Hydroxyapatite Deposition Disease: A Comprehensive Review of Pathogenesis, Radiological Findings, and Treatment Strategies

Abstract

Hydroxyapatite deposition disease (HADD) represents a multifaceted condition characterized by the accumulation of hydroxyapatite crystals in soft tissues, leading to subsequent inflammation and discomfort. The intricate etiology of HADD is the subject of this comprehensive review, which encompasses an in-depth analysis of the four proposed pathogenic mechanisms and a deliberation on the predisposing factors that instigate the development of this disease. In order to provide a thorough understanding of the disease’s progression, this manuscript delineates the stages of HADD—those preceding calcification, occurring during calcification, and following calcification—in meticulous detail. This chronology forms the basis of a complete portrayal of the evolution of HADD. Moreover, this review encompasses an examination of the radiological findings associated with HADD, furnishing an extensive discourse on imaging characteristics. The potential of HADD to mimic other diseases, thereby posing diagnostic challenges, is also articulated. The discourse continues with an investigation of HADD’s differential diagnosis. This section furnishes a robust framework for distinguishing HADD from other conditions based on imaging results. To enrich the understanding of this diagnostic process, case studies illustrating real-world applications are provided. An overview of treatment modalities for HADD, including both conservative and interventional approaches, forms the concluding discussion. The pivotal role of imaging specialists in the diagnosis and management of HADD is emphasized, highlighting their vital contribution to image-guided procedures and disease monitoring.

Anakinra for Refractory Pseudogout in Patients with End-stage Renal Disease on Haemodialysis

“… 18 Hydroxyapatite crystals are usually found at periarticular sites and are a cause of periarthritis rather than frank arthritis. 19 Oxalate is a metabolic end-product that is normally excreted in the urine, and also removed by haemodialysis. Accumulation of oxalate in patients on renal replacement therapy occurs infrequently and may result in the deposition of calcium oxalate crystals and musculoskeletal manifestations resembling CPPD.…”

Hydroxyapatite Crystal Deposition Disease with Multiple Joint Involvement Resulting in Severe Lumbar Spinal Canal Stenosis: A Case Report

“…CT revelaed hyperdense calcifications along the lumbar spine, wile magnetic resonance imaging provided detailed insights into the extent of the pathology. The identification of hypointense periarticular lesions with fluid levels on both T1 and T2-weighted images, along with severe spinal canal stenosis and medullary cone compression, guided the decision for the intervention [6][7][8].…”

Imaging findings of acute calcific periarthritis, with emphasis on magnetic resonance imaging: pictorial essay

“…The symptoms of ACP can be treated with local anesthetics, corticosteroids, oral non-steroidal anti-inflammatory drugs, and immobilization ( 1 ) . The administration of corticosteroids and local anesthetics can be guided by computed tomography or ultrasound ( 7 ) .…”

“…It is at this moment that the increase in echogenicity of the surrounding tissues and the adjacent capsular and pericapsular hyperemia are seen most clearly on color Doppler ( Figure 1 ). In the final (post-calcific) phase, the deposits appear as small hyperechoic foci with well-defined borders and no posterior acoustic shadowing, accompanied by intratendinous cysts ( 7 ) .…”