Pseudogout and Its Treatment

Chondrocalcinosis (also called Pseudogout) most commonly occurs in the knee.

What is Pseudogout "false gout"?

   Calcium Pyrophosphate Deposition (CPPD) also known as Pseudogout, is a joint problem caused by crystals of calcium salt called Pyrophosphate that are deposited in the joint space. A patient can be asymptomatic for many weeks or can experience flare-ups that present with a severe pain, swelling, stiffness, redness and warmth of one or more joints that can last from days to weeks, usually self-limited. The crystals can be deposited in the synovial fluid or the cartilage in an older patient that has no symptoms. The most common affected joint is the knee, but it can also present in the shoulder, elbow, wrist, hand, ankle or other joints. The calcium pyrophosphate crystals will deposit in the cartilage resulting in pain and inflammation. There is no clear evidence of why the crystals will deposit in the cartilage but there has been a direct relationship with increased age especially those over 65 with no major sex predominance. Medical problems that are considered highly possible contributors to pseudogout include Hypomagnesemia (no magnesium in blood), Hyperparathyroidism (increased activity of parathyroid gland), Hemochromatosis (excess iron storage), Hypercalcemia (excess calcium in blood) or Hypothyroidism (under anctive thyroid).

 

How is Pseudogout diagnosed?

   The diagnosis will be made based on the clinical presentation and positive test results ordered by your physician. Imaging such as anterior-posterior view x-ray of bilateral knee., will present with a radiopaque (appear light or white) line paralleling the surface of the underlying bone. Due to the overlapping symptoms with Gout, Rheumatoid Arthritis and other joint infection, your physician may perform an Arthrocentesis (aspiration of fluid in the joint space) with synovial analysis for detection of the calcium pyrophosphate crystals under the microscope. If present the results will prove positively birefringent material.

 

How is Pseudogout treated?

   There is no definite treatment that will cure pseudogout. Over-the-counter NSAIDs such as ibuprofen or naproxen sodium combined with resting of the joint for a few days and applying cold packs to reduce the inflammation associated with acute attacks has been proven effective. If the previously mentioned fails, your physician may prescribe medication to improve the joint function. Prescription strength Non-Steroidal Anti-Inflammatory Drugs such as naproxen and indomethacin have been proven effective for presenting symptoms management. Special caution should be taken with NSAIDs if there is a previous stomach bleeding or impaired renal function; oral corticosteroids will help reduce the inflammation in patients that cannot tolerate NSAIDs. Low dose colchicine is prescribed at a long term to reduce the risk of recurrent attacks. Another alternative for treatment is jojnt drainage followed by a corticosteroid injection (3.00cc of Lidocaine HCl 1% for numbness and 1.00cc of Triamcinolone Acetomide Injectable Suspension for inflammation). 

Author
Luis G. Colon Gonzalez MS3 Third year medical student at University of Medicine and Health Sciences (UMHS)

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