CMC capsule enthesis change

[Ray Chien-Hsing Chen]

Steve

This is a patient with psoriasis.
He has CMC synovitis s/p my treatment.
There is a focal tender spot where he can point out clearly.
I found the spot corresponding to the elevated bone on the capsule insertion, where seems enthesopathy.

Do you agree my diagnosis?
Is this also a common area of pain?
thanks
Ray

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[Stephen Bird]

Hi Ray,

This is an interesting one,

There is certainly synovitis of the joint,

The echogenic area is indeed in the capsule insertion,

But it is not an enthesophyte.

An enthesophyte is made of bone and this echogenic area has no acoustic shadow so it can’t be an enthesophyte.

So in that case it must be some sort of crystal deposition or dystrophic calcification.

Hydroxyapatite is more likely to migrate into a tendon rather than a joint capsule,

CPPD is the likely culprit here as it tends to like joint capsules and fibrocartilage to propagate.

I guess gout is also possible

So I am going for some type of crystal deposition in the joint capsule, just can’t be sure exactly what crystal we are dealing with.

History and bloods may assist in narrowing it down.

I note the history of psoriasis which increases the chance of a seronegative arthritis and this makes the enthesis where the joint capsule attaches to the skeleton susceptible to attack.

Steve.

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