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FINDING THE CAUSE OF CALCIFICATIONS

Q: My 66-year-old mother suffers from a calcium deposit around a finger joint and also in her neck. Her finger swells from time to time, and sometimes the skin will split open and a chalky substance seep out.

She had the calcium removed from her neck, but it has returned. Can you tell what's happening and if there's anything she can do about it?

A: I'm sorry to hear that your mother's conditions keep returning. So it's particularly important to determine which of many possible conditions is the cause in your mother's case. It's also important to recognize that the problem in her neck and hands may be due to two different factors.

Before you can identify the cause, the actual location of the calcification needs to be determined. The most likely place for calcification in the neck is around the joints (articulations) between the vertebra. In addition, there are two other structures near joints in the hand that can become calcified -- tendons and bursae (fluid-filled sacks).

Calcification is usually the result of inflammation, though it may be a sign of cancer. Inflammation of the tendon is called tendonitis, and inflammation a bursa is called bursitis. The draining cyst you describe sounds more like a bursa, but it could be coming from the joint itself.

Almost every type of arthritis can cause calcification in and around joints. This is either due to deposits of calcium related to inflammation or to the growth of bone spurs caused by bone rubbing directly on bone. However, spontaneous drainage should raise the concern that a joint is infected or that she has gout or pseudogout.

Pseudogout (also called chondrocalcinosis) is a condition in which calcium-containing salts are deposited into the joints. It is usually seen in people who are over 60 and most often occurs in larger joints, such as knees and wrists, but may also occur in the hand.

Diagnosing pseudogout is important, not only for better treating this problem, but also because it is often associated with other metabolic diseases, including diabetes, hemochromatosis, hypothyroidism and Wilson's disease.

I presume that your mother has had X-rays, as well as a sample of the fluid from her finger tested and looked at under a microscope. These tests should provide a very good basis for diagnosing her problem and indicate whether additional tests should be done to see if she has something else.

In summary, to best help your mother, I suggest that you help her talk with her doctor to ask the following questions: What body structures are involved? What was seen in the draining fluid? Do the neck and hand problem have the same cause? What is the suspected diagnosis for each? Could she have a medical problem that is causing more than the calcifications?

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Chlamydia can be effectively treated with standard antibiotics, but testing for it obviously comes first. And this may be even more important for men, since they are more often asymptomatic.

Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, Ill. 60611. His e-mail address is DRFamily@aol.com.

This column is for informational and educational purposes only. It is not intended to provide medical advice or take the place of consultation with a doctor or other health-care provider.

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