Destructive arthropathy in chondrocalcinosis articularis.
Destructive arthropathy in chondrocalcinosis articularis.
复制标题
关节软骨钙质沉着症的破坏性关节病。
DOI：
10.1136/ard.33.3.196
复制
发表时间：
1973
影响因子：
27.4
通讯作者：
E. Hamilton
中科院分区：
文献类型：
--
作者：
A J Richards;E. Hamilton
目前公认的是，关节软骨钙质沉着症，以及与急性发作的焦磷酸盐关节病，可能导致过早退行性变化的关节参与。一些工作者也偶尔提到关节旁溶骨性病变的存在（McCarty，Kohn和Faires，1962; Currey，1970）。最近有一些关于破坏性关节改变的报道，这种改变可导致相当大的残疾（罗宾逊，1971;Menkes，Simon，Chouraki，Ecoffet，Amor和Delbarre，1973）。在国王学院医院就诊的80例特发性软骨钙质沉着症患者中，有5例（4女1男）发生了严重的破坏性关节病。无一例有血色病或甲状旁腺功能亢进的迹象，血清学试验中，抗风湿因子和类风湿因子均为阴性。五名患者中有一名最近患上了糖尿病，另一名患有佩吉特病，尽管这两种疾病都没有引起症状。病例报告1号病人，75岁，1969年首次就诊，主诉双手疼痛、肿胀，右膝和颈部疼痛。检查显示红细胞沉降率（ESR）正常，WaalerRosetest阴性，髋关节、膝关节和腰椎X线片显示广泛的软骨钙质沉着。血钙在正常范围内，碱性磷酸酶升高至99i.u/ml。升（正常范围30 -85），放射学检查显示骨盆Paget病。除了软骨钙质沉着，髋关节、膝关节和脊柱也有退行性改变。手部的X线照片很有趣，因为它们显示出不寻常的破坏性变化，尤其是右手（图1），中指掌指关节中存在微弱的透明软骨钙化。该关节破坏性改变明显，关节表面有囊肿形成和破碎，但不存在类风湿关节炎所见的边缘侵蚀。患者2为69岁女性，左肩疼痛、肿胀。左肩关节炎吸出焦磷酸钙结晶
Itisnowwellrecognized thatidiopathic chondrocalcinosis articularis, aswell asbeing associated with acute episodes ofpyrophosphate arthropathy, may lead topremature degenerative changes inthejoints involved. Someworkers havealsomadeoccasional reference tothepresence ofjuxta-articular osteolytic lesions (McCarty, Kohn,andFaires, 1962; Currey, 1970.) Morerecently there havebeenreports of destructive joint changes which canbethecauseof considerable disability (Robinson, 1971;Menkes, Simon,Chouraki, Ecoffet, Amor,andDelbarre, 1973). Fivepatients (4womenand1man), fromaseries of eighty patients withidiopathic chondrocalcinosis seen atKing's College Hospital, havedeveloped asevere destructive arthropathy. Innoneofthemwasthere evidence ofhaemochromatosis orhyperparathyroidism andserological tests forsyphilis andfor rheumatoid factor werenegative. Oneofthefive patients hasrecently developed diabetes mellitus and another hasPaget's disease, although neither ofthese conditions iscausing symptoms. Casereports Patient 1,a75-year-old man,wasfirst seenin1969complaining ofpainandswelling ofbothhandsandpainin theright kneeandneck. Investigations showed anormal erythrocyte sedimentation rate (ESR), anegative WaalerRosetest, andwidespread chondrocalcinosis inradiographs ofhiships, knees, andlumbar spine. Theserum calcium wasinthenormal range butthealkaline phosphatase wasraised at99i.u./litre (normal range30-85), andPaget's disease ofthepelvis wasseenradiologically. Apart fromthechondrocalcinosis there weredegenerative changes inthehips, knees, andspine. Theradiographs of thehandsareinteresting inthattheyshowunusual destructive changes, especially intheright hand(Fig. 1), andfaint calcification ofhyaline cartilage ispresent inthe metacarpophalangeal joint ofthemiddle finger. The destructive change atthisjoint isobvious withcyst formation andcrumbling ofthejoint surface, butmarginal erosions asseeninrheumatoid arthritis arenotpresent. Patient 2,a 69-year-old woman,developed painand swelling oftheleft shoulder. Aneffusion oftheleft shoulder joint wasaspirated andcalcium pyrophosphate crystals