Calcific periarthritis

What is calcific periarthritis?

Calcific periarthritis (perry-arth-ritus) is a condition that involves painful swelling around joints.

It’s known as a calcium crystal disease because the pain is caused by crystals of the mineral calcium rubbing against soft tissue inside the body.

The part of the word ‘peri’ means that the swelling is around, and not actually in the joint.

We need crystals of the mineral calcium because they help make our bones and teeth strong. However, if people have too many calcium crystals in their body and in the wrong place, this can cause problems.

In calcific periarthritis, these hard, sharp crystals rub against the soft tissue surrounding a joint causing pain and swelling.

The pain from calcific periarthritis doesn’t usually last longer than four weeks and people often only have one episode of calcific periarthritis in their life, but it can be very unpleasant.

This condition commonly affects shoulders, but it can also affect the hips, hands and elsewhere around the body.

Calcific periarthritis is linked to a condition called calcific tendonitis. This is when calcium crystals form in a tendon. Tendons are strong cords that attach muscles to bones.

Some people can have calcium crystals in a tendon and not know that they’re there, as they might not cause pain or other problems.

When the crystals leave the tendon, or ‘shed’, into the soft tissue surrounding the joint they can cause pain and swelling there. This is known as calcific periarthritis.

With calcific periarthritis, once crystal shedding starts and causes pain and swelling, the crystals usually continue to shed from the tendon until they’ve all gone. Usually the crystals do not re-form, making it a one-off problem at that site.

However, people with calcific periarthritis in one shoulder are more prone to have it in the other shoulder, and it can then happen in other sites around their body.

Calcific periarthritis most commonly affects a tendon that helps the shoulder move. It can also affect tendons around the hips, hands and elsewhere around the body.

Symptoms

Calcific periarthritis causes pain and swelling around a joint. These symptoms come on quite fast, and can be severe.

The affected joint can feel tender to touch.

The symptoms are usually at their worst in the first 24 to 36 hours. They usually settle back to normal after two to four weeks.

If crystals form in a tendon this often won’t cause any pain. In most cases the pain and swelling only occurs when the crystals leave the tendon and go into the soft tissues in the surrounding area.

However, if you have crystals in a tendon around the shoulder, this can cause problems even if they haven’t shed into the soft tissues in the surrounding area. They can be painful and make it difficult to move the arm. Especially if it is a large deposit of crystals.

The crystals in the tendon around a shoulder can also shed and cause pain and swelling.

Causes

Why do I have a build-up of calcium crystals in my body?

As you get older, natural chemical changes in the body can make it more likely that calcium crystals will form in blood, urine or soft tissues.

The following conditions can also cause you to have too much calcium in your body:

  • hyperparathyroidism – a condition that means the body produces too much of a hormone called parathyroid. This happens because one or more of four small glands in the throat, called the parathyroid glands, are overactive.
  • kidneys that aren’t functioning properly
  • diabetes – a condition that causes high levels of glucose, a type of sugar, in the body.

What triggers painful episodes of calcific periarthritis?

The pain and swelling of calcific periarthritis happens when the crystals shed from a tendon into the soft surrounding area. Often, it’s not clear why the crystals have shed.

Sometimes it will be clear what has caused the crystals to shake loose from a tendon, for example it could be caused by:

  • an injury – causing pain and swelling a day or two afterwards
  • an illness that causes a fever – such as the flu or a chest infection
  • a major stress to the body – like having an operation or a heart attack.

How could calcific periarthritis affect me?

Typical attacks of calcific periarthritis gradually settle on their own, without causing any damage to the tendon or surrounding tissues.

You may notice the swelling going down within a week, though it may be very painful for the first few days. The affected area may take up to four to six weeks to get completely back to normal.

If you have a large crystal in the tendon that is causing you discomfort and stopping you from moving your shoulder, you might be offered surgery to remove it. Or, you could have a procedure called shock-wave treatment.

 

Diagnosis

There are several tests that can help make a diagnosis of calcific periarthritis.

X-rays or ultrasound scans can show any calcium crystals forming in a tendon.

Blood tests can check for:

  • inflammation in the body
  • calcium levels
  • possible other causes of symptoms, such as an infection
  • problems with the kidneys, which in rare cases can be a cause of calcific periarthritis.

Treatments

Calcific periarthritis usually settles on its own without any treatment. However, because it can be very painful and distressing, treatment aimed at relieving pain and reducing inflammation may be offered.

Joint aspiration and injection

Your doctor may use a needle and syringe to remove extra fluid from a bursa, if your condition is causing swelling there. A bursa is a sac filled with fluid that provides cushioning to joints.

They will numb the area with an injection first, so it isn’t painful. This is called joint aspiration, and it can quickly reduce pain.

Usually, once the fluid has been drawn out, your doctor will inject a small amount (1–2 ml) of a long-acting steroid treatment into the bursa through the same needle. This helps to reduce swelling in the lining of your bursa and prevent the build-up of more fluid.

Applying ice

Applying an ice-pack around the painful region is a quick and safe way of taking the edge off pain. You can buy ice packs, or you could use a pack of frozen peas or ice cubes wrapped up in a damp towel, to protect your skin.

Drugs

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, may reduce the swelling and ease the pain.

As with any drug, there are risks of side effects with NSAIDs. Ask your doctor about any risk for you, and how to minimise them.

Are there any treatments to prevent the crystals forming?

There are no drug treatments that can prevent the formation of calcium crystals in tendons.

If you have a condition that may increase the likelihood of calcific periarthritis, such as hyperparathyroidism – which causes raised calcium levels in the blood – or chronic kidney disease, these should be treated.

Are there any treatments to remove the crystals?

If necessary there are procedures to remove crystals, especially if they are large deposits.

Surgery

Endoscopic, also known as key-hole, surgery may be used to remove a large deposit that is blocking movement and causing discomfort. This is a very precise form of surgery in which small incisions are made to allow the surgeon to remove a calcium deposit.

As with any surgery, there are risks of complications, such as infection. If you’re considering surgery, it’s important to discuss this with your doctor.

Shock-wave treatment

In some areas of the country, a procedure called shock-wave treatment may be available to remove large calcium deposits, normally in a tendon in the shoulder.

High-frequency shock waves are sent to the affected area. The theory behind the treatment is that the vibrations break up large deposits and allow the smaller particles to be slowly dissolved away.

People are given an NSAID tablet to reduce swelling and an anesthetic patch to help numb the area.

During the treatment you may experience a slight feeling of discomfort.

Because shock-wave treatment only lasts about five minutes, most people find they’re able to tolerate this discomfort. It’s possible for the intensity of the treatment to be reduced, so if you’re unable to cope with it tell the healthcare professional delivering the treatment.

This procedure is supposed to cause the calcium deposits to shed, which is necessary but in itself can cause pain and swelling. Therefore, there can be some tenderness and bruising afterwards.

People normally have several sessions spaced about a week apart.

There are some possible complications from shock-wave treatment, such as the risk of damage to the tendon. Therefore, if you’re considering this procedure it’s important to discuss it fully with your doctor.

Living with calcific periarthritis

Exercise

It’s important that you get the joint and muscles in the affected region moving as soon as possible. It will help the healing and prevent the joint from becoming stiff.

Doing a small amount of exercise on a regular basis will help the inflamed tissues return to normal. A physiotherapist can help you with expert advice.

Diet and nutrition

The formation of calcium crystals isn’t usually affected by your diet. For general health and well-being, however, you should eat a well-balanced diet and avoid becoming overweight.

It’s not possible to get calcific periarthritis or calcific tendonitis by eating too much calcium. It’s important to eat calcium, such as in dairy products, because it can reduce the chances of osteoporosis, a condition which causes bones to thin and fracture.