Need help for a friend with calcium deposits in fingers

I am looking for some information on calcium deposits on fingers. One of my friends who also has scleroderma is suffering from the pain in her fingers due to the build up and I am looking for some information for her.

Does anyone out there have the same thing? What causes it and are there any treatments for it?

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I don't have it yet as far as I know, but here are some pictures of it: http://www.google.com/images?q=calcinosis&oe=utf-8&rls=org.mozilla:en-US:of ficial&client=firefox-a&um=1&ie=UTF-8&source=og&sa=N&hl=en&tab=wi&biw=989&b ih=509 .

What causes it? That's a good question. I don't think it's fully understood. It does tend to go more with limited systemic scleroderma. And I was reading something interesting about it concerning Vitamin D metabolism. Let's see if I can find it again...

Here: http://www.ncbi.nlm.nih.gov/pubmed/2413693 . This article says that although in scleroderma patients the levels of precusor forms of vitamin D are normal, for some reason in patients with calcinosis the serum concentration of 1,25-dihydroxyvitamin D (Calcitriol) was significantly lower than in scleroderma patients without calcinosis. That form of vitamin D is made by a conversion that is supposed to take place in the kidneys, but apparently that simply isn't occurring well in these patients. Something is apparently going wrong in the kidneys preventing this ACTIVE form of vitamin D from being made from the inactive precursor form of vitamin D.

And of course we know that the active form of vitamin D is very important in calcium metabolism and deposition of calcium into BONE. Apparently, because the active form of vitamin D isn't getting made, instead of calcium being put into bone, it is being put into globs here and there in the body! And the bones are losing calcium (osteoporosis/osteopenia and acroosteolysis). That acroosteolysis means resorption of the end of the finger bones! Here's an x-ray of what that looks like in the scleroderma hand: http://roentgenrayreader.blogspot.com/2009/05/acroosteolysis.html .

So should we (particularly those of us with anticentromere antibodies) be taking the active form (Calcitrol) directly? That's a good question! Some say it's risky and it might raise the blood level of calcium too high or make kidney problems worse. I think it might be something to be discussed with a VERY knowledgeable scleroderma specialist!

Here's a page on Calcitriol: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000651 .

I'd love to hear what your scleroderma specialists have to say about this! Show them this article! Report back to us what they say!

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Oh yeah, I forgot to draw a correlation here also with all that bone resorption that takes place in the jaw and internal resorption in the teeth too!

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Daisy,
I've been chewing on what you said about vitamin D and calcinosis. I'm confused about whether or not to take vit D.
In spring of 2009 - before being diagnosed last summer with Limited SSc - my doctor put me on a high dose of vitamin D (my blood tests revealed I was low and I had muscle pain). Months later bumps appeared on my knee. In June 2010 those calcified bumps eventually became infected requiring surgery to remove the infected bursa which was filled w/calcified matter. I received my scleroderma diagnosis in Aug and confirmed Dec 2010.
Two weeks ago I went back on a fairly high dose of D (8,000 IU) and noticed a deposit in my fingertip seems to have doubled in size. I have printed your comments and report from your link and will discuss this with my doctor in March.
Thank you for the information,
Alice

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My doc has me supplementing with 2,000 iu D3 daily. I really don't know what to tell you! I wish I knew whether Calcitriol is worth the risk! I don't have calcinosis YET, but if I did, I'd certainly be discussing this article with my doc. Let us know what you find out!

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I have these painful deposits on my finger tips and my doctor gave me a script for silver sulfadiazine cream. It softens the deposit and allows it to fall off. I also increase my vitamin D intake. Hope this helps your friend, God Bless.

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I just ran across this interesting 1990 article: http://www.ncbi.nlm.nih.gov/pubmed/2390132 . It says diltiazem may reduce the size of calcinosis lesions as well as preventing new ones from forming.

Then in 1995 this article was published: http://www.ncbi.nlm.nih.gov/pubmed/2390132 also saying that diltiazem helped.

In 2005 this article: http://www.ncbi.nlm.nih.gov/pubmed/15757822 gave a case report of a single patient who had dramatic benefit.

In 1998 this article: showed a slight improvement in only 3 out of 12 patients. I wonder if the dose was lower?

Have any of you ever been treated with diltiazem for calcinosis (brand names are:

Cardizem

Cartia

Dilacor

Dilt

Diltia

Diltzac

Matzim

Taztia

Tiamate

Tiazac)

And if so, did it help your calcinosis?

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I cover my fingers with eithor metal finger splints to go over the fingertip or the rubber finger covers that secretaries use to sort papers or reshaped metal splint to go over knuckles. I ,of course, use antibotic onit. with pain relief or Bactroban onit. and EMLA (lidocaine cream-get MD prescription) as needed. The Emla REALLY cuts down on the pain with a cream instead of a pill. I first used it to get bld drawn and then realized to would help around ulcers and calcinosis The pharmicist said there is a 7.5% cream that is stronger if I need it -talk to the doctor.

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yes i take diltiazam and vitamin d and calicum supplements for my scleroderma. i also had surgery for the calicum deposits in my fingers. i have many deposits all over my body. the surgery helped somewhat in that it removed deposits and mrsa that developed in my fingers, but some of the deposits have reyurned. i have bouts of remission and than i plunge back into the cycle of deposits pain and everything that goes with sclera. no changes in my life or diet, this disease has a mind of its own. cant predict whats going to happen next. just keep a positive attitude snf press on.wish i can be of more help, but i am clueless as to what to do next.

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Thanks, Magpie,

Anyone else with experience with diltiazem used for calcinosis?

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yes i too have tumous califcation, very painful, lov to talk, bell

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lov,to talk to others who have calification. thanks bell

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All my ring ,middle and pointers have calcium deposits. When my Dr. xrayed said that they have pretty much turned into wood. I live with the pain that goes along with these used to be fingers ,now they have become wood sticks.

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I just got diagnosed with calinosis (calcifications) by a derm doc who specializes in autoimmune skin issues. I then told my rheumy that i wasn't a patient in denial, but was thinking of another opinion and that's when she ordered the x-ray of my hand which confirmed it was calcinosis. I now have started to develop telangiectasias on my chest and face. At least they appear to be them as they blanch like a telangiectasia would. The calcifications popped up about 4 1/2 months ago and both were at the finger joints. One has broken through the skin now. You can hardly tell where the one was now. It got tender and inflamed right before it broke through the skin. So I only have one left on my one finger. I've read where it says they're common to come back in the same place. Is this true for anyone that has calcifications?

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Calcifications are caused by tissue damage and are not caused by taking too much calcium. Would be nice if it was as we'd have a fix for that issue. Maybe one day.

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Hi,
I have limited sclero with mild ILD, but the first symptom that led to my diagnosis was calcium deposit on my left thumb tip. X-rays showed deposits in several other fingers, but the thumb is the only one that breaks through the skin. I first noticed it about 2 years ago, when the thumb tip got very tender. It rapidly progressed to something that looked like an abscess, and about 6 months later the calcium hardened and fell off, leaving a tiny hole. Since then calcium keeps coming up in the same area of my thumb, forms a little mushroom cap shaped "stone" under the skin which eventually falls off, leaving a hole through which little calcium extrudes like toothpaste. Each time it happens the area involved is a bit smaller. I just keep it bandaged to protect it from dirt and bumps. I'm lucky I've not had any painful ulcer develop. What with all the other complications, my life is complicated enough without having my fingers out of commission. I can't use that thumb very well, and had to stop playing the recorder- couldn't press down on the thumb hole. Taking Cellcept and Nexium, lots of tests and Dr. appointments, family problems all take their toll, but I am lucky all symptoms are pretty mild right now. Best of luck to you.
-Diane

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Diane,
Do you have any skin tightening or thickening in your hands or face? If so, how long ago did you develop those and when did you develop ILD? Was the ILD after you developed or before you developed the calcifications? Have you developed any kidney issues? I have esophageal issues, raynaud's and a few other issues, but I think I'm developing telagiectasias. At least they appear to be that but will wait until I see my rheumy. I saw the derm doc 6 weeks ago, but didn't have them or if I did they weren't noticeable to me. Just seems like over the past several weeks I've started to notice more of them on my face and chest. They're very small, but they do blanch. Do you or any of the others have very small telangectasias. Jalee in the group has them, but mine aren't as big as hers so I wasn't sure if some have very small ones too. Sorry you are having family issues. That doesn't help things and I'm sure the combo of illness, family issues, etc can certainly take its toll on someone. Especially when they're sick. Hang in there :-)

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Kacklebird,
When I first noticed the thumb problem, 2 years ago, I had some thickening on my right index finger, it was shortened, and also my right thumb was "clubbed", that is short and wide. In the 2 years since, my skin has hardened some on both hands, just from the finger tips up to the middle joint. The tufts, that is ends of the bones, have been resorbed on most of the fingers. I can make a fist, but my index fingers won't curl in completely- skin is too tight. Last month I had a procedure requiring anesthesia, (not related to sclero), and the anesthesiologist said that is was more difficult to place an IV in my hands because of sclero related skin changes, even though I don't notice anything. Haven't noticed much thickening on my face, although at age 68 I have very few wrinkles!

About the ILD, the first rheumatologist I saw said I didn't need an HRCT of the lungs because I didn't have shortness of breath or other symptoms of lung disease. I did have high scl-70. That was fall of 2009. (First noticed calcification earlier, in May of 2009) I saw a specialist in Spring of 2010, and she said I needed HRCT (high resolution cat scan) of lungs because even though I have limited desease (CREST) my high scl-70 was associated with ILD. I had the HRCT and sure enough it showed inflammation and scarring, but mild and in early stages. My lung function tests and 6 minute walk have been good throughout, just my DLCO is a little low, 64%-71%- so I am a bit worried about PAH down the road- I've been taking 2000mg cellcept daily for a year and lungs seem stable.

No kidney problems. Esophageal issues, dry eyes, a few small telangectasias on my fingers, Raynauds, irritable bowel, chronic cystitis (don't know if that is related to sclero), migraines, osteoarthritis, osteopenia---- all pretty minor, nothing incapacitating- just complicated, lots of dr. appts and tests, an inconvenience more than anything. I have stopped worrying as much as I did at first- I know what you are going through, wanting to know what's coming-- like the hitchhikers guide says, DON'T PANIC-

Take care.

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I had a lot of calcium deposits on my fingers as a child. It was my only symptom from 6 to 24 along with random stomach aches. No doctor put it all together for me until I was 24 when the other symptoms of CREST came out.

That said, I had many of them removed through my adolescence. The ones on my right middle and ring finger were so large I couldn't put gloves on well. I had to have skin grafts from my stomach place over the removal sites. My index finger on my left hand was left as is and now appears boxy and hard as a rock. It has disfigured the nail on that finger. I also had calcium removed from my left elbow as it was painful to move. That calcium came out in a gooey, stringy bubblegum like form that baffled the surgeon at the time. I am glad I had them removed as it has given me back dexterity in my hands and fingers that as a teen, terrified me.

I am now 33 and have had no new calcium deposits grow since I was around 14.

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I started to get the gooey fingertip calcium deposits(also showed on x-rays), now after needing to come off of cellcept b/c of side effects. I do not know if cellcept kept them from forming, BUT the knuckle sores and finger pitting etc.also has increased since decreasing cellcept after 2.5 yr of use and now stopping it. I think cellcept helped.(the bone reabsorption still happened with cellcept though.)

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Hi I never had it on my hands or fingers but i have it really bad on my tail bone, buttocks, right elbow, it first started on my knees but went away i mean just stop hurting me. I have crest limited. was diagnosed in 99' and i'm now 50 but some days feel like 80. The only meds I've everbeen on is inflammatorys my doc has'nt done much with me

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