Acute calcific periarthritis

Last revised by Henry Knipe on 18 Feb 2024

Acute calcific periarthritis is an acutely painful monoarticular condition characterized 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 leads to an acute inflammatory response.

Acute calcific periarthritis is thought to represent a clinical subset of hydroxyapatite deposition disease (HADD) and occurs when crystals are acutely deposited in the periarticular capsular structures:

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 edema

  • 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 3-4 weeks but takes longer to clear, typically 6-8 weeks

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

  • recognizing the clinical presentation with correlation of imaging would avoid unnecessary treatments such as antibiotics or surgery

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