Severe bursitis in shoulder arthritis – a manifestation of hydroxyapatite crystal deposition disease

Abstract

In the present understanding of joint pathology, the exact pathogenic role of hydroxyapatite crystals, both periarticular and intraarticular, is not yet completely clear. An association between rapidly destructive osteoarthritis (OA) and hydroxyapatite or basic calcium crystals was confirmed. This is a case report of a 78-year old female patient presenting with a five-month history of shoulder pain with swelling of both AC joints. Imaging showed a large bursitis starting in the AC joints of both shoulders. Synovial fluid analysis showed many hydroxyapatite crystals and no calcium pyrophosphate or sodium urate crystals, which confirmed the diagnosis of crystal-induced periarthropathy and AC arthritis. These periarticular radiographic and synovial fluid findings are a frequent and known manifestation of hydroxyapatite crystal deposition disease, similar to the intra-articular destructive "Milwaukee shoulder syndrome". Surgical intervention was the only therapeutic option to reduce the patient's shoulder pain.

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

“…Patient's presentation with recurrent fever, elevated inflammatory markers points out the systemic impact of HADD. HADD's association with conditions such as chronic kidney disease and anabolic-androgenic steroid use suggests potential predisposing factors in this case [2][3][4][5].…”

Elongated odontoid process in late Holocene skeletal remains from B6 archaeological site, Mendoza, Argentina

“…Multiple deposition sites are common, including the cervical vertebrae, but the shoulders, wrist and fingers are the most frequently affected joints (Hayes and Conway, 1990). Deposition of hydroxyapatite crystals in tendon insertions might cause articular destruction and chronic periarticular bursitis and tendinitis at these anatomical locations (Kerl-Skurka et al, 2015;Schneider and Hirsch, 2017).…”