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Periarthritis associated with basic calcium phosphate crystal deposition and low levels of serum alkaline phosphatase--report of three cases from one family.

Three siblings, 2 women and one man, from an Iranian-Jewish family with low serum levels of alkaline phosphatase (liver fraction) and symptomatic calcific periarthritis of multiple joints are described. Both parents and 2 additional siblings had normal serum alkaline phosphatase levels and no joint symptoms. The disease in the proposita, a 49-year-old woman, showed 3 unusual features: (1) no rise in acute phase serum proteins despite severe attacks of periarthritis; (2) refractoriness to treatment; (3) pure octacalcium phosphate found in a deposit obtained by biopsy.

Adult↗

Evaluation of the efficacy and tolerability of a new locally acting preparation of flurbiprofen in scapulohumeral periarthritis.

This randomised, double-blind, placebo-controlled, parallel-group trial was carried out to assess the efficacy and tolerability of a new, locally acting, transcutaneous flurbiprofen preparation (flurbiprofen LATTM, Boots Company PLC) in the treatment of scapulohumeral periarthritis. The new preparation consists of a nonwoven polyester patch supporting a mentholated formulation containing flurbiprofen 40 mg. Eighty patients suffering from the acute, painful phase of scapulohumeral periarthritis entered the trial, three of which failed to provide follow-up data. Each patient applied one patch every 12 hours for the 14 day trial period. Efficacy was assessed in terms of reduction of pain, improvement in shoulder movement and overall clinical assessment of the severity of the condition after treatment. Statistically significant improvements from baseline were observed in both treatment groups, with a constant overall trend in favour of flurbiprofen. The differences between the two treatment groups, however, did not reach statistical significance.

Administration, Cutaneous↗

[Clarification of the concept humeroscapular periarthritis].

Shoulder pain may be due to various reasons. It is primarily produced by changes in the periarticular structures of the shoulder joint. The term "periarthritis humeroscapularis" (PHS), often used at diagnosis, is unsuitable however because it prevents differentiation of the various clinical pictures related to the anatomical structures. Among the anatomical structures concerned, above all the rotator cuff and here especially the suprasinatus muscle must be mentioned. Also the long biceps tendon and the shoulder joint capsule are, according to Welfling, locations of painful processes, not to forget the subacromial bursa. The pathology responsible for the clinical symptoms and signs is primarily produced by degenerative changes. They lead to tendopathy, as well as to tendon rupture, and also seem to be of importance in connection with calcifying tendopathy. Capsule shrinkage in shoulder stiffness can also be influenced by neighboring degenerative processes. This also applies to isolated bursitis. Today thorough clinical and radiological clarification makes a differentiated diagnosis possible so that the vague term "periarthritis humeroscapularis" can be dropped.

Diagnosis, Differential↗

[Analysis of deposits in calcific periarthritis].

Analysis was conducted on calcific deposits from 5 patients with calcific periarthritis. These calcific deposits were dried, immersed in hydrazine, or heated to 1000 degrees C for 1 hour, to prepare 3 kinds of samples. The samples were classified as dried samples, hydrazine-deproteinated samples, or as heated samples. All samples were analyzed by X-ray diffraction (XRD). Fourier transform infrared spectroscopy (FTIR), Raman spectroscopy (Raman), and by electron probe microanalysis (EPMA). Although the XRD patterns of the dried samples and of the deproteinated samples were similar to that of hydroxyapatite (HAp), it was still unclear whether or not the calcific deposits were HAp. FTIR then revealed that the dried samples contained carbonate. Raman showed that the dried samples and the deproteinated samples do not have an OH-group. The dried samples were then heated to 1000 degrees C for one hour and analyzed by all 4 methods. The heated samples were found to be HAp. From these results, the calcific deposits from the 5 patients with calcific periarthritis were found to be carbonate apatite: Ca10-x-y/2 (PO4)6-x (CO3) x (OH) 2-y (CO3)y/2.nH2O.

Apatites↗

The so-called "periarthritis humeroscapularis"--possibilities of an operative treatment.

The pathological alterations of the periarticular tissue in the differential diagnostics of so called periarthritis humeroscapularis are demonstrated. Their pathological mechanism is explained briefly. Clinical and radiological methods to differentiate the pathological symptoms are described. It has been tried to define the indication and the exact date for an operative intervention. Those operative treatments are demonstrated which allow the expectation of good results in clinical practice.

Humans↗

Clinical and laboratory parameters in adult diabetics with and without calcific shoulder periarthritis.

The clinical and laboratory parameters of calcific shoulder periarthritis (CSP) were examined in 900 patients with type II diabetes mellitus as well as in 350 age- and sex-matched control subjects. A threefold increased prevalence of CSP in diabetics compared with the control group was associated with the presence of longstanding and poorly controlled diabetes, hypercholesterolemia, and hypertriglyceridemia suggesting pronounced diabetic angiopathy, as well as with minor trauma and hypomagnesemia. Aging and serum calcium concentrations were not related to the presence of CSP. Thirty-two percent of diabetics with CSP were symptomatic; 15% of them presented with severe pain and restriction of shoulder movement. These findings confirm a close pathogenetic interrelation between CSP and diabetes mellitus.

Adult↗

Periarthritis promotes gait disturbance in zymosan-induced arthritis in rats.

OBJECTIVE AND DESIGN: We studied the contribution of periarthritis and synovitis to gait disturbance in zymosan (Zy)-induced arthritis. METHODS: Sixty Wistar rats were subjected to injection of Zy (1 mg) into their right knee joints. A first group of animals (GI) had Zy injected through the intact skin. A second group (GII) had Zy injected directly into the articular cavity after excision of the skin and subcutaneous tissue surrounding the joint. Gait disturbance was evaluated using the rat-knee joint incapacitation test. Increase in vascular permeability and cell influx were assessed in joint fluids and joint histology was performed. RESULTS: Zy injection induced a dose-dependent gait disturbance which was maximal at the third/fourth hour of arthritis, being significantly greater in GI rats, whereas cell influx (neutrophils > or = 80%) was maximal at the sixth hour. Cell influx and increase in vasopermeability did not differ between both groups. Histology revealed no significant difference between GI and GII. A third group (GIII), subjected to immune-complex arthritis, that received anti-bovine serum albumin (BSA) antibodies intra-articularly and BSA i.v., did not present gait disturbance, despite the increase in cell counts. CONCLUSIONS: Vascular permeability increase and cell influx are phenomena independent of gait disturbance. Neutrophils do not seem to contribute to development of gait disturbance in Zy arthritis. Sensitization of specific pain receptors in periarticular rather than in synovial tissue is responsible for gait disturbance in Zy-induced arthritis.

Animals↗

Magnetic resonance imaging in Löfgren's syndrome: demonstration of periarthritis.

In Löfgren's syndrome, pain and swelling commonly involves the ankle joints. In this prospective case series, the magnetic resonance imaging findings of ankle joint involvement are described. Extensive subcutaneous and soft tissue oedema was commonly seen around the ankles. Bone, cartilage, ligaments and tendons were typically uninvolved. Small amounts of joint and tenosynovial fluid were present without evidence of synovial thickening or synovitis. The fluid is probably reactive to adjacent inflammation in the para-articular soft tissues and probably not representing a primary site of involvement. These findings demonstrate that the arthritis in Löfgren's syndrome stems primarily from periarthritis. This is consistent with prior descriptions using ultrasonography.

Adult↗

Hydroxyapatite pseudopodagra in a young man: acute calcific periarthritis of the first metatarsophalangeal joint.

Pain and swelling at the first metatarsophalangeal joint can be caused by acute calcific periarthritis (ACP), an inflammatory condition resulting from deposition of hydroxyapatite crystals. A case is reported of a 23-year-old man in whom ACP was initially mistaken for gout, septic arthritis, and cellulitis. The diagnosis of ACP is based on the finding of inflammation around a joint along with radiographic evidence of periarticular soft tissue calcifications. Calcifications may disappear over time, as they did in this case. Failure to recognize this condition can lead to unnecessary testing and inappropriate treatment.

Acute Disease↗

[Mobilization of the partially stiff shoulder under anesthesia (ankylosing humeroscapular periarthritis)].

"Humeroscapular periarthritis" (HPA) was first described by Duplay in 1872 and is to be understood as a syndrome whose typical symptoms are pain and partial or total stiffness of the shoulder ("ankylosing" HPA). This term includes all regressive and reactive affections occurring in the region of the shoulder joint proper (Refish and van Laack, 1985), and has meanwhile become a synonym for painful shoulder stiffness, a term which covers many different processes which are not covered in detail here. Today, however, thanks to refined clinical and radiological examination methods, it is often possible to detect objectively at least some of the changes and to gain insights into the pathophysiological processes. The goal of treatment of HPA is to restore the function of the shoulder joint and eliminate the pain. To this end, various forms of treatment are fundamentally available: 1) conservative treatment, with medication and physiotherapy; 2) surgical treatment; and 3) mobilization under anesthetic, with which, comparatively speaking, results have been best.

Adult↗

Comparison between the analgesic and therapeutic effects of a musically modulated electromagnetic field (TAMMEF) and those of a 100 Hz electromagnetic field: blind experiment on patients suffering from cervical spondylosis or shoulder periarthritis.

The analgesic-therapeutic efficacy and tolerability of a low-frequency electromagnetic field (ELF), modulated at a frequency of 100 Hz with a sinusoidal waveform and mean induction of a few gauss, has been demonstrated by the authors in numerous previous studies of various hyperalgic pathologies, particularly of the locomotor apparatus. In the present study, the authors tested a new type of all-inclusive field, denoted TAMMEF, whose parameters (frequency, intensity, waveform) are modified in time, randomly varying within the respective ranges, so that all the possible codes can occur during a single application. For the comparison, 150 subjects (118 women and 32 men, between 37 and 66 years of age) were enrolled. They were affected by cervical spondylosis (101 cases) or shoulder periarthritis (49 cases). Unbeknownst to them, they were randomly divided into three groups of 50 subjects. One group was exposed to the new TAMMEF, another group to the usual ELF, and the third group to simulated treatment. The results show that the effects of the new TAMMEF therapy are equivalent to those obtained with the ELF.

Adult↗

Anti-inflammatory drugs in periarthritis of the shoulder: a double-blind, between-patient study of naproxen versus indomethacin.

Fifty-nine patients were entered into a double-blind, parallel comparison of the efficacy and side-effects of naproxen sodium (825 mg daily) and indomethacin (100 mg daily) in the treatment of periarthritis of the shoulder joint. Assessments were made on entry to the study, at two weeks, and at the end of four weeks when objective and subjective recordings of mobility, loss of function, pain and the presence of absence of side-effects were noted. The two treatment groups were found to be matched for age, sex and duration of disease, and an assessment at the start of the study differed only in respect of the degree of active medial rotation of the shoulder joint and pain. There was an overall improvement from the time of admission to the study in both the naproxen sodium and the indomethacin treatment groups but there was no significant difference between the efficacy of the two groups. One patient from the naproxen sodium group and three patients from the indomethacin group withdrew from the trial because of side-effects which in each case involved the gastro-intestinal tract.

Clinical Trials as Topic↗

Familial calcific periarthritis.

A family of 4 is described in which both children had calcific periarthritis affecting the shoulders, and the mother had radiological evidence of periarticular calcification near the left greater trochanter.

Adult↗

Acute calcific periarthritis outside the shoulder: a frequently misdiagnosed condition.

Thirteen patients presented to an accident and emergency (A&E) department with acute calcific periarthritis of joints other than the shoulder. In only three patients was the correct diagnosis made on the initial attendance with inappropriate treatment and delay in recovery as a result. The specific features and guidelines for management of this condition are reviewed.

Acute Disease↗

Double-blind trial comparing bufexamac infiltrations with triamcinolone acetonide infiltrations in patients with periarthritis of the shoulder.

A double-blind trial was carried out in 40 patients with an acute episode of periarthritis of the shoulder to compare the effectiveness and toleration of local infiltrations of bufexamac and triamcinolone acetonide. Patients received 1 or 2 local infiltrations with either 20 mg bufexamac or 40 mg triamcinolone acetonide. The results were evaluated by objective and subjective assessments of pain, loss of function, mobility, and by doctors' and patients' opinions of relief. There was a significant, comparable reduction in pain and discomfort in both groups after the first injection. Fourteen patients in each group required a second injection, with slightly more improvement in those receiving bufexamac. Local intolerance of the injections was noted in approximately 25% to 30% of the patients.

Adult↗