A gentleman in his 80' scame to the clinic with a background of haemachromatosis which was diagnosed in his 70s, rotator cuff disease bilaterally and he had been diagnosed with rheumatoid arthritis several years earlier and treated with methotrexate with good benefit in terms of symptoms. He tolerated methotrexate well and was wondering if he could come off it at this stage. He reported no early morning stiffness and interestingly had never had early morning stiffness..
Ultrasound demonstrates chondrocalcinosis in the 2nd and 3rd MCPs bilaterally. There were no erosions. His wrists were unremarkable. Normal inflammatory markers are noted and autoantibodies (rheumatoid factor etc) were unavailable. Synovial hyperaemia is noted in conjunction with the chondrocalcinosis. Chondrocalcinosis is noted as a thin hyper echoic line which parallels the head of the metacarpal bone.
Chondrocalcinosis is seen as both a primary and secondary phenomenon. In this case, the most likely cause of it is his haemachromatosis. He had been treated with phlebotomy (blood letting) since diagnosis and his total body iron stores had reduced to normal levels.
The european league against rheumatic diseases (EULAR) do not recommend treatment of asymptomatic chondrocalcinosis1. I therefore discontinued his methotrexate and arranged follow up 3 months from now.
Ultrasound is useful in the differential diagnosis of many musculoskeletal presentations. Chondrocalcinosis is readily diagnosed on ultrasound and in this case facilitates a change in management .