular ligament, joining the radius with the ulnar (cubitus) the isolated impingement of the scaphoid, trapezium, trapezoidal joint, and the affection of scapho-lunate ligaments with dissociation of the two bones.
Affection of the pisi-pyramidal and medial carpal joint occasionally occurs.

How is it treated ?

This disease is not arthrosis : degenerative or post traumatic affection of the cartilage. Therefore treatment is different.
At first, treatment is medical, which is sufficient in most cases; it consists of temporary immobilisation with splints and the utilisation of colchicine. Other medicaments such as anti-inflammatory drugs and intra-articular injections are a bit less active.

Sometimes surgery is required, when localisation is relatively limited, such as :

an isolated affections of the scapho-trapezium-trapezoidal joint (different from rizartrosis, with which it is often confused)

instability in the carpal due to destruction of the ligament, which is necessary to stabilise through intra-carpal arthodesis, provided the cartilage is still in good conditions.
destruction of the distal radial-ulnar joint, which is painful at pronosupination motion (rotation of the forearm)

When the affection is generalised, which usually happens at the age of 80, surgery is not indicated.


Conclusion :

Chrondocalcinosis is probably the most frequent rheumatoid disease of the wrist.
Not much attention has been paid to it, as it affects particularly elderly people, and it is often painless.
This affection is often easy to diagnose, not only due to its typical radiological aspect, but also due to its association with arthrosis.
Treatment is required particularly when carpal tunnel syndrome, arthrosis at the base of the thumb, or painful instability of the carpal are present.