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hydroxyapatite deposition disease; calcium hydroxyapatite deposition disease; basic calcium phosphate deposition disease

Etiology: - often occurs in the setting of trauma Epidemiology: - mostly occurs in women Pathology: - deposition of calcium hydroxyapatite in synovial joints & tendon sheaths Clinical manifestations: 1) acute inflammation a) calcific tendonitis b) osteoarthritis c) periarthritis/arthritis dialysis syndrome d) rupture of calcinotic deposits in scleroderma 2) chronic inflammation a) glenohumeral osteoarthritis b) rotator cuff tear c) Milwaukee shoulder [2] 3) active motion is limited 4) passive motion may be preserved 5) may be asymptomatic Laboratory: 1) synovial fluid a) individual crystals cannot be seen on routine polarization microscopy b) small, round bodies 0.5-100 um seen as lumps of crystals c) positive identification requires electron microscopy or elemental analysis d) Alizarin red staining for Ca+2 plus exclusion of CPPD provides presumptive diagnosis e) non-inflammatory: case [2] with 8300 leukocytes/uL Radiology: - X-ray may show articular & periarticular dystrophic calcification Differential diagnosis: - pseudogout with inflammatory synovial fluid Management: 1) NSAIDs 2) intra-articular glucocorticoids 3) colchicine [2] 4) joint aspiration & tidal lavage [2]

Related

hydroxyapatite

Specific

Milwaukee shoulder/knee syndrome

General

crystalline arthritis (crytalline arthropathy) chronic inflammation

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 862
  2. Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2022.