A ROENTGENOLOGICALLY DISTINCTIVE ARTHROPATHY IN SOME PATIENTS WITH THE PSEUDOGOUT SYNDROME

Abstract

A degenerative arthropathy which is characteristic roentgenologically may be observed in some patients with pseudogout. Although it is possible that chondrocalcinosis and repeated bouts of joint inflammation may lead to a secondary osteoarthritis, certain pseudogout patients appear to have a form of primary cartilage degeneration. This frequently causes cartilage calcification which may, under circumstances that are not well understood, lead to the pseudogout syndrome. The arthropathy is often severe and generalized and shows a predilection for the elbows, wrists, ankles, and knees and, in particular, the metacarpophalangeal joints. Discrete subchondral rarefactions, probably representing "degenerative cysts," are characteristic and conspicuous and may develop prior to roentgenologically apparent cartilage degeneration of calcification. Paraarticular, tendon and bursal calcification frequently accompanies this type of arthropathy. Pseudogout patients may present with diffuse swelling of a hand possibly due to involvement of the tendons in the carpal tunnel. The possibility of pseudogout should be considered and chondrocalcinosis searched for in patients, particularly the elderly, who have episodic acute arthritis with the roentgenologic and clinical findings of degenerative joint disease. Chondrocalcinosis is frequently widespread in pseudogout but when it is present in true gout, as it often is, it is usually limited to the knees and occasionally the wrists, affecting fibrocartilage predominantly. The possibility that gout and pseudogout may coexist in the same patient is presented.