J Rheum Dis.  2016 Apr;23(2):125-129. 10.4078/jrd.2016.23.2.125.

A Case of Acute Calcium Pyrophosphate Crystal Arthritis in the Lumbar Facet Joint

• Chung SW
• Yoo JJ
• Lee JW
• Ha YJ
• Kang EH
• Song YW
• Lee YJ

• KMID: 2222790
• DOI: http://doi.org/10.4078/jrd.2016.23.2.125

Abstract

Calcium pyrophosphate dihydrate deposition disease most commonly presents with acute arthritis of the peripheral joints. Infrequently, a mass effect of this disease can cause axial symptoms, such as spinal stenosis, radiculopathy, or myelopathy. Herein, we report on the first Korean case of acute arthritis in the lumbar facet joint due to calcium pyrophosphate dihydrate crystal deposition disease. A 73-year-old female presented with acute fever, severe lumbago, and knee arthralgia, 11 days after partial parathyroidectomy. Plain radiographs showed multiple chondrocalcinosis, while a bone scan, computed tomography, and magnetic resonance imaging showed right L5-S1 facet arthritis. In synovial fluid from the facet and knee joints, positively birefringent calcium pyrophosphate dihydrate crystals were observed under polarized light microscopy. Under the diagnosis of acute calcium pyrophosphate dihydrate crystal arthritis (formerly known as 'pseudogout') in the facet joint, an intra-articular triamcinolone injection was administered, which resulted in dramatic improvement of the symptoms within 24 hours.

Keyword

Calcium pyrophosphate dihydrate deposition; Chondrocalcinosis; Zygapophyseal joint; Low back pain

MeSH Terms

Aged
Arthralgia
Arthritis*
Calcium Pyrophosphate*
Calcium*
Chondrocalcinosis
Diagnosis
Female
Fever
Humans
Joints
Knee
Knee Joint
Low Back Pain
Magnetic Resonance Imaging
Microscopy, Polarization
Parathyroidectomy
Radiculopathy
Spinal Cord Diseases
Spinal Stenosis
Synovial Fluid
Triamcinolone
Zygapophyseal Joint*
Calcium
Calcium Pyrophosphate
Triamcinolone

Figure

• 

  Figure 1. Plain radiographs and bone scan. Radiographs show calcification (white arrows) in the intervertebral and foraminal spaces (A), pubic symphysis (B), and meniscus (C). (D) A technetium bone scan demonstrates increased radiotracer uptake in the right L5-S1 facet joint (black arrowhead).

• 

  Figure 2. Lumbar spine computed tomography scans and magnetic resonance images. (A∼ C) Axial and sagittal computed tomography scans show calcification of the L5-S1 facet joint capsules, ligamentum flavum, and annulus fibrosus (asterisks). (D) Calcification around the facet joint is demonstrated as low signal intensity on a T1-weighted magnetic resonance image (white ar-rowhead). (E, F) T2-weighted and fat-suppressed imaging reveals facet joint effusion and bone marrow edema (white arrows).

• 

  Figure 3. Compensated polarized light microscopy of a synovial fluid sample from the facet joint. Intracellular calcium pyrophosphate dihydrate crystals appear as rhomboids with positive birefringence (×200). The double headed arrows indicate the axis of the analyzer.

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