Crystal Arthritis - Pseudogout

Question 1

What is Pseudogout?

Answer 1

Crystal arthropathy caused by Calcium Pyrophosphate Dihydrate crystals.

Question 2

Risk Factors of Pseudogout (5).

Answer 2

1. Increasing Age.
2. Haemochromatosis.
3. Hyperparathyroidism.
4. Low Magnesium + Low Phosphate.
5. Acromegaly + Wilson’s Disease.

Question 3

Aetiology of Pseudogout.

Answer 3

Calcium Pyrophosphate crystals are deposited in the joint - also known as Chondrocalcinosis.

Question 4

Clinical Presentation of Pseudogout (3).

Answer 4

1. Stereotypical Patient : Older Adult with hot, swollen, stiff, painful knee.
2. Asymptomatic (+ Incidental X-Ray Finding).
3. Chronic Condition affecting multiple joints e.g. shoulders, wrists, hips.

Question 5

Diagnosis of Pseudogout (2).

Answer 5

1. EXCLUDE SEPTIC ARTHRITIS.

2. Joint Aspiration - Synovial Fluid.

Question 6

What will Aspirated Fluid show in Pseudogout? (4)

Answer 6

1. No bacterial growth.
2. Calcium Pyrophosphate Crystals.
3. Rhomboid Shaped Crystals.
4. Weakly Positive Birefringent of Polarised Light.

Question 7

X-Ray Changes in Pseudogout (5).

Answer 7

1. LOSS.
2. Chondrocalcinosis - thin white line in the middle of the joint space caused by Calcium deposition : pathognomonic of pseudogout.

Question 8

Management of Pseudogout (3).

Answer 8

1. Chronic - No Management.
2. Symptomatic - NSAIDs, Colchicine, Joint Aspiration, Steroid Injections, Oral Steroids.
3. Severe - Joint Washout (Arthrocentesis).