Paraarticular soft tissue changes in systemic diseases

Abstract

ALTS ARE PRECIPITATED in articular and periarticular structures during the course of a number of systemic disorders. The conditions share a common clinical picture of recurrent acute episodes of articular and periarticular inflammation induced by crystal deposition. These diseases include pseudogout, calcific periarthritis, metastatic calcification, and gout. Each of these entities has characteristic radiologic findings. Pseudogout The pseudogout syndrome is characterized by episodes of abrupt onset of pain, swelling, redness, and heat involving a single joint or just a few joints. Knees and wrists are predilected. The patient is acutely ill with fever for 2-4 days followed by gradual disappearance of symptoms over the next couple of weeks. Attacks can be aborted by the aspiration of joint fluid. This fluid contains crystals of calcium pyrophosphate which are rhombic or rod shaped and yield a weakly positive birefringence with polarized light. Roentgenograms almost invariably reveal calcification of the fibrocartilage menisci of the knees and frequently of the fibrocartilages of the wrists, hips, shoulders, and the symphysis pubis. l6 Calcification of hyaline articular cartin%ge, manifest by a delicate line of punctate calcification paralleling the articular surface of bone, is usually seen in the knees and may also be noted in other affected joints. Martel et al. observed tendon calcifications in 9 of 19