Effective period of conservative treatment in patients with acute calcific periarthritis of the hand

Abstract

Background: Acute calcific periarthritis of the hand is a relatively uncommon painful condition involving juxta-articular deposits of amorphous calcium hydroxyapatite. Although conservative treatments have been generally considered effective, there is little evidence regarding how long they could remain effective. Methods: We retrospectively reviewed ten patients who were diagnosed with acute calcific periarthritis of the hand from January 2015 to June 2018. We recommended the use of warm baths, nonsteroidal anti-inflammatory drugs (NSAIDs), and limited activity as initial treatments. If the pain persisted despite at least 3months of conservative treatment, we explained surgical treatment options. If the pain improved, we recommended gradual range-of-motion exercises with the continuation of daily NSAIDs use. The visual analogue scale (VAS) score for pain at each subsequent visit (3, 6, and 9months) was compared with that of the previous visit to investigate whether the pain had decreased during each time interval. Simple radiographs taken at each visit were compared with those taken at the previous visit to determine whether any significant changes in the amount of calcification had occurred during each time interval. Results: All 10 patients with 17 affected joints continued conservative treatments for an average of 11.1months. The average VAS score for pain at the initial visit was 7, while that at 3, 6, and 9months was 4.3, 3.3, and 2.9, respectively. There was a significant reduction in the VAS score at 3 and 6months, but not at 9months (P values = 0.004, 0.008, and 0.598, respectively). The simple radiographs also showed a significant reduction in the amount of calcification at 3 and 6months, but not at 9months (P values = 0.020, 0.034, and 0.083, respectively). Conclusions: Patients with acute calcific periarthritis of the hand exhibited residual pain and calcification for a relatively prolonged period. Those who continued conservative treatment, including NSAIDs, showed pain relief and reduced calcification for up to 6months. These results suggest that conservative treatment could be tried for at least 6months before considering the surgical treatment of calcific periarthritis of the hand.