pseudogouty arthritis
Introduction
Introduction to pseudo gouty arthritis Pseudodogout, also known as articular cartilage calcification, was first described by Zitnan and Sitai in 1960. The disease is a joint disease caused by the crystal deposition of calcium dihydrogen pyrophosphate, including acute arthritis with intermittent onset; degenerative joint disease, sometimes severe, sometimes without symptoms, X-ray examination can be in specific parts See images of calcination of articular cartilage. basic knowledge The proportion of illness: 0.001% Susceptible people: mostly after the age of 30, the elderly Mode of infection: non-infectious Complications: osteoarthritis joint pain
Cause
Cause of pseudo-gouty arthritis
The cause of the disease is unknown, often associated with trauma (including surgery), amyloidosis, myxedema, hyperparathyroidism, gout and hemochromatosis, suggesting that calcium dihydrogen pyrophosphate (PPD) crystals are deposited in the cartilage. It is a degenerative or metabolic change secondary to cartilage. The disease usually occurs in patients over 60 years old. The incidence of cartilage calcification in patients over 70 years old is about 30%, and the incidence rate is close to 90 years old. The incidence rate is 50%. The rate is the same.
Prevention
False gouty arthritis prevention
For the prevention of this disease, pay special attention to living habits:
1. During the holidays, do not overeating, avoid overnutrition and obesity, maintain ideal weight, stay away from smoking, alcoholism and other bad habits, pay attention to work and rest, long-term mental work, daily physical activity should be Brain activity and physical activity alternate and persist.
2, reasonable arrangements for life, life should be regular and temperate, while cultivating the spirit of optimism, often participate in entertainment and sports activities.
3, regular physical examination, physical examination is very important to prevent gout, especially those over 40 years old or obese, should do a physical examination every 1-2 years, including blood uric acid determination, to early detection of patients with hyperuricemia, to prevent To the development of gout.
Complication
False gouty arthritis complications Complications osteoarthritis joint pain
The fibrocartilage and hyaline cartilage of the joint of the disease can be seen in punctate and strip calcification. Calcareous deposits can also be seen in the synovial membrane, joint capsule, tendon and intra-articular ligament. Although the prognosis is generally good, similar neurogenic joints can occur. Severe destructive joint damage to the disease (Charcot joint), so once diagnosed, it should be actively treated to prevent complications.
Symptom
False gouty arthritis symptoms Common symptoms Osteopathic erythrocyte sedimentation increased elbow joints can not flex the hips, knees, elbows...
The age of onset of this disease is mostly in the middle and old age after 30 years old, similar to gout, and there is no obvious gender difference in this disease.
According to a group of 192 patients reported by Resnick (1988), the clinical manifestations of the disease were classified into the following seven types:
Type I pseudogout (pseudogout), similar to gout attacks rather than gout, characterized by acute or subacute, self-limiting arthritis episodes involving 1 or several small joints, with an attack time of 1 day to several weeks, usually painful Light, this type is best to invade the knee, but hips, shoulders, elbows, wrists, ankles, etc. can be affected, accounting for about 10% to 20%.
Type II pseudo-rheumatoid arthritis, characterized by persistent, acute onset of arthritis, symptoms can last from 4 weeks to several months, and erythrocyte sedimentation rate is accelerated, accounting for about 2% to 6%.
Type III pseudo-osteoarthritis (1), the most common type, accounting for 35% to 60%, manifested as chronic progressive arthritis, and may be associated with occasional acute infection, symmetric involvement of large joints Such as the knee, hip and metacarpophalangeal joints, elbows, ankles, wrists and shoulder joints, which are characterized by bilateral symmetry involvement and flexion contracture, especially the knee and elbow joints.
Type IV pseudo-osteoarthritis (2), accounting for about 10% to 35%, this type of clinical features is chronic progressive arthritis, and no acute exacerbation, such as type III, its performance is similar to regression Sexual joint disease.
Type V asymptomatic joint disease, although it has been reported that patients with asymptomatic CPPD may account for 10% to 20% of asymptomatic patients, and the incidence of this clinical type is quite high, but clinically rare There are asymptomatic patients, and it has been reported in recent years that older Jews can account for 27.6% of cartilage calcification. Most of these patients are asymptomatic, and even in some patients with joint symptoms, calcification is In addition, joints with no obvious symptoms were used for aspiration of joints without symptoms, such as the metatarsophalangeal joint, which confirmed the presence of CPPD crystals. These patients had radiological findings with or without pseudogout.
Type VI pseudo-neuroarthropathy (Pseudo-neuroarthropathy), accounting for about 0 to 2%, is a rare clinical type of CPPD crystalloid disease, similar to the manifestations of neurological joint disease.
Type VII has a miscellaneous pattern, which is the least common type of disease, accounting for about 0-1%. McCarty has emphasized that CPPD crystalloid disease can produce rheumatic fever and psychotic symptoms, and the clinical manifestations can be similar to rigidity. Spondylitis.
In conclusion, CPPD crystalloid disease can manifest as acute or chronic arthritis-like symptoms, can also be asymptomatic, or one patient can have several different clinical manifestations.
Examine
Examination of pseudo-gouty arthritis
The disease is often based on imaging examination methods, and its performance mainly has the following aspects:
1, cartilage calcification
The most commonly affected areas are the knee, wrist, pubic symphysis, elbow and hip, and the affected cartilage includes fibrocartilage and hyaline cartilage.
(1) Fibrocartilage calcification: the most commonly involved are the meniscus of the knee joint, the triangular cartilage disc of the wrist joint, the pubic symphysis, the annulus of the intervertebral disc (Fig. 1), and the acetabular and scapular lips; The pads of the joints and sterno-lock joints, the deposits of fibrocartilage, appear as thickened, rough and irregular dense areas, especially in the middle of the joint cavity.
(2) Calcification of hyaline cartilage: can occur in many parts, but most often in the wrist, knee, elbow and hip joints, these deposits are thin, line-like, parallel to the adjacent subchondral bone.
2, synovial calcification
Calcification in the synovium is a common sign of CPPD crystalloid disease. This calcification usually coexists with cartilage calcification, but this calcification is often more pronounced. Synovial deposition is most common in the wrist, especially around the wrist joint. Ulnar joints, knee joints, metacarpophalangeal joints and metatarsophalangeal joints; also visible in the tibial joints, elbows, hips and acromioclavicular joints, sediments are cloud-like, especially at the joint edges, but also similar to idiopathic synovium Osteochondromatosis, a fragment of calcified synovial membrane, may have fragments of calcified cartilage.
3, joint capsule calcification
CPPD crystals are deposited in the joint capsule, most commonly in the elbow and metatarsophalangeal joints, and also in the metacarpophalangeal and scapular joints (Fig. 2). These piles, fine or irregular linear calcifications cross the joints, and possibly Combined with joint contracture, especially the elbow joint.
4, tendons, bursae and ligament calcification
Patients with CPPD crystal disease may have calcification of tendons and ligaments. Common sites are Achilles tendon, triceps, quadriceps and supraspinatus and acromio sac; sometimes it can also be seen in the sacral sac. 3), the calcification of the tendon is thin and linear, and can be extended from the edge of the bone to a considerable distance. The calcification of the infected bursa is common in the olecranon, the tendon of the shoulder, the calcification of the bursa, sometimes seen in the shoulder. Sleeve laceration.
5, soft tissue and vascular calcification
In some patients, soft tissue and vascular calcification are seen, which is characterized by unclear calcium deposits. Soft tissue calcification is most common in the elbow, wrist and pelvic regions. Vascular calcification may be associated with comorbid diabetes.
Diagnosis
Diagnosis and diagnosis of pseudo-gouty arthritis
Diagnostic criteria
1 Two or more joints show typical hyaline cartilage or fibrocartilage calcification, disc calcification is not included;
2 The effusion was aspirated from the joint with or without symptoms, and the monoclinic or polyclinic crystals were observed by compensatory aurora microscopy, lacking or exhibiting weak positive birefringence.
Differential diagnosis
1. Neurological joint disease
That is, the Charcot joint, its hyperplastic hypertrophy can have calcification of joint capsule and articular cartilage, narrow joint space and articular surface sclerosis, sometimes confused with pseudogout, but Charcot joint still has joint structure disorder, clinical painful joints If the decline or loss of pain, etc., the identification of the two is not difficult.
2, traumatic joint disease
Joint structure damage, bleeding, joint capsule, synovial membrane and tendon, calcification or ossification of the ligament, free body visible in the joint, narrow joint space, joint surface sclerosis and cystic changes at the joint end Gout is similar; but traumatic arthritis still has a history of trauma, in addition, mostly single joint involvement.
3, hyperparathyroidism
Parathyroid hormone can cause bone calcium dissociation, and blood calcium is elevated, and can cause calcification of articular cartilage and soft tissue calcification around the joint. Hyperparathyroidism is accompanied by subperiosteal bone resorption, general osteoporosis and Fibrocystic osteitis, etc., is an important distinguishing point from pseudogout.
4, gouty arthritis
Both ginseng and gout can be seen as calcification or calcareous in the soft tissues around the joints and joints. Gout is often easy to invade the hands and feet, while pseudogout is good for invading the large joints.
5, uric acid arthritis
It can also cause soft tissue calcification in the knee, hip, shoulder joint or around the joint. It can also be seen in the pubic symphysis and intervertebral disc calcification. It is similar to the pseudo gout, but the former infant can have black uric acid symptoms in early childhood.
