Acute calcific periarthritis is an acutely painful monoarticular condition characterised by the juxta-articular deposition of calcium hydroxyapatite crystals and local inflammation.
Affects both males and females over a wide age range, however, occurs more frequently in females than males between the ages of 40 to 70 years.
- sudden onset of severe pain and swelling around one joint, usually of finger or toe
- no history of acute trauma
- no fever, systemic complaints or arthralgia of other joints
Acute juxta-articular soft tissue deposition of calcium hydroxyapatite crystals leading to an acute inflammatory response.
ACP is thought to represent a clinical subset of hydroxyapatite deposition disease (HADD) and occurs when crystals are acutely deposited in the periarticular capsular structures:
- HADD in tendons results in calcific tendonitis
- HADD in bursa results in calcific bursitis
- HADD in shoulder joint results in Milwaukee shoulder
Well-circumscribed ovoid or curvilinear calcification adjacent to a joint (usually on one side).
- curvilinear/ovoid calcification with acoustic shadowing
- capsular soft tissue swelling
- periarticular calcification
- generally low signal from calcification
- high signal on fluid weighted sequences from soft tissue oedema
- infectious arthritis (soft tissue calcification is not seen in acute septic arthritis)
- tendon-related HADD
Other causes of soft tissue calcification such as:
- acute calcific periarthritis should be considered when faced with an acutely painful finger, especially in the presence of periarticular calcification on radiographs or ultrasound.
- recognising the clinical presentation with correlation of imaging would avoid unnecessary treatments such as antibiotics or surgery
Treatment and prognosis
- managed conservatively with nonsteroidal anti-inflammatory drugs
- may require corticosteroid injection
- usually responds to treatment within a week with resolution of the acute symptoms
- periarticular calcification significantly decreases in 3-to-4 weeks but takes longer to clear, typically 6-to-8 weeks
- 1. Moradi A, Kachooei AR, Mudgal CS. Acute calcium deposits in the hand and wrist. (2014) The Journal of hand surgery. 39 (9): 1854-7; quiz 1858. doi:10.1016/j.jhsa.2014.06.011 - Pubmed
- 2. Christopher Doumas, Raja M. Vazirani, Paul D. Clifford, Patrick Owens. Acute calcific periarthritis of the hand and wrist: a series and review of the literature. (2007) Emergency Radiology. 14 (4): 199. doi:10.1007/s10140-007-0626-9 - Pubmed
- 3. Lee KB, Song KJ, Kwak HS, Lee SY Acute calcific periarthritis of proximal interphalangeal joint in a professional golfer 's hand. (2004) Journal of Korean medical science. 19 (6): 904-6. doi:10.3346/jkms.2004.19.6.904 - Pubmed
- 4. Aguiar F, Brito I. Acute calcific periarthritis in proximal interphalangeal joint: An unusual cause of acute finger pain. (2017) Reumatologia clinica. doi:10.1016/j.reuma.2017.08.006 - Pubmed
- 5. Touraine S, Wybier M, Sibileau E, Genah I, Petrover D, Parlier-Cuau C, Bousson V, Laredo JD. Non-traumatic calcifications/ossifications of the bone surface and soft tissues of the wrist, hand and fingers: a diagnostic approach. (2014) Diagnostic and interventional imaging. 95 (11): 1035-44. doi:10.1016/j.diii.2014.07.004 - Pubmed