Chondrocalcinosis and chondrocalsynovitis (pseudogout syndrome): Analysis of twenty-four cases

Abstract

Analysis of twenty-four cases of articular chondrocalcinosis reveals that in five chondrocalcinosis appeared in association with other rheumatic diseases but of the remaining nineteen cases there was otherwise unexplained acute or subacute arthritis in twelve (63 per cent) at some time during the illness, and chronic symptoms of joint involvement, characterized mainly by low grade arthralgias, in ten (53 per cent). Hyperuricemia with or without gouty arthritis was found in six of nineteen cases in which uric acid studies were carried out, suggesting a possible relationship between hyperuricemia and chondrocalcinosis. Roentgenologic evidence of calcification was most commonly seen in the knees, both as calcification of menisci and articular hyaline cartilage. Crystals characteristic of calcium pyrophosphate dihydrate were found in the majority of cases but the findings of crystals with birefringent properties consistent with dicalcium phosphate dihydrate suggests that other crystalline deposits may give similar clinical findings. The etiology of the abnormal calcification is unknown. In certain forms the disease may be the result of a primary defect in calcification with secondary degenerative changes, in others calcification appears to be secondary and follows primary degenerative change. Treatment of the acute attack is symptomatic. Joint fluid aspiration usually gives significant relief, especially when combined with intra-articular steroids when feasible. In addition, various antiinflammatory agents, including phenylbutazone, oral corticosteroids and, at times, salicylates and colchicine, appear to be of value. Associated disease states such as hyperparathyroidism and hemochromatosis should be sought and ruled out. The number of cases of articular chondrocalcinosis and chondrocalsynovitis which has rapidly accumulated since the syndrome was emphasized recently testifies to its relative frequency as a cause of articular symptoms and future studies should establish further its importance as a rheumatologic entity.