Chondrocalcinosis and Pseudogout

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Chondrocalcinosis is defined as the deposition of calcium salts in articular hyaline cartilage and fibrocartilage.131 This study showed that most patients were asymptomatic (21 of 71 [30%]) and that only 4 (5.6%) of 71 had intermittent attacks of pseudogout. Chondrocalcinosis and pseudogout are said to be sufficiently frequent (3.8%) in hyperparathyroidism such that screening of such patients is warranted.132 Occasionally, pseudogout is the initial manifestation. It is characterized by arthritis and pain in one or more joints associated with the presence of calcium pyrophosphate dihydrate crystals in the synovial joint fluid. Acute attacks of pseudogout arthritis may be precipitated by transient or rapid changes in the serum calcium concentration. A rapid change in calcium concentration is often seen after successful surgery, causing attacks of pseudogout, which may complicate the postoperative clinical picture. Unlike the predominance of gouty arthritis, pseudogout rarely involves the foot. The most common joint involved is the knee; less commonly involved are the elbows, wrists, and ankles. Radiographic features of chondrocalcinosis include calcification of articular cartilage and joint effusion that may be characteristic enough to suggest PHPT. Identification of the crystals through aspiration is diagnostic for pseudogout. A series of eight patients in whom pseudogout arthritis developed as the initial clue to PHPT had no further arthritic complaints 6 weeks postoperatively.132 In the same study, 12 patients developed pseudogout acutely after parathyroidectomy. Nonsteroidal anti-inflammatory analgesics brought relief from these symptoms.132 It seems that parathyroidectomy prevents the progression of chondrocalcinosis and in general relieves symptoms, although acute episodes of pseudogout and gout may occur after parathyroidectomy, usually at the nadir of postoperative hypocalcemia.

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