Acute calcific periarthritis-a commonly misdiagnosed pathology.

Acute calcific periarthritis (ACP) is a self-limiting, monoarticular, peri-articular process of dystrophic mineral deposition and adjacent inflammation. Patients present with a sudden onset of pain, localised swelling, erythema, tenderness and restricted range of motion. Symptoms reduce in severity within 4-7 days and self resolve in 3-4 weeks. ACP is commonly misdiagnosed, in particular, as infective or inflammatory pathologies such as septic arthritis and gout. This condition has specific imaging findings which allows differentiation from other disorders when combined with the clinical presentation. Prompt diagnosis results in appropriate management and reduces the likelihood of unnecessary diagnostic and therapeutic procedures.

Comparison of efficacy and safety of complementary and alternative therapies for scapulohumeral periarthritis: A protocol for Bayesian network meta-analysis.

BACKGROUND: Scapulohumeral periarthritis is a disease with high incidence and great pain. The current western treatments with many side effects, poor efficacy cannot fundamentally solve the problem. Complementary and alternative therapies have played an excellent role in the treatment of scapulohumeral periarthritis. However, it is not clear which complementary and alternative therapy is more effective. Therefore, we propose a protocol to compare the efficacy and safety of various complementary and alternative therapies through network meta-analysis (NMA) to provide choice guidance for the therapy. METHODS: A comprehensive search will be conducted for randomized controlled trials of complementary and alternative therapy for scapulohumeral periarthritis as well as ongoing trials. The time limit is from the establishment of the database until January 2021. Literature and data extraction were completed independently by two researchers. Through pairwise comparison and meta-analysis of Bayesian NMA, all the evidences are evaluated comprehensively. STATA16.0 and WinBUGS1.4.3 software will be used for data processing and analysis, and recommendation evaluation will be used to develop and assess grades to classify the quality of NMA evidence. RESULTS: Through the analysis, we will obtain the ranking of the efficacy and safety of different complementary and alternative therapies in the treatment of scapulohumeral periarthritis, in order to provide reference for clinical selection of treatment methods. CONCLUSION: Complementary and alternative therapies of scapulohumeral periarthritis plays a positive role in improving the symptoms of scapulohumeral periarthritis. This study can provide evidence support for clinicians and patients.International Platform of Registered Systematic Review and Meta-Analysis Protocols registration number: INPLASY202140044.

Multifocal calcific periarthritis with distinctive clinical and radiological features in patients with CD73 deficiency.

OBJECTIVES: Arterial calcification due to deficiency of CD73 (ACDC) is a hereditary autosomal recessive ectopic mineralization syndrome caused by loss-of-function mutations in the ecto-5'-nucleotidase gene. Periarticular calcification has been reported but the clinical characterization of arthritis as well as the microstructure and chemical composition of periarticular calcifications and SF crystals has not been systematically investigated. METHODS: Eight ACDC patients underwent extensive rheumatological and radiological evaluation over a period of 11 years. Periarticular and synovial biopsies were obtained from four patients. Characterization of crystal composition was evaluated by compensated polarized light microscopy, Alizarin Red staining for synovial fluid along with X-ray diffraction and X-ray micro tomosynthesis scanner for periarticular calcification. RESULTS: Arthritis in ACDC patients has a clinical presentation of mixed erosive-degenerative joint changes with a median onset of articular symptoms at 17 years of age and progresses over time to the development of fixed deformities and functional limitations of small peripheral joints with, eventually, larger joint and distinct axial involvement later in life. We have identified calcium pyrophosphate and calcium hydroxyapatite (CHA) crystals in SF specimens and determined that CHA crystals are the principal component of periarticular calcifications. CONCLUSION: This is the largest study in ACDC patients to describe erosive peripheral arthropathy and axial enthesopathic calcifications over a period of 11 years and the first to identify the composition of periarticular calcifications and SF crystals. ACDC should be considered among the genetic causes of early-onset OA, as musculoskeletal disease signs may often precede vascular symptoms.

Acute calcific periarthritis of the proximal phalangeal joint on the fifth finger: A case report and literature review.

RATIONALE: Acute calcium deposits, including acute calcific periarthritis or acute calcific peritendinitis, are benign calcifying soft tissue lesions that have a self-resolving course. These calcifying lesions usually develop in the shoulder, while acute calcific periarthritis in the digits is uncommon. When acute calcific periarthritis involves the digits, the lesion occasionally mimics other benign calcifying or ossifying lesions and can easily be misdiagnosed, resulting in unnecessary diagnostic studies and treatment. We present a rare case of acute calcific periarthritis around the proximal phalangeal joint of the left fifth finger that took a long time to spontaneously resolve, and review previous reports of similar cases. PATIENT CONCERNS: A 69-year-old woman complained of longstanding pain and swelling of the fifth finger of the left hand. She had visited several clinics and hospitals and had been treated with analgesics and splinting for more than 2 months, but the pain in the finger had gradually worsened. DIAGNOSES: Blood chemistry analysis showed no signs of inflammation or other abnormalities. Radiographs revealed a well-defined subcutaneous calcifying lesion without bony destruction, suggesting a benign calcification process. Computed tomography and magnetic resonance imaging led to a diagnosis of acute calcific periarthritis of the proximal interphalangeal joint of the fifth finger. INTERVENTIONS: An excisional biopsy was recommended to achieve a definitive diagnosis, but this was declined by the patient. Thus, no invasive treatments were administered, and she was treated with analgesics and encouraged to massage the affected finger. OUTCOMES: The pain gradually improved, and follow-up radiographs showed complete disappearance of the calcifying mass 6 months after the initial visit to our hospital, without recurrence during a follow-up period of more than 2 years. LESSONS: Acute calcific periarthritis is diagnosed based on history, clinical examination, and imaging findings, which provide evidence for the diagnosis of calcium deposition in the digits even if the lesions have been present for a long time. Watchful observation is an appropriate treatment strategy for acute calcific periarthritis of the digits.

Arthroscopic treatment of symptomatic calcific periarthritis on the medial side of the knee after posterior cruciate ligament reconstruction: Case report and literature review.

Calcific periarthritis in the distal femur is a rare condition. Forty two year old Asian male visited to the outpatient clinic of orthopedic department with acute excruciating knee pain. The arthroscopic posterior cruciate ligament (PCL) reconstruction was performed 20 years ago with the bonepatellar tendon-bone (BPTB) autograft combined with Trevira (polyethylene terephthalate) artificial ligament. Severe tenderness was noted incidentally over the medial epicondyle area of the distal femur which the cancellous screw was inserted for PCL reconstruction, without any preceding trauma history or medial joint line tenderness due to degenerative change. The poorly defined calcific deposition was found in plain radiograph. The arthroscopic debridement of the calcification and screw removal from the distal femur was performed due to resist to conservative treatment with analgesics. After operation, the symptoms were resolved completely. The arthroscopic debridement of calcific periarthritis should be considered in specific cases, such as refractory cases with conservative management during 4-6 weeks. We present the arthroscopic treatment of the symptomatic calcific periarthritis on distal femur after PCL reconstruction can be effective.

Calcific periarthritis: more than a shoulder problem: a series of fifteen cases.

BACKGROUND: Calcific periarthritis, referring to a circumscribed juxta-articular deposit of minute non-birefringent mineral grains, is rarely the clinical diagnosis accompanying a pathologic specimen. Familiarity with the clinical, pathologic, and radiologic manifestations of calcific periarthritis, particularly when encountered adjacent to joints other than the shoulder, facilitates diagnosis and may obviate biopsy, avoid confusion with other entities, and speed appropriate treatment. METHODS: Pathologic specimens that fulfilled the criteria for a diagnosis of calcific periarthritis were prospectively collected. Clinical history and radiologic studies were acquired and analyzed. Well-controlled special stains were employed on two specimens with a neutrophilic infiltrate that excluded fungal and bacterial agents, as corroborated by microbiologic cultures showing no growth. RESULTS: Over a five-year period, fifteen patients between the ages of thirty-one and eighty-eight years (mean age, fifty-nine years) presented to various local healthcare providers for treatment of juxta-articular swelling that was subsequently determined to be calcific periarthritis. In seven patients, deposits were alongside a toe joint; in five, alongside a finger joint; and in three, involving the shoulder. The majority of the patients were female (73%). No patient had a documented recurrence of calcific periarthritis in follow-up periods ranging from eighteen to eighty-seven months (average forty-five months). CONCLUSIONS: Of twelve histologically verified cases of calcific periarthritis adjacent to joints other than the shoulder, in only one patient (toe) was the preoperative clinical diagnosis accurate, which signals the need for greater awareness of this entity as a differential diagnostic option.

[Crystal arthropathies]. / Kristallarthropathien.

Crystal arthropathies represent a heterogenic group of skeletal diseases associated with the deposition of mineralised material within joints and periarticular soft tissues. Gout is the most common and pathogenetically best understood crystal arthropathy, followed by basic calcium phosphate and calcium pyrophosphate dihydrate deposition diseases, and, in very rare cases, calcium oxalate crystal arthropathy. These crystals are responsible for different rheumatic syndromes, including acute or chronic synovial inflammation, and also contribute to cartilage degeneration. This review gives an overview of the pathological and clinical changes of these arthropathies.

[The analysis of the efficacy of the local treatment of patients with different course of humeroscapular periarthrosis].

The efficacy of the local treatment (anesthetic and hormonal blockades) in patients with different types of the course of humeroscapular periarthrosis (HP) has been analyzed. The examination of patients with HP (mean age 57±11,9 years) included the assessment of pain with the VAS, palpation and resistive tests, biomechanical parameters of movement volume in the shoulder joint; the 1,5 year follow-up of 58 patients. Forty patients underwent MRI of the shoulder joint. Four types of HP course have been singled out: remitting, partly regradient, regradient and stagnating. The complete or partial remission was observed in 48,2% of patients. No significant between-group differences in tomographic parameters were found that indicated the low value of MRI in the prediction of local treatment outcome. The major factors of stagnating type of HP course were the long duration of the primary exacerbation and non-maintenance of the treatment-prevention regime by patients. Differential criteria of remitting HP course were revealed: the low subjective pain perception in a large number of "painful dots", mild biomechanical disturbances and the presence of less than 6 findings in the MRI of the shoulder joint. In these patients, the use of local treatment is not effective.

Idiopathic chronic calcific periarthritis in a child.

Calcific periarthritis is a calcium deposition disease of the periarticular tissues. Deposits of calcium from calcific periarthritis can be found in the periarticular tissues of the shoulders, hips, elbows, wrists, and knees. This disease is often the manifestation of another primary process, such as end-stage renal disease, collagen vascular disease, and systemic diseases (eg, diabetes mellitus, rheumatoid arthritis), among others. Furthermore, calcific periarthritis has been linked to certain areas of the body because of pathologic stress related to repetitive motions, microtrauma, and local hypoxia. This type of soft-tissue mass is usually found in older men and women. In addition, its incidence, calcium deposits related to calcific periarthritis, and soft-tissue masses in general, are rare in children. Here we present the first report of idiopathic chronic calcific periarthritis in a child. The diagnosis was suspected on the basis of clinical and radiographic appearance and despite the rarity of the disease in children. The patient underwent surgical treatment and was free of local recurrence. The cause of this case was never determined.

[Palindromic rheumatism. Report of one case]. / Reumatismo palindrómico (Enfermedad de Hench Rosemberg). Caso clínico con respuesta a los glucocorticoides.

Palindromic rheumatism is characterized by multiple recurrent episodes of arthritis and periarthritis (mono or oligoarticular) that may last hours or days, disappearing without sequels. We report a 69-year-old male with a history of hypertension and a presumptive diagnosis of gout due to recurrent episodes of arthritis and periarthritis in the last thirty years. They involved at least two joints, lasted few days and were self limited. The patient was admitted due to arthritis and periarthritis of both wrists, knees, ankles, elbows and hands. He presented with fever (38-39 degrees C), intense articular pain and anorexia. With a presumptive diagnosis of palindromic rheumatism and the lack of response to non steroidal anti inflammatory drugs, methylprednisolone 20 mg/od per os was started, with an excellent response.

Reumatismo palindrómico (Enfermedad de Hench Rosemberg): Caso clínico con respuesta a los glucocorticoides / Palindromic rheumatism: Report of one case

Palindromic rheumatism is characterized by multiple recurrent episodes of arthritis and periarthritis (mono or oligoarticular) that may last hours or days, disappearing without sequels. We report a 69-year-old male with a history of hypertension and a presumptive diagnosis of gout due to recurrent episodes of arthritis and periarthritis in the last thirty years. They involved at least two joints, lasted few days and were self limited. The patient was admitted due to arthritis and periarthritis of both wrists, knees, ankles, elbows and hands. He presented with fever (38-39º C), intense articular pain and anorexia. With a presumptive diagnosis of palindromic rheumatism and the lack of response to non steroidal anti infammatory drugs, methylprednisolone 20 mg/od per os was started, with an excellent response.

[Effects of adhesion releasing under nerve block and arthrolysis on adhesive scapulohumeral periarthritis: a comparative study].

OBJECTIVE: To compare the effects of adhesion releasing under nerve block and arthrolysis on adhesive scapulohumeral periarthritis. METHODS: Sixty patients with adhesive scapulohumeral periarthritis 24 males and 36 females, aged 52.5 (40 - 67), were randomly divided into 4 equal groups: Group I, undergoing adhesion releasing under brachial plexus block, Group II, undergoing adhesion releasing under stellate ganglion block, Group III, undergoing limited adhesion releasing under stellate ganglion block, and Group IV undergoing arthrolysis under stellate ganglion block. The clinical effects were recorded and compared. RESULTS: The short-term effect of Group IV was significantly superior to the other 3 groups (all P < 0.05). The frequency of block + manipulation treatment of Group I was significantly less than those of the other 3 groups (all P < 0.01), and the frequency of pain point injection of Group I was significantly higher than those of the other 3 groups (all P < 0.01). CONCLUSION: The 4 methods are all effective for the treatment of adhesive scapulohumeral periarthritis. In particular, arthrolysis under stellate ganglion block shows greater improvement in the joint function and less uncomfortableness caused by numbness and weakness of the arm.

[Periarthritis of the shoulder joint: variants of the course and treatment with artrofoon].

AIM: To compare efficacy of shoulder joint periarthritis (SJP) treatment with artrofoon vs non-steroid anti-inflammatory drugs (NSAID). MATERIAL AND METHODS: SJP patients of the study group (12 males, 18 females, mean age 59.4 +/- 8.9 years, the disease duration 6.5 +/- 3.8 years) received artrofoon (1 tablet 8 times a day for 3 months, in improvement of the condition the dose was reduced to 4 tablets a day). Patients of the control group (11 males, 19 females, mean age 58.3 +/- 9.6 years, the disease duration 5.1 +/- 4.1 years) were given NSAID (primarily diclofenac in a dose 100 mg/day with subsequent dose reduction in improvement). All the patients were examined on the day of the treatment start, 2 weeks, 1 and 3 months later. The examination protocol included general examination, measurement of blood pressure, body mass, height, pain at rest and exercise, motility of the shoulder joint, subjective and objective efficacy and tolerance of the drugs. Total blood count, biochemical blood analysis, urine test, ECG, x-ray, ultrasound investigation of the joint were performed before and after therapy. RESULTS: The majority of the patients from both groups experienced nocturnal pain relief, artrofoon relived also pain at the joint movement. Significant objective and subjective responses were registered in 15 and 14, partial response--in 10 and 12 patients of the study group, respectively, no response--in 5 and 4 patients, respectively. In the controls, the above degree of the response was in 9 and 12, 18 and 16, 3 and 2 patients, respectively. Negative effects of the treatments were not seen. CONCLUSION: SJP treatment with artrofoon is effective. It relieves pain, improves motility of the joint, normalizes mental and somatic status of the patients.

Magnetic resonance imaging in Löfgren's syndrome: demonstration of periarthritis.

In Löfgren's syndrome, pain and swelling commonly involves the ankle joints. In this prospective case series, the magnetic resonance imaging findings of ankle joint involvement are described. Extensive subcutaneous and soft tissue oedema was commonly seen around the ankles. Bone, cartilage, ligaments and tendons were typically uninvolved. Small amounts of joint and tenosynovial fluid were present without evidence of synovial thickening or synovitis. The fluid is probably reactive to adjacent inflammation in the para-articular soft tissues and probably not representing a primary site of involvement. These findings demonstrate that the arthritis in Löfgren's syndrome stems primarily from periarthritis. This is consistent with prior descriptions using ultrasonography.

Does the nature of deposited basic calcium phosphate crystals determine clinical course in calcific periarthritis of the shoulder?

OBJECTIVE: Two typical clinical courses of calcific periarthritis in the shoulder are known: acute, with severe inflammation, and chronic, in the form of impingement syndrome with secondary subacromial bursitis. It remains unclear what factors determine these clinical courses. Our objectives were to clarify whether the calcified deposits that occur in both acute and chronic cases are composed of carbonate apatite; and to compare the Ca:P molar ratio in the 2 forms and to determine if there was any correlation in this respect with the intensity of inflammation induced by basic calcium phosphate crystals. METHODS: Ten samples were aspirated from 10 women (ages 42-65 yrs) with acute inflammation. The average time from first attack to aspiration was 2.3 days. A further 10 samples were operatively removed from 10 women (ages 35-58 yrs) with refractory chronic subacromial bursitis, among whom an average of 7.8 months had passed since the onset of symptoms. All samples were analyzed by x-ray diffraction, Fourier transform infrared spectroscopy, and Raman spectroscopy, and Ca:P molar ratios were measured by x-ray fluorescence spectrometry. RESULTS: Calcified deposits from both acute and chronic cases were identified as carbonate apatite, and not hydroxyapatite, octacalcium phosphate, tricalcium phosphate, or dicalcium phosphate dihydrate. The average Ca:P molar ratio of calcified deposits was calculated as 1.71 +/- 0.16 in acute cases and 1.71 +/- 0.16 in chronic cases (statistically nonsignificant). CONCLUSION: Deposits around the shoulder in both acute and chronic calcific periarthritis are composed of carbonate apatite, Ca:P molar ratios being almost identical in the 2 forms. The results suggest that some factor other than the composition of the crystalline deposits may determine clinical course in calcific periarthritis of the shoulder.

Pseudopodagra: A presenting manifestation of infective endocarditis.

Podagra is a term used to describe acute monoarthritis of the first metatarsophalangeal (1st MTP) joint. The most common diagnoses of arthritis in this joint are: crystal-induced synovitis, septic arthritis, traumatic conditions and reactive arthritis. When etiologies other than gout are involved this is frequently referred to as pseudopodagra. We report the case of a patient who presented with pain and swelling of the 1st MTP The absence of intraarticular crystals and hyperuricemia encouraged further evaluation of the patient. A cardiac murmur was investigated by echocardiography, which revealed valvular vegetations and the diagnosis of infective endocarditis (IE) was established. This is the first reported case of a podagra-like presentation of IE. As in this case, the diagnosis of gout should rest on findings beyond the presence at 1st MTP arthritis, with evaluation of all extraarticular signs in order to rule out other possible diagnoses.

Calcific tendinosis and periarthritis: classic magnetic resonance imaging appearance and associated findings.

Calcification within tendon and periarticular soft tissues with or without a history of pain is commonly encountered in the interpretation of musculoskeletal MR imaging (MRI) studies. This article presents a pictorial illustration of both the classic and atypical MR imaging (MRI) features of soft tissue calcifications in the musculoskeletal system. Familiarity with this topic can help to avoid pitfalls in imaging diagnosis.