Effective period of conservative treatment in patients with acute calcific periarthritis of the hand

Abstract

BackgroundAcute calcific periarthritis of the hand is a relatively uncommon painful condition involving juxta-articular deposits of amorphous calcium hydroxyapatite. Although conservative treatments have been generally considered effective, there is little evidence regarding how long they could remain effective.MethodsWe retrospectively reviewed ten patients who were diagnosed with acute calcific periarthritis of the hand from January 2015 to June 2018. We recommended the use of warm baths, nonsteroidal anti-inflammatory drugs (NSAIDs), and limited activity as initial treatments. If the pain persisted despite at least 3 months of conservative treatment, we explained surgical treatment options. If the pain improved, we recommended gradual range-of-motion exercises with the continuation of daily NSAIDs use. The visual analogue scale (VAS) score for pain at each subsequent visit (3, 6, and 9 months) was compared with that of the previous visit to investigate whether the pain had decreased during each time interval. Simple radiographs taken at each visit were compared with those taken at the previous visit to determine whether any significant changes in the amount of calcification had occurred during each time interval.ResultsAll 10 patients with 17 affected joints continued conservative treatments for an average of 11.1 months. The average VAS score for pain at the initial visit was 7, while that at 3, 6, and 9 months was 4.3, 3.3, and 2.9, respectively. There was a significant reduction in the VAS score at 3 and 6 months, but not at 9 months (P values = 0.004, 0.008, and 0.598, respectively). The simple radiographs also showed a significant reduction in the amount of calcification at 3 and 6 months, but not at 9 months (P values = 0.020, 0.034, and 0.083, respectively).ConclusionsPatients with acute calcific periarthritis of the hand exhibited residual pain and calcification for a relatively prolonged period. Those who continued conservative treatment, including NSAIDs, showed pain relief and reduced calcification for up to 6 months. These results suggest that conservative treatment could be tried for at least 6 months before considering the surgical treatment of calcific periarthritis of the hand.

Enveloping calcification of flexor digitorum profundus tendon: a diagnosis easily missed

“…Intralesional steroids have been reported to be of limited benefit. Surgical excision is rarely necessary and should be reserved for the refractory cases lasting more than 6 months 16…”

Hydroxyapatite deposits of the hand and wrist: a diagnosis not to be ignored

“…The clinical manifestations in the acute phase are often impressive, with acute juxta-articular inflammation suggesting septic arthritis [ 1 , 5 ]. Pain is intense and is present in all cases in the literature [ 1 - 3 , 10 , 11 , 14 ]. In our patient series functional disability was always present, with edema in three-quarters of cases and objective signs of inflammation in two-thirds.…”

“…Although an infectious cause is in principle the first to be considered, the possibility of HADD must be suggested if there is a clinical picture of extremely painful inflammation of rapid onset, in particular in the absence of a portal of entry and a context of decreased immune defenses [ 5 , 9 ]. The diagnosis of HADD may reasonably be made based solely on the presence of calcifications whose radiographic appearance is characteristic [ 1 , 10 , 11 ]. The course is spontaneously favorable but the cure may be hastened by 2-week treatment with systemic nonsteroidal anti-inflammatory drugs (NSAIDs) [ 3 , 12 ].…”

“…The course is spontaneously favorable but the cure may be hastened by 2-week treatment with systemic nonsteroidal anti-inflammatory drugs (NSAIDs) [ 3 , 12 ]. Surgery is only indicated if symptoms persist beyond the acute episode [ 11 ]. Conversely, treatment for septic arthritis is undoubtedly surgical and NSAIDs are formally contra-indicated [ 6 , 9 ].…”

Acute calcific periarthritis of the proximal phalangeal joint on the fifth finger

“…Acute calcific arthritis and peritendinitis follow a self-limiting disease process, typically showing mild improvement during the first week and resolution within 1 month. [ 2 , 25 ]…”