Chondrocalcinosis

Chondrocalcinosis is a disorder we see quite often in rheumatology. It is classified according to ICD-10 as M 11.1/2. The higher the age, the higher the percentage of people being affected, you might see 50% of the age group 85 years and more, though most people will be asymptomatic. The disease might come with painful attacks like in gout. As the disease is also due to crystals, which are called calcium pyrophosphate dihydrate crystals (CPPD), it is very close to gout, we also call the disease pseudo-gout and the attacks might be called pseudo-gout attacks.

The term chondrocalcinosis has been coined after the radiographic findings, which I’ll show later in this short communication. Especially the knee joints are often affected and we also see it on X-ray charts of the wrists. The diagnosis can be verified by looking at the synovial fluid with a microscope that has a function of polarized light (crossed polarizing filters). The CPPD crystals are rhombus shaped and are “positively birefringent” (you better leave this to the expert :-) ). There are quite a lot of conditions that are associated with chondrocalcinosis and you might look these up in the good article on Wikipedia: http://en.wikipedia.org/wiki/Chondrocalcinosis.

So here is your X-ray. It was done in the right knee of an elderly lady. The red arrows show distinctive parts of osteoarthritis, the green arrow point at the calcifications of the menisci.

The next picture I have taken of an X-ray chart in Switzerland. It is the X-ray of a mummy, which is shown at the museum of Yverdon. The mummy has been a priest by the name of Nesshu. If you are at Yverdon I can recommend visiting the Musée d’Yverdon (http://www.musee-yverdon-region.ch/musee.php?include=vocation&lng=en). More on the Archeology part of the museum at http://www.musee-yverdon-region.ch/musee.php?include=collections&lng=en#egypte . And check, if the mummy is at the center for evolutionary medicine in Zürich instead: http://evolutionäremedizin.ch/2011/09/nes-shou-the-mummy-from-yverdon/.

Treatment is like in gout attacks, mostly NSAIDs, sometimes colchicine [one of my colleagues here likes colchicine, but I think it also may have lots of side effects], but other medications might also be considered. Reducing uric acid doesn’t have an effect on acute pseudogout.