Hondrokaltsinoz is the chronic disease which is characterized by inflammatory damage of joints owing to deposition of a calcium pyrophosphate in them. Can clinically proceed as asymptomatically, and with displays of sharp monoarthritis or insignificant joint pains. The diagnosis is made on the basis of symptomatology, the anamnesis, detection in sinovialny liquid of the crystals of a pyrophosphate of calcium at polarizing microscopy given a X-ray analysis and ultrasound examination of joints. Treatment consists in use of nonsteroid resolvents (NPVS), colchicine, intra articulate introduction of glucocorticosteroids. If necessary endoprosthesis replacement is carried out.
Hondrokaltsinoz - (a pyrophosphatic artropatiya, pseudo-gout) – a chronic rheumatologic disease which concerns to group of microcrystalline arthritises. This pathology is characterized by adjournment of pyrophosphatic calcic deposits in articulate cartilages and periartikulyarny fabrics (ligaments, sinews, articulate bags) that leads to their inflammation and a degeneration. Hondrokaltsinoz is considered "a disease elderly" and occurs at 30-40% of people 70 years are more senior. Exact data on prevalence among persons of young age are absent. Imitation of symptoms of other rheumatologic pathologies is peculiar to pseudo-gout. The sharp form in the form of monoarthritis is more often observed at men. Artropatiya as osteoarthrosis is specific to a female.
There are several reasons of development of a hondrokaltsinoz, however most often precisely it is not possible to define an etiologichesky factor. Risk factors are advanced age and injuries of joints in the anamnesis. The states capable to cause shifts in metabolism of a pyrophosphate of calcium the following:
- Hereditary predisposition. During the genetic researches ANKH gene mutation (a locus 5p15.2) coding protein which transports an intracellular inorganic pyrophosphate is found in a part of patients. Genetic defect is resulted by accumulation of connection in articulate fabric. Inheritance of a gene is carried out on autosomno-prepotent type.
- Diseases. The metabolic and endocrine pathologies breaking exchange of a pyrophosphate of calcium include hemochromatosis, , a gepatolentikulyarny degeneration (Wilson-Konovalov's disease). Also there is an association of a hondrokaltsinoz with an alkaptonuriya, a gipomagniyemiya, deficiency of alkaline phosphatase.
- Medicines. Some medicines cause a calcic dismetabolizm which can lead to a hondrokaltsinoz. Hormones of a thyroid gland and diuretics belong to such drugs. Adjournment of an inorganic pyrophosphate also arises at long parenteral introduction of medicines of iron and calcium.
The main pathogenetic mechanism at a hondrokaltsinoza is education and accumulation in cartilages of joints of crystals of an inorganic pyrophosphate of calcium. Under the influence of various factors (genetic defect, diseases, reception of medicines) activity of enzymes of group nukleozidtrifosfat-pyrophosphohydromanholes which catalyze reactions of formation of a pyrophosphate by adenosine triphosphate hydrolysis increases. Transition of crystals to sinovialny liquid provokes development of a sinovit. Further adjournment of pyrophosphatic crystals leads to degradation of an articulate cartilage, fibrosis of a sinovialny cover and kaltsifikation of periartikulyarny fabrics (sinews, ligaments, an aponeurosis). Pathoanatomical puffiness of a sinovialny cover, its infiltration by macrophages, lymphocytes and huge multinuclear cages, a hypertrophy and apoptosis of hondrotsit is found. Proliferation of sinoviotsit, erosion of cartilaginous tissue and fragmentation of a blanket of a cartilage are also characteristic.
On a clinical current distinguish the pseudo-gout, pseudo-osteoarthrosis, pseudo-rheumatoid arthritis imitating symptomatology of other diseases of joints. Isolated cases of the psevdoneyropatichesky hondrokaltsinoz reminding Sharko's joint at diabetes are also described. On an etiologichesky factor allocate the following forms:
- Family (hereditary). The disease is caused by a genetic mutation. Develops at young patients (30-40 years) more often. The most severe form of pathology resulting in disability.
- Primary (idiopathic). The most widespread type of a hondrokaltsinoz with not clear reason. The main contingent of patients – elderly people.
- Secondary. Arises at various diseases, and also at reception of the medicines breaking exchange of calcium and an inorganic pyrophosphate.
Symptoms of a hondrokaltsinoz
The clinical picture of a pyrophosphatic artropatiya is various. In some cases the disease proceeds completely asimptomno. Any joints, however favourite localization – knee and luchezapyastny joints can be surprised. The most rare localizations of adjournment of a pyrophosphate of calcium – cervical department of a backbone, pubic , a temporal and mandibular joint. Sharp monoarthritis (pseudo-gout) develops at 25% of patients. Attacks occur in spring time more often. There is a severe acute pain in a joint, puffiness, reddening of skin over a joint, difficulty and morbidity of movements. Skin to the touch hot. Intensity of pain increases within 24-36 hours, then slowly weakens within a week. The first plusnefalangovy joint can be involved that considerably complicates differential diagnostics with gout. Distinctive signs of a hondrokaltsinoz from gout – absence of fever and specific tofus (knots) on skin. Out of an attack of the patient disturbs nothing.
Approximately at a half of patients the symptoms reminding osteoarthrosis – the moderate symmetric aching large joint pains amplifying at the movement and weakening at rest, osteofita (Bouchard and Geberden's small knots) on disteel interphalanx joints having the size from rice grain to a pea are observed. At damage of meniscuses of knee joints there is an Au-shaped curvature of the lower extremities. 5% of patients have the pseudo-rheumatoid arthritis which is characterized by pain and a swelling in pyastno-phalanx joints with morning constraint.
Hondrokaltsinoz is a benign disease with the minimum quantity of complications. Formation of the expressed deformation or rough contractures of the joints breaking their functions happens only at a hereditary form. The main problem is represented by pathological states which served as a background for development of an artropatiya. Treat damage of a liver and central nervous system at Wilson-Konovalov's disease them, a kaltsifikation of vessels and kidney tubules at a giperparatireoza, cardiovascular accidents at hemochromatosis.
Of patients with hondrokaltsinozy rheumatologists are engaged in Kuration. At diagnosis the clinical picture, the family anamnesis, prescription of a disease, existence of associated diseases, reception of medicines are considered. For confirmation of the diagnosis the following methods researches are conducted:
- Blood tests. Specific changes are absent. At a pseudo-rheumatoid form inflammation markers – , increase in speed of subsidence of erythrocytes, S-jet protein and a rheumatoid factor sometimes come to light. For an exception of the diseases associated with hondrokaltsinozy determine the level of iron, the ionized calcium, copper, paratireoidny hormone.
- Tool methods. At a X-ray analysis of joints the radiological sign, specific to a hondrokaltsinoz, – a hyaline articulate cartilage which is presented in the form of the narrow shadow repeating a contour of an articulate surface is noted. Also narrowing of an articulate crack, existence of a sclerosis of a subkhondralny bone, subkhondralny cysts, a kaltsifikation of sinews and sheaves are observed. Ultrasonography of joints is more sensitive that gives the chance to identify calcic deposits of the smaller size which look as giperekhogenny spots in a hyaline cartilage.
- Analysis of sinovialny liquid. The decisive test allowing to establish authentically the diagnosis. Liquid transparent, viscous, contains a small amount of leukocytes. By means of polarizing microscopy with use of the compensator the monoklinny or triclinic crystals of a pyrophosphate of calcium having the diamond-shaped form and a blue luminescence are found.
Bad attacks of a hondrokaltsinoz should be differentiated first of all with gouty arthritis. Also it needs to be distinguished from other rheumatologic diseases proceeding with similar symptomatology – rheumatoid arthritis, infectious arthritis. Orthopedists and surgeons take part in differential diagnostics.
Treatment of a hondrokaltsinoz
There are no strict indications for hospitalization at this disease. Treatment can be carried out both in out-patient conditions, and in a hospital. Etiotropny therapy does not exist. Non-drug methods of influence come down to Holodov to applications, balneoprotsedura, unloading of the affected joint and performance of special physical exercises for strengthening of the muscles stabilizing a joint. At a secondary form of a disease cancellation of causal medicines and treatment of the main disease is required (a giperparatireoza, hemochromatosis, a gepatolentikulyarny degeneration).
For removal of a pain syndrome use not narcotic analgetics (diclofenac, , to lornoksika). Considering need of patients for long reception of NPVS, additional purpose of inhibitors of a proton pomp (, ) is necessary for prevention of development NPVS-indutsirovannykh of gastropatiya. At bad pseudo-gouty attacks NPVS combination to colchicine is effective. With the anti-inflammatory purpose intra articulate injections of glucocorticosteroids are applied (, beta metazones). At the expressed degenerate changes in joints surgical intervention (endoprosthesis replacement) is carried out.
Forecast and prevention
Hondrokaltsinoz in most cases has the favorable forecast. The expressed deformations and the rough contractures of joints leading to violations of their functions happen seldom and generally at a genetic form of pathology. At cancellation of the medicines causing development of a pyrophosphatic artropatiya quickly there occurs regress of symptoms without any residual phenomena. Specific methods of prevention it is not developed. For prevention of progressing of a disease it is necessary to carry out treatment of pathologies which are associated with hondrokaltsinozy.