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 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 edema
- 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
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