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Articular Chondrocalcinosis, Quadriceps Calcification, by Copyright Ann Rheum Dis: first published as 10.1136/ard.42.Suppl_1.104 on 1 January 1983. Downloaded from Suppl p 104 Annals of the Rheumatic Diseases These results show that periarticular calcification may be considered to result References calcification of the shoulder, often from apatite deposits,"2 which are the is common 1 Genant H K. Roentgenographic aspects clinically silent, among most common cause of calcifying ten- of calcium pyrophosphate dihydrate patients with articular chondro- dinitis of the shoulder. This was crystal deposition disease (pseudogout). calcinosis. It is found mainly at more frequent, but not significantly so, Arthritis Rheum 1976; 19: 307-28. the insertion of the supraspinatus in the study group than in the control 2 Gerster J C, Baud C A, Lagier R, Bous- tendon. group; further radiological studies are sina I, Fallet G H. Tendon calcifications Eight patients in the study group needed to see whether apatite in chondrocalcinosis. A clinical, radio- had fine linear tendon calcification. deposition disease could be associated logic, histologic and crystallographic This calcification is supposed to be with articular chondrocalcinosis. In study.ArthritisRheum 1977; 20: 717-22. made of calcium 3 Gerster J C, Lagier R, Boivin G. Olecra- pyrophosphate three cases both linear and dense non bursitis related to calcium pyro- dihydrate crystal deposits, inasmuch as tendon deposits were present; these phosphate dihydrate crystal deposition their morphology is similar to that findings have to be compared with disease. Clinical and pathologic study. observed in other tendons with typical those of a triceps tendon where both Arthritis Rheum 1982; 25: 989-96. CPPD crystal deposits.2 However, CPPD and hydroxyapatite crystals 4 Resnick D. Calcium hydroxyapatite the prevalence in the supraspinatus could be demonstrated by crystal deposition disease. In: Resnick D, tendon is twice that in the Achilles or radiocrystallography,3 suggesting that Niwayama G, eds. Diagnosis ofbone and quadriceps tendons2; this could mixed crystal deposition disease may joint disorders. Philadelphia, London, because of strains due Toronto: W B Saunders, 1981: 1575-97. be repeated occur in certain tendons. There is an 5 Dieppe P A, Doyle D V, Huskisson E C, to the great mobility of the shoulder analogy with what occurs in some Willoughby D A, Crocker P R. Mixed joints. osteoarthritic joints where the two crystal deposition disease and osteo- Dense homogeneous tendon kinds of crystals can coexist.5 arthritis. Br Med J 1978; i: 150. Articular chondrocalcinosis, quadriceps calcification, by copyright. and patellofemoral degeneration in the elderly EDWARD WILKINS, AND GORDON EVISON From St Martin's Hospital, Bath Linear calcific deposits in the observers, using light intensification haemochromatosis or hypercalcaemia. quadriceps tendon1 2 and 'isolated' and magnification. Articular Thirty-four patients had http://ard.bmj.com/ patellofemoral degeneration3 have chondrocalcinosis was defined as the intra-articular chondrocalcinosis; 25 been described as radiographic finding of dense, hazy, linear, or had changes at the knee. The features seen in association with stippled intra-articular calcification. prevalence rose from 15% (3 out of intra-articular chondrocalcinosis. It Quadriceps calcification as seen on 20) in those aged 65-74 to 36% (20 has been suggested that their presence lateral views ofthe knee was defined as out of 55) in those aged 75-84, and to may be of value in distinguishing either in the muscle belly or in the 44% (11 out of 25) in patients aged between pyrophosphate arthropathy tendinous insertion. Formation of from 85 to 97 years. and other forms of degenerative joint osteophyte on the upper margin of the Quadriceps calcification at the on September 24, 2021 by guest. Protected disease. articular surface of the patella, loss of tendinous insertion was seen in 54 We assessed the influence of aging articular cartilage in the patients. The prevalence increased on this interrelationship by analysing patellofemoral joint, and subchondral from 20% in patients aged 65 to 74 radiographs taken on consecutive sclerosis was used to assess the years to 60% in those aged 75 to 84, to admissions to an acute geriatric unit. presence of patellofemoral 64% in those aged 84 to 97. We documented the prevalence of degeneration, classified as mild, Fifty patients had evidence of intra-articular chondrocalcinosis, moderate, or severe. patellofemoral degeneration. In 13 patellofemoral degeneration, and To achieve maximum sensitivity and patients the changes were mild, in 27 quadriceps calcification and defined to avoid excessive radiation exposure, patients moderate, and in 10 severe. In their interrelationship. Ilford rapid R film was used for the 17 cases radiographs showed no other knee x-ray examinations, and abnormality-that is, degeneration METHODS AND RESULTS X-6-Mat RP-X-RPI for the pelvis. was isolated. The prevalence rose from A total of 120 consecutive x-ray films Data were avilable on 100 patients 35 % in patients aged 65 to 74 to 49% of the knee (anteroposterior and (31 men, 69 women) aged from 65 to in those aged 75 to 84 years, and to lateral), pelvis, and wrists were 97 years (mean (SD) 79-4years (6-6)). 64% in patients above 84 years. analysed by four independent None of the patients had The table shows the Ann Rheum Dis: first published as 10.1136/ard.42.Suppl_1.104 on 1 January 1983. Downloaded from Abstracts Suppl p 105 interrelationship between articular Table 1 Relationship between articular chondrocalcinosis (A CC), quadriceps chondrocalcinosis, patellofemoral calcification, and patellofemoral degeneration degeneration, and quadriceps calci- fication. Articular chondrocalcinosis is In association In association No evidence subcategorised into present at the with ACC at with ACC ofACC knee and in joints other than the knee. the knee (n =25) elsewhere (n 9) (n =66) Analysis of these figures shows that Quadriceps calcification: the prevalence of patellofemoral Tendon (n=54) 14 (56%) 4 (44%) 37 (56%) degeneration and quadriceps Muscle (n=10) 3 (12%) 2 (22%) 5 (8%) calcification is similar in patients with and without articular chondro- Patellofemoral degeneration: Overall (n=37) 14 (56%) 5 (55%) 31 (46%) calcinosis. Isolated (n= 16) (mild, moderate and CONCLUSION severe) 3 (12%) 1 (11%) 13 (20%) Articular chondrocalcinosis, Isolated (moderate patellofemoral degeneration, and and severe only) 2 (8%) 1 (11%) 8 (12%) quadriceps calcification are common in the elderly and their prevalence increases in a linear fashion with aging. They are radiographic phenomena closely related to aging and caution Tendon calcification in chondro- logical abnormalities in calcium pyro- must be exercised in postulating a calcinosis. Arthritis Rheum 1977; 20: phosphate dihydrate deposition disease with a disease process in 717-22. (CPPD): pseudogout. Radiology 1977; relationship 2 Waltzing P, Breville P H, de Fugeres 122: 1-15. the elderly. Y D L. La calcification du cul de sac 4 Lagier R. Femoral cortical erosions and quadricipital. Nouvre Presse Med 1980; 9: osteoarthrosis of the knee: an anatomo- 41. radiological study of two cases. Fortschr References 3 Resnick D, Niwayama G, Goergen T G, Geb Roentgenstr Nuklearmed Ergan- 1 Gerster J C, Baud C A, Lagier R, et al. et al. Calcium radiographic and patho- zungsbana 1974; 120: 460-7. by copyright. Arthritis of idiopathic haemochromatosis E. B. D. HAMILTON, A. B. BOMFORD, J. W. LAWS. AND R. WILLIAMS From the Departments ofRheumatology and Radiology, and the Liver Research Unit, King's College Hospital, London http://ard.bmj.com/ We have previously described the Table 1 Prevalence ofchondrocalcinosis in haemochromatosis atfirstand follow arthritis of haemochromatosis,' 2 and up examination in 18 patients (duration offollow up 9-4 years) have now re-examined 18 of these cases after a mean interval of 9 4 First Second years. All patients underwent repeat examination examination x-ray examination. Wrists 3 10 Chondrocalcinosis was found in at Knees: on September 24, 2021 by guest. Protected least one joint in seven patients Meniscus 6 11 initially and in 13 patients at the Hyaline cartilage 4 6 second assessment. Despite adequate Hips 2 5 treatment of iron overload by Symphysis pubis 4 5 venesection it increased in severity and Spine 2 4 spread to new joints. Thirteen patients developed arthritis of the metacarpophalangeal joints, but none of them had associated stores or the patient's age. The table 2 Dymock I M, Hamilton E B D, Laws J W, chondrocalcinosis visible radio- shows the incidence of Williams R. Arthropathy of haemo- logically at this site or in the triangular chondrocalcinosis.3 chromatosis. Clinical and radiological ligament of the wrist. References analysis of 63 patients with iron overload. Ann Rheum Dis 1970; 29: 469-76. It was not possible to show a 1 Hamilton E, Williams R, Barlow K A, 3 Hamilton E B D. Chondrocalcinosis and correlation between the presence of Smith P M. The arthropathy of idio- osteoarthritis. In: Peyron J G, ed. chondrocalcinosis at the initial pathic haemochromatosis. Q J Med 1968; Epidemiology of osteoarthritis. Maccles- assessment and the extent of iron 37: 171. field: Geigy Publications, 1980: 109-12..
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