Alkaline calcium phosphate crystal deposition disease

Although physician outlining have long been aware of calcified material deposition in articular tissues and in particular deposition in the tendon, can cause recurrent inflammation, but for the naming of such different diseases, the next call tendon calcification disorders, hydroxyapatite () sexual rheumatism, calcified joints adjacent to inflammation or calcifying tendinitis. Calcification of the most common site for material deposition shoulder, especially on the scapular spine ligament, often called calcific tendinitis, But calcification can be deposited in many other parts. Alkaline calcium phosphate crystal can be deposited in the joint tissue and the formation of a typical clinical and X-ray features. The most common X-ray characteristics of the deposition shoulder, but the other parts can be found similar changes. Pathogenesis alkaline calcium deposition in the pathogenesis of sexually transmitted diseases, although not yet fully clear, but the following hypothesis : 1.Codman considers the original injury is not normal because of the pressure caused tendon degeneration. Then calcium deposition in the degradation of tendon. Pain is due to inflammation or calcium deposition caused by the normal pressure. Key 2.Pederson and that the calcium deposition in the necrotic tissue or blood for less regional, with the local pH change. Support of this argument is the so-called "blood for the relative lack of control area" theory (critical zone of r elative hypovascularity) found at a distance on the scapular spine ligament insertion of about 1 cm existence lack of a blood supply, This is not the most common calcium deposition zones. 3.Gondos observed that the activity of large joints, prone to calcium deposition. Therefore, he thinks that the injury is made abundantly clear in one of the reasons. 4.Amor others of 38 patients received the HLA typing, and 591 compared to the control group, found HLA-A2 and HLA-Bw35 is higher in dialysis patients. can be found in different parts of the calcium deposition, it was believed to genetic and metabolic disorders, and the incidence. 5.Unthoff others in the 1970s made a new argument, that formation of calcified joints adjacent to the incentives tendon after hypoxia is producing fibroblasts cartilage metaplasia (fibrocatilagen ous metaplasia), secondary calcium deposition. Biopsy study found that In Uhthoff others found calcium deposition site near the existence of a similar cartilage cells (chondr ocyte like cell), but found that inflammatory cells. He calcification process that occurred in the living cell, but not necrosis, and the occurrence of calcification process in tendon and ligament on the endochondral ossification (endochondrol ossific ation) is similar. The difference is the lack of vascular calcification tendon, and endochondral ossification are long-angiogenesis. However, there is as yet no proof of this theory, the real mechanism is still to be explored. Moseley pathological changes observed in the sediments of calcification following the evolutionary process. 1. Completely inactive calcification in the tendon deposition, the stage will not result in any clinical symptoms, At this time X-ray showed a clear edge calcification sediments, if adopted surgery to remove, can be found calcification of concentration of particles or cheese - like objects. 2. Machinery period increased sediment, oppression subacromial bursa, this time caused varying degrees of shoulder pain symptoms, bursectomy vascular congestion, X-ray visible calcification edges unclear, or decentralized into line, or even completely disappear. ⑴ bursectomy Break : some sediment discharge from the tendon to bursectomy, this process can be repeated. even all of the sediment discharge from the tendon. ⑵ bursectomy within rupture : sediment discharged into bursectomy rupture, sometimes cause severe pain and inflammation. 3. Adhesive joints adjacent to inflammation of this period tendon calcification within the sediments and adhesive bursitis occurred at the same time patients from feeling pain, weakness, joint activities restricted. 4. Small bone calcification sometimes the sediment will expand to near the nodular form of nodular cystic sizes within objects. 5. Dumbbell-small minority of the cases, because of coracoid process acromial ligament oppression, subacromial bursectomy the dumbbell-shaped sediment formation. Although the process is not very clear, but showed calcification in the left shoulder of sediments may have different forms, and the location of calcification in the left shoulder under deposition in which a tendon varies. Diagnosis (1) Identification of crystallization (2) around the shoulder joint synovial tendon, bursectomy ligament and organizations is the most common site of the deposition. Bosworth found over the right shoulder of the left shoulder common, but about 50% of patients also have bilateral deposition phenomenon. Almost alkaline calcium deposition in the body Ne joint or tendon. Gondos found that the greater the activities of joint, the more easily find alkaline calcium deposition, found that patients with calcification in the left shoulder about 69%, followed by the hips, elbow, wrist and knee. Scapula and shoulder through the supraspinal ligament, humerus from the large nodules (greater tubercle) Attachment 1 cm Department Office of the most common single deposition spaces. When the shoulder in internal rotation and the swing-and they can clearly see the calcium deposition on the scapular spine ligament. At the scapular spine ligament attached to the humeral the calcified nodules, as secondary degenerative calcification, This degenerative calcification is not reversible, and the above-mentioned joint primary next calcification different. Calcified joints adjacent inflammation calcification may change with time, become small and scattered, or completely disappear. (3) clinical manifestations (4) typical X-ray findings of a clinical manifestations, calcified joints adjacent to inflammation early in 1870 was on the description resistance adjacent joint inflammation most often occurs in the shoulder, However, it was not until 1938 before they are carried out systematically organized. An insurance company survey of five 061 employees, of which 138 were found to have calcium deposits in one or both shoulder, over 70% of patients less than 40 years old, and most have no symptoms, but after a follow-up investigation found that more calcium deposition often leads to acute inflammation attack. Some smaller deposition can naturally absorb. Taipei Veterans General Hospital, Dr. Yi-Feng at the 1992 investigation of 81 cases of shoulder calcifying tendinitis patients The average age of 61.2 years, underwent arthrography, which found 22 cases of a rotator cuff tear phenomenon. Most acute calcified joints adjacent to inflammation, in a single joint, accompanied red, swelling, heat, pain, sustainable several weeks. X-ray found that calcium deposition is the best basis for the diagnosis. Relapsed multiple calcified joints adjacent to inflammation, suggesting that the disease is not only restricted but a systemic disease, Some reports were found to be familial aggregation. 2. articular alkaline calcium phosphate crystal deposition arthropathy now that the crystallization of calcium is alkaline addition urate crystal Coke phosphorus and calcium beyond the crystallization of calcium third articular crystallization. Schumacher and others have described the young man attack of acute and chronic arthritis, often acute red, swollen, pain, and acute gouty very similar. Using scanning electron microscopy in the synovial fluid may find alkaline calcium phosphate crystal, joint fluid WBC also increased significantly. Alkaline crystallization of calcium phosphate directly injected into animals joints, which can induce acute arthritis attack. 1976 Dippe and others discovered that degenerative arthritis synovial fluid within the crystal by energy dispersive X-ray analysis, Alkaline crystallization of calcium phosphate. Other reports found that about 30 -60% of degenerative joint synovial fluid of patients can be found within the alkaline calcium phosphate crystal, Alkaline phosphatase crystallization and crystallization of calcium pyrophosphate dihydrate often appear together, and results showed that Alkaline calcium phosphate crystal and joint closely related to the extent of the damage, and the crystallization of calcium pyrophosphate dihydrate deposition, and the patients were age-related. 3. Milwankee shoulder / knee syndrome McCarty special on 30 cases of patients with arthritis, will be named Milwankee shoulder / knee syndrome. This syndrome has a special clinical, X-ray and synovial fluid performance. 1. Clinical manifestations 80% of female patients, and violations of shoulder mainly associated with glenohumeral joint degradation and significant rotator cuff tear. Patients aged 53-90 years, with an average age of 72.5 years old. Slow onset, from a year to 10 years. Most flu patients with mild-to-moderate pain, especially in the shoulder, after resting a few people may feel severe pain. Other symptoms include joint activities limited, rigid and night pain. Zha body can be found by the joint activity limitations, unstable, if the humeral head to glenoid would create friction Tone bone pain, joint puncture fluid often gutsy, about 30-40ml and sometimes even more to 130ml. 2. Related factors associated factors, including : ① injuries and excessive use include : falls, motorcycle abuse, professional wrestling athletes and arthritis recurrent shoulder dislocation; ② shoulder congenital dysplasia; ③ neuropathy : If cervical radiculopathy or syringomyelia; ④ long-term dialysis patients; ⑤ unknown reason : about one third. Milwankee shoulder / knee syndrome, may be many reasons for the common role of the results. Neer and others described in the rotator cuff tear arthropathy very similar, may be the same diseases. 3.X characteristic X-ray lines can be found glenohumeral joint degradation, soft tissue calcification, upward humeral head subluxation. Arthrography found rotator cuff tear. Most of the patients humeral head to curbs on the edge of the acromion distance of less than 2 mm. Coracoid process is common, subacromial surface and acromioclavicular joint injury. Humeral head and the acromion and clavicle often pseudojoint formed. Common humeral head is damaged, but spur formation is not serious. These X-ray changes in the shoulder with degenerative arthritis different. So far, China has not found such cases. 4. Synovial fluid characteristics of the synovial fluid leukocyte number of often less than 1 × 109 / L. Most of the synovial fluid can be found within the alkaline calcium phosphate crystal, granular collagen, can be found in collagenase and protease activity increased. 5. McCarty knee performance reported in the 30 patients, 16 patients with knee involvement, with the lateral tibial joint cavity about 30% stenosis. This form of the knee and the general degradation of degenerative arthritis of the knee is different. 4, secondary alkaline calcium phosphate crystal arthropathy certain diseases, including chronic failure, Autoimmune diseases and nerve damage can produce deposition phenomenon. Alkaline calcium phosphate crystal can be deposited in the joint adjacent soft tissue and articular bursectomy, often combining some of the symptoms of rheumatic diseases. It was reported that in the scleroderma patients joints were found to have calcification, or even out Fenbihui-like synovial fluid, Furthermore, it was reported in the overlap syndrome (overlap syndrome) patients found multiple deposition phenomenon. It was found that intra-articular injection of sugar Paper hormone drugs, the needle along the way can produce para-articular calcification, Calcification phenomenon can occur in the months after injection, such as calcification of a few months or a few years later, can be gradually absorbed. Tumor calcification diseases is a single or multiple joints within or adjacent to a large number of joints, gradually expanding the calcified deposits, more common in Africa, North America and Europe rarely see. If the patients have high phosphate hyperlipidemia, to identify methods of treatment to limit phosphate uptake. This disease often familial tendency. Uremic also could be merged within the joint or joint and soft tissue adjacent to the crystallization of alkaline calcium deposition. Uremic patients can often arise metastatic soft tissue calcification, and guide the festival next joint inflammation or inflammation. Crystal-induced arthritis in uremic patients is not uncommon, these can be crystallization of uric acid salt crystallization or alkaline calcium phosphate crystal, and coke phosphate dihydrate - crystallization is often associated with secondary hyperparathyroidism. Treatment of alkaline calcium deposition caused by acute or para-articular joint inflammation and can be used non-steroidal anti-inflammatory drug therapy, and the amount of the same acute gout. Colchicine oral or intravenous drip treatment are useful. And the treatment of other crystal deposition disease, joint fluid aspiration after injection of glucocorticoid effects. In chronic phase patients, a small daily doses of non-steroidal anti-inflammatory drug therapy, the result is better. And all other sub-acute and chronic arthritis, physical therapy, including hyperthermia and movement. to maintain range of motion and to alleviate the symptoms are important. Dali joint right next to the crystal deposition, if conservative treatment fails, surgery can remove the sediment crystallization. Check auxiliary alkaline calcium phosphate crystal deposition disease, the diagnosis is a very difficult task, because so far There is no simple and reliable screening method. Faure and others use was distinguished by transmission electron microscopy to direct measurement of apatite crystal, found that the crystallization is not a single component. McCarty and others use infrared study of synovial fluid crystallization and found at least contain hydroxyapatite, 8 calcium phosphate (octacalcium phosphate, OCP), tricalcium phosphate (tricalcium phosphate. TCP) and granular collagen (particulate. collagen) these methods is a good research tool, but not clinically practical. Clinically, the general use of radiology and synovial fluid to Ototsugu diagnosis. Radiology : sedimentary alkaline calcium phosphate crystal X-ray, can present round or villous calcification. from several millimeters to several centimeters in size, it can be a single point or more calcification calcifications. Although X-ray is a very useful diagnostic tool, but in the diagnosis of alkaline calcium phosphate crystalline arthropathy, Sensitivity and specificity is not very high. Clinically asymptomatic often can be seen beside the joint calcifications. Synovial fluid : Although polarized light microscopy is useful in the diagnosis of gout and pseudo gout tools, but it can not be used for the diagnosis of alkaline calcium phosphate crystal, because of the size of a single crystal (75-250mm) optical microscope no less than the scope of the resolution. Although sometimes crystallization can be gathered together, but because their order is random, so it will not show polarizing nature. In a very limited circumstances, just a few thousand crystallization with the same axis, then there will be the polarizing nature. When a large number of basic calcium phosphate crystal together, the optical microscope can see the shiny coin-ray crystal. It was suggested to use Alizarin red S stain of joint fluid staining, Basic screening for the crystallization of calcium phosphate method, which although highly sensitive, but not specific, Yi is false positive. There is a lack of a simple and highly specific way to identify alkaline calcium phosphate crystal. Although there are difficulties in the diagnosis, but the crystallization of calcium phosphate and alkaline joint or joints adjacent to the lesion is likely to determine. Whether alkaline calcium deposition in which parts have certain common X-ray performance, radiology physicians can often so characteristic it and other diseases separate. Alkaline calcium phosphate crystal sediments, the X-ray showed uniform but irregularly shaped sediment, There is no small bone beams (trabeculation) formation, it is easy and ectopic bone or bone identification seed. Sediment sizes, most of the sediment circular shape slightly, but may also show a linear or triangular, Edge clear or unclear. Tendon sediment, mostly near the tendon attachment points. Although the adjacent joint is the most common location, but may also be seen in the far distance joints, such as the gluteus maximus, adductor muscle pectoralis major and the attachment point. Differential Diagnosis of calcifying tendinitis and bursitis have the following three major categories of disease were identified. 1st Class metastatic calcification : abnormal calcium and phosphorus metabolism, for example : Renal Osteodystrophy (renal osteodystrophy), hypoparathyroidism. Vitamin D excessive and sarcoidosis, etc.. The second category of calcium deposition disease (calcinosis) : calcification occurs in the skin or subcutaneous tissue between, But the normal metabolism of calcium, such as calcium deposition body interstitial disease, scleroderma, dermatomyositis and tumor calcification disease (tumoral calcinosis). The third category is malnutrition calcification (scoliosis calification) calcium deposition that can not survive in the organization, for local or systemic, such as deposition in the degradation of necrosis and tumor inflammation, trauma, even parasitic infection organization. Calcifying tendinitis and bursitis must ossification and soft tissue differentiate ossification there will be a small bone formation and the beams no calcification. Ossification of the soft tissue and is common in traumatic myositis ossificans progressiva (myositis ossificans). nerve injuries, burns, soft tissue sarcoma, surgery scars, varicose veins, or even myositis ossificans progressiva. Tendon and ligament attachment Department osteophytes, can be accompanied by the beams formed a small bone tendon attachment to the Department extend tendon calcification and easily differentiated. Calcifying tendinitis can also take place in pyrophosphate dihydrate crystal deposition disease, the disease can be seen calcified cartilage and tendon calcification. often show more diffuse and long strip. Regular alkaline calcium deposition of roundness. Gout and calcifying tendinitis is sometimes difficult to distinguish between clinical have inflammation, X-ray sometimes have swelling and soft tissue calcification, Colchicine and to have effective treatment. Gout is sometimes associated with bone erosion and calcifying tendinitis no. Articular alkaline phosphatase crystal deposition disease of the X-ray findings and degenerative arthritis and crystallization of calcium pyrophosphate dihydrate deposition disease similar. At the knee, alkaline calcium phosphate crystal joints caused by invasive lesions of degenerative arthritis often more important, and the good parts of the lateral tibial Unit (femorotibial) or the patellofemoral joint (femoropate lla) joint, and degenerative arthritis occurs in the medial tibial shares or part of the patellofemoral joint. Glenohumeral joint degenerative arthritis of the X-ray findings often very slight, Unlike alkaline calcium phosphate crystal joint disease accompanied by severe joint destruction. And alkaline calcium phosphate crystal joint disease is most similar to the crystallization of calcium pyrophosphate dihydrate arthritis disease, and two kinds of diseases that can often exist in a person or a joint. Generally, Alkaline calcium phosphate crystal deposition will not cause calcified cartilage (chondrocalcinosis). It formed the uniform goes the same as articular opaque impact associated with or without capsular calcification. Both can cause serious joint sexual degradation. To emphasize that the alkaline calcium phosphate crystal can be deposited on other diseases caused by intra-articular, For example, degenerative arthritis and rheumatoid arthritis. Once deposited, which will accelerate the crystallization of the original disease, resulting in cartilage, bone and soft tissue severely damaged.