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Chondrocalcinosis
Commonly found in the elderly Mostly occuring in the knee joint Deposition of different types of crystals in the hyaline articular cartilage and/or fibrous cartilage of the menisci ➢ Predominant：Calcium pyrophosphate dihydrate
bone cortex with concomitant new periosteal bone formation trying to contain the tophus Asymmetric polyarticular distribution
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X-RAY
Chronicity of the disease process Only 45％,only 6-8 years “Punched out” ➢ Until 6–12 years after the initial acute
(CPPD) Produce severe degenerative joint disease (pyrophosphate arthropathy)
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Radiographic hallmarks
Articular and periarticular calcification ➢ Only involving 1 or 2 joints Discrete areas of low signal intensity within the articular cartilage ➢ More apparent on GRE sequences Joint space narrowing Subchondral osteosclerosis Articular surface subsidence
CASE DISCUSSION
By Bone Group 2013-10-24
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History
Male,29Y Complaint:bilateral knee pain with intermittent fever for 4 years
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Key signs？பைடு நூலகம்Your impression？ DDX？
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Radiologic hallmarks
Presence of macroscopic tophi Normal mineralization Relative joint space preservation Erosions with overhanging edges ➢ A gradually expanding tophus eroding at the
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Pathogenesis
MSU crystals ➢ Lipids ➢ Protein ➢ Mucopolysaccharides The tophus eroding the underlying bone is pivotal in the development of bone erosions in gouty arthritis. MSU crystal deposition is associated with the presence of underlying OA.
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Background
Most classically in the first metatarsophalangeal joint (toe) A history of underlying renal disease or use of medications that cause hyperuricemia Gold standard : monosodium urate (MSU) crystals in the joint fluid or tophus
attack
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CT
82% visible tophi Large erosions ➢ >7.5 mm diameter
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MRI——Tophi
T1WI ➢ Homogeneous and generally isointense to muscle T2WI ➢ Varied ➢ Intermediate to low heterogeneous signal
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Laboratory examination ➢ Uric Acid（UA）：478.3μmol/L↑ Treatment ➢ Allopurinol（ALLO）
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Final diagnosis Gouty Arthritis
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Background
Gout is a form of inflammatory arthritis that is characterized initially by acute attacks of active synovitis related to the presence of monosodium urate (MSU) crystals in the joints and periarticular soft tissues. Accounting for 3-7％ in panarthritis Men＞40 years old Genetic predisposition
intensity A variable enhancement ➢ Peripheral enhancement pattern
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DDX
Chondrocalcinosis (pseudogout) Rheumatoid arthritis (RA) Pigmented villonodular synovitis（PVNS）