Pyrophosphate arthropathy: symptoms, diagnosis, treatment, prevention
Pyrophosphate arthropathy: symptoms and treatment
Pyrophosphate arthropathy — a pathological condition characterized by deposition of crystals of calcium pyrophosphate in the cartilage of joints and synovial membrane and belongs to the microcrystalline arthritis.
The disease can wear acute and manifest in the form of individual attacks of arthritis, which are repeated from time to time and/or become chronic. Usually the acute form of the disease is more common in men, and chronic and is diagnosed mostly in women.
The disease usually develops in people over 50 years old, and pathology equally affects both sexes.
Generally, the occurrence of the disease at a younger age due to genetic factors or a manifestation of fibrous-cystic osteitis and other pathologies.
The causes and mechanism of development of the disease
Often crystals of calcium pyrophosphate are formed in the tissues of the joints, in the fixation of tendons and ligaments to the skeleton in individuals under the age of 40-50 age. The pathological process progresses through the natural aging of man.
Currently, the cause of the crystals and the mechanism of the disease is not fully understood.
It is known that there is a genetic variation of pyrophosphate arthropathy. I assume that it is based on violation of the activity of the enzymes involved in the metabolism of calcium pyrophosphate, as well as genetic abnormalities in the structure of the cartilage.
Pyrophosphate arthropathy is often diagnosed in patients suffering from:
- fibrous-cystic osteitis;
- bronze diabetes;
- the Wilson’s disease.
With all these diseases there is abnormality of calcium metabolism and /or calcium pyrophosphate or creates the necessary conditions for the formation of crystals of calcium pyrophosphate in the junction, including cartilage.
But what is more often essential (primary) form pyrophosphate arthropathy. The etiology of the disease in these patients is unknown, they have not revealed abnormalities of calcium metabolism and calcium pyrophosphate.
According to the hypothesis, the primary form of the disorder can be associated with trauma to the cartilage, separate the anomalies of the joints, age-related degenerative disorders of cartilage.
Despite the fact that the Deposit of crystals of calcium pyrophosphate in cartilage disrupt their structure and function, these changes usually does not clinically manifest.
Even if chondrocalcinosis joints, in which the x-rays show the mass deposition of crystals signs of the disease is often not observed.
Only when the migration of crystals from the cartilage into the joint cavity symptoms of disease. Only in these patients develops an inflammatory process, crystals of calcium pyrophosphate are absorbed by cells of the synovial membrane and synovia, causing allocated protease, and aktiviziruyutsya a number of other inflammatory factors.
The clinical picture in each individual case
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Symptoms pyrophosphate arthropathy, in General, are nonspecific and are similar to other pathologies of joints. Therefore, the specific clinical types of the disease, it is customary to add the prefix «pseudo», for example, pseudogout, psevdoosteoartroz etc.
But for each variety of the disease characterized by microcrystalline arthritis. The disease periodically becomes aggravated, during an attack, there are signs of inflammation, which are themselves.
Resembles gout, but not this one
Some patients with pyrophosphate arthropathy resembles gout. This variant of the disease called «pseudogout».
With this development of the disease the patient is having periodic fever, similar to attacks of gout: a sharp pain, the affected joint swells, usually suffers a single joint.
50% of patients in the pathological process involved the knee joint, less commonly affects large and medium-sized joints.
During an attack can worsen the overall health of the patient, temperature to rise. Pain when psevdopodagra not as strong as in gout, and the attacks longer. Sometimes an attack can last more than 3 weeks.
After some time, the symptoms completely disappear. To provoke an attack of pseudogout can: trauma to the joint, surgery, major physical diseases, such as myocardial infarction, acute violation of cerebral circulation, etc.
Symptoms similar to osteoarthritis
Somewhere in 50% of patients the clinical picture of pyrophosphate arthropathy similar to osteoarthritis, and therefore it is called «psevdoosteoartroz.»
For this type of disease is characterized by loss of several joints. Usually affects large and metacarpophalangeal joints.
Pain syndrome of moderate, but constant, against which at times have short-lived attacks of pseudogout also.
With the development of the disease can experience decreased range of motion of the joints, a mild violation of their extension.
The case is rare, but possible
5% of the patients symptoms similar to rheumatoid arthritis, hence the name «pseudorheumatoid arthritis.»
In the pathological process involved simultaneous multiple joints, there is pain, swelling, stiffness, decrease range of motion.
A blood test may show an elevated RBE. In patients, there was a General for pyrophosphate arthropathy feature: paroxysmal course of the disease. But attacks are not so strong as when psevdopodagra, and can last for several months.
There are other clinical types of pyrophosphate arthropathy, for example, destroyed any one, usually the knee, a joint that is similar to lesions of the joints in syringomyelia.
Suspect pyrophosphate arthropathy is when arthritis attacks the knee or other major joint in patients of older age group. The diagnosis is confirmed if the patient revealed crystals of calcium pyrophosphate in synovitis.
Find them with the help of polarization microscopy. It allows you to identify the typical optical quality of the crystals, namely the effect of birefringence.
The characteristic symptom of the disease, to which experts pay attention to, is the joint chondrocalcinosis, in which there is calcification of the cartilaginous intra-articular disc and articular cartilage.
Tend to suffer menisci, disks, pubic symphysis, and wrist joints. So suspecting pyrophosphate arthropathy doctors prescribe for diagnostic radiography of these parts of the skeleton.
Although chondrocalcinosis may develop when depositing in the articular cartilages of other calcium crystals, for example, oxalate.
The x-rays can often be seen and abnormalities characteristic of osteoarthritis and sometimes substantial destruction of the joints, calcification of areas of the fixing tendons and ligaments to the bones.
To exclude secondary pyrophosphate arthropathy prescribe tests to determine the level of calcium, magnesium, phosphorus and alkaline phosphatase activity in patient’s blood.
Treatment of the disease
Because the pathogenesis and etiology of the disease is not fully known, specific therapy to date does not exist.
At the beginning of an acute attack Colchicine prescribed, but he acts slowly and is not able to prevent the worsening of the disease.
Further, the development of the attack used non-steroidal anti-inflammatory drugs. After 3-4 days the symptoms are reduced. If a strong inflammation in the joints prescribe corticosteroids that are injected directly into the joint. They quickly stop pain and inflammation.
In chronic disease patients shows similar methods of treatment as in arthritis:
- unloading of the joint (normalization of body weight, restriction of walking, stay in a vertical position, carrying heavy loads and etc.);
- a General tonic and stimulant drugs that normalize metabolism (aloe, vitreous body, ATP, Rumalon in capsules, multivitamins);
- physical methods that improve the local and General metabolism and blood flow and possess analgesic and resolving effect (balneotherapy, application of mud, radon and hydrogen sulfide baths, etc.).
Patients recommended Spa treatment. When severe joint damage, surgery is indicated.
Specific prevention pyrophosphate arthropathy does not exist. Patients contraindicated physical activity, they need to avoid injuries to the affected joint, as this facilitates the migration of crystals from cartilage into the synovial cavity, which causes synovitis and joint damage.
The progression of the disease and the destruction of joints leads to disability of the patient.