Intra-articular Calcification Research Articles

Остеоартроз в различных экологических регионах. Сообщение 2. Связь с состоянием питьевой воды

Целью работы стала оценка клинико-патогенетических связей остеоартроза (ОА) с качественным составом питьевой воды в зонах проживания больных. Материал и методы. Под наблюдением находились 133 больных первичным ОA в возрасте 58,90 ± 0,83 года. Оценивали в 33 городских и сельских регионах уровни жесткости и минерализации питьевой воды, концентрации в ней хлоридов, сульфатов, фосфатов и нитратов, содержание токсичных микроэлементов (Ba, Li, Ni, Pb). Результаты. Низкое качество питьевой воды в регионах проживания людей способствует развитию ОА в более молодом возрасте, что в последующем определяет интегральную тяжесть артикулярного синдрома, характер костно-деструктивных изменений в суставах (развитие остеопороза, остеоузур, хондромных тел), формирование манифестного реактивного синовита (концентрации хлоридов и нитратов), темпы прогрессирования заболевания, появление внутрисуставных отложений кальцинатов, остеофитоза и эпифизарного остеопороза (степень минерализации и жесткости воды). Тяжесть ОА и темпы прогрессирования костно-деструктивных изменений со стороны суставов зависят от уровня микроэлементов, которые определяют распространенность суставного синдрома, развитие узелков Гебердена и/или Бушара, спондилопатии, степень реактивного синовита, остеопороза, субхондрального склероза, лигаментоза, интраартикулярных хондромных тел и тел Гоффа, а высокое содержание Pb является фактором риска неблагоприятного течения заболевания. Выводы: выявлены определенные клинико-патогенетические связи ОА с качественным составом питьевой воды в регионах проживания больных.

Hypertrophic osteoarthropathy in a sheep

ABSTRACT: This research described the radiological, clinical and pathological aspects of hypertrophic osteoarthropathy in a seven-year-old Santa Inês ram. The main clinical features were lameness of the thoracic and pelvic limbs, rigid, cracking and enlarged of the humeroradial, humeroulnar and tibiofemoral joints, cervical spine stiffness, and severe lordosis of the thoracolumbar vertebrae. Dyspnea, nasal discharge and abdominal breathing were also observed. On radiographic examination of the thoracic and pelvic limbs, osteoarthrosis with the formation of osteophyte bridging, intra-articular calcification and periosteum reaction were observed. At necropsy were reported bilateral osteophytosis in the humeroradial, humeroulnar, tibiofemoral and interphalangeal joints, and fusion of the bodies of thoracic vertebrae T5-13 T6 and T12-T13. Microscopically, extensive areas of fibrosis were observed in the lungs and the affected joints were thickened by well demarcated and perpendicular orientated woven and trabecular bone proliferation in the epiphysis. The periosteum was also expanded by fibrous connective tissue that extended into and between the new proliferated bone. Based on these findings, hypertrophic osteoarthropathy, which is an unusual condition in sheep, was diagnosed.

Application of elbow arthrography in the treatment of severe radial neck fractures in children under 6 years old

Objective To introduce the application value of elbow arthrography in severe radial neck fractures in children younger than 6 years old and to summarize its clinical efficacy. Methods From May 2012 to December 2016, 18 children under 6 years old with severe radial neck fractures were treated in our hospital, including 11 males and 7 females, aged 40 to 70 months, with an average of 59.7 months. The preoperative radiographs did not show any obvious ossification center and only a thin bone slice displaced from metaphysis could be seen. According to O'Brien classification, there were 8 cases of type Ⅱ and 10 cases of type Ⅲ. Under anesthesia, routine lateral elbow arthrography and manual reduction with Metaizeau technique were conducted. If manual reduction is unsatisfactory, percutaneous pin prying reduction with Metaizeau technique or open reduction was conducted. After the operation, the long arm plaster was used for fixation for 4 weeks. Postoperative evaluation was based on Tibone and Stotz scoring system. Radial head ischemic necrosis, epiphyseal premature closure, intra-articular calcification and joint fusion were evaluated by X-ray films of the healthy and the injured side. Results One child had minor skin allergy during operation, and the others did not have adverse effects. Elbow arthrography can clearly reveal the articular surface and the degree of fracture displacement. All the patients were successfully repositioned by closed and/or pin prying reduction without open reduction. X-ray examination showed that the fracture healed well. There was no malunion at the fracture site, no premature epiphyseal closure and necrosis of the radius head. According to Tibone and Stotz criteria, 13 cases were excellent and 4 cases were good. Conclusion The intraoperative arthrography can provide a clear judgment of the displacement degree of fracture and evaluation of reduction quality for the patients with severe radial neck fractures under 6 years old. The method is simple and effective, and the clinical effect is satisfactory. It is worth promoting. Key words: Fractures,bone; Child; Arthrography; Metaizeau technique

Intra-Articular Cartilage Calcification Associated with Type II Pro-Collagen Accumulation in Chondrocytes and Abnormal Fibrils in the Extra Cellular Matrix (ECM): Case Report

Objective: The purpose of this case-study was to perform morphological and molecular analysis of articular cartilage biopsies from the femoral condyle of a 33 year old woman with intra-articular calcification in the right knee joint and compare the findings with those of normal cartilage. Methods: Femural condyle cartilage biopsies were used for Light Microscopy (LM), Transmission Electron Microscopy (TEM), explant culturing and DNA mutation analysis of the COL2A1 gene. Results: X-ray of the affected knee joint showed intra-articular calcifications on the femur condyle, tibia and meniscus. Pathological LM and TEM examination of cartilage biopsies revealed calcified islands morphologically identical to calcium pyro-phosphate dehydrate (CPPD) and hydroxyapatite (HA)-like crystals. In addition, chondrocytes showed accumulation of pro-collagen molecules. With explant culturing and immunochemistry, it was confirmed that matrix calcification correlated with high intracellular matrix accumulation and expression of type X collagen. The induction of hypertrophy in chondrocytes was further associated with matrix vesicle (MV) release and a prominent calcification zone. Surprisingly, TEM showed crystal development on thick abnormal type II collagen fibrils suggesting that these ECM components might nucleate and contribute to calcification. Conclusions: We suggest that intra-articular calcification may be associated with type II pro-collagen accumulation in chondrocytes. In particular, we hypothesize that matrix accumulation may induce hypertrophy and type X collagen expression in cartilage cells and release of MV’s into the ECM, which together with thick abnormal type II collagen hetero-fibrils, are responsible for crystal deposition in the ECM.

CT imaging for evaluation of calcium crystal deposition in the knee: initial experience from the Multicenter Osteoarthritis (MOST) study

Role of intra-articular calcium crystals in osteoarthritis (OA) is unclear. Imaging modalities used to date for its evaluation have limitations in their ability to fully characterize intra-articular crystal deposition. Since Computed Tomography (CT) imaging provides excellent visualization of bones and calcified tissue, in this pilot project we evaluated the utility of CT scan in describing intra-articular calcium crystal deposition in the knees. We included 12 subjects with and four subjects without radiographic chondrocalcinosis in the most recent visit from the Multicenter Osteoarthritis (MOST) study, which is a longitudinal cohort of community-dwelling older adults with or at risk for knee OA. All subjects underwent CT scans of bilateral knees. Each knee was divided into 25 subregions and each subregion was read for presence of calcium crystals by a musculoskeletal radiologist. To assess reliability, readings were repeated 4 weeks later. CT images permitted visualization of 25 subregions with calcification within and around the tibio-femoral and patello-femoral joints in all 24 knees with radiographic chondrocalcinosis. Intra-articular calcification was seen universally including meniscal cartilage (most common site involved in 21/24 knees), hyaline cartilage, cruciate ligaments, medial collateral ligament and joint capsule. Readings showed good agreement for specific tissues involved with calcium deposition (kappa: 0.70, 95% CI 0.62-0.80). We found CT scan to be a useful and reliable tool for describing calcium crystal deposition in the knee and therefore potentially for studying role of calcium crystals in OA. We also confirmed that "chondrocalcinosis" is a misnomer because calcification is present ubiquitously.

Intraartikuläre Steroidtherapie bei Kindern mit juveniler idiopathischer Arthritis

Intra-articular corticosteroid therapy offers prompt pain release and functional improvement for the involved joints in juvenile idiopathic arthritis. It is indicated for children with mono- or oligo-articular disease to reduce the amounts of drug therapy. For patients with polyarthritis, intra-articular injections can bridge the time interval until DMARDs become effective. Important differential diagnoses like septic arthritis, Lyme disease, tumours, osteonecrosis and other diseases must be excluded before injection. The injection should be administered only when the child is adequately sedated. It requires a consequent treatment afterwards which comprises daily physiotherapy and from our experience also load-relief of the joint. Side effects concern periarticular atrophies and intra-articular calcification, rarely crystal synovitis. Joint infections can be minimized with a strict sterile procedure. Depending on the global situation, intra-articular injections offer a success rate of 50 to 90 % for a follow-up of 6 to 24 months.

Reduction and osteosynthesis of radial neck fractures in children by centromedullary pinning

Radial neck fractures are infrequent but very difficult to treat and have many possible complications. Conservative treatment is unable to reduce severe displacements, resulting in malunion. Open reduction frequently leads to intraarticular calcification, avascular necrosis, and joint stiffness. In most cases, intramedullary nailing allows complete reduction without open joint and a very low complication rate. The pin is left in place, stabilizes the epiphysis, and prevents secondary displacement.

Intra-articular calcification in primary hyperparathyroidism

We report a case of intra-articular calcification involving the knee joint secondary to primary hyperparathyroidism. This caused significant disability to the patient and following excision of the calcified mass the patients knee function returned to normal. This feature of hyperparathyroidism has not been previously reported.

Intra-articular calcification in primary hyperparathyroidism

<h2>Abstract</h2> We report a case of intra-articular calcification involving the knee joint secondary to primary hyperparathyroidism. This caused significant disability to the patient and following excision of the calcified mass the patients knee function returned to normal. This feature of hyperparathyroidism has not been previously reported.

Enteropathic arthritis in the sacroiliac joint. Imaging and differential diagnosis

Objectives: A new high resolution computed tomography (HRCT) scoring system of sacroiliac joint (SIJ) involvement in enteropathic arthritis is introduced. Patients and methods: SIJ’s of 100 patients were studied. A total of 25 patients presented with pain syndrome, 25 with suspicious seronegative spondylarthritis, 25 with inflammatory bowel diseases and 25 without joint or bowel diseases, as a control group. HRCT was carried out in all 100 patients. For comparison, a plain film radiography (PFR), conventional CT (slices of 10 mm) and bone scan were used. Results: Quantitative differences: In the pain syndrome group, there were no erosions identified neither intraarticular calcifications. Disc degeneration was seen in 12/25 cases. In 4/25 patients, vacuum phenomena appeared in the SIJ. In 3/25 patients, ventral capsular calcification occurred in the ventral sacroiliac ligament (anterior capsule complex). In the seronegative spondylarthritis group, 16/25 patients had positive findings, while PFR documented erosions only in 3/25 cases. In the bowel diseases group, erosions were detected in 17/25 cases with HRCT, while the plain film was positive only in three cases and in seven cases the findings were questionable. Intraarticular calcification with erosion was documented in three cases and in seven cases without erosion. The bone scan was positive in 7/25 of this cases, but in 5/7 there was mismatching with HRCT. Important new finding was the HRCT detected erosion which was not detected on BS but was obvious on Anti-Granulocyte–Antibody scintigraphy. In the control group, only degenerative changes were seen in 4/25 cases and no erosions. Conclusion: HRCT is: (1) the reliable imaging of definitive (often ‘cold stage’) sacroileitis; (2) gives optimal detection of erosion; and (3) appears to be the only method in the documentation of calcifications in the posterior ligamental portion of the SIJ.

Soft tissue calcification in hyperparathyroidism.

Abstract. Observations of soft tissue calcifications in a series of 71 cases of primary hyperparathyroidism are presented together with a review of the literature. Four cases with unusual and illustrative features are presented in detail. From the localization, the appearance and the frequency the soft tissue calcifications in primary hyperparathyroidism can be divided into four groups. Soft tissue calcifications of diagnostic significance, essentially nephrocalcinosis and peri‐ and intraarticular calcification do not seem to occur in more than 5–10% of all cases with primary hyperparathyroidism. The phenomenon seems to be much more common in secondary hyperparathyroidism. This is most probably due to the impaired kidney function usually found in secondary hyperparathyroidism.