Pseudo-gout

Question 1

What are the features of gout/pseudogout?

Answer 1

An acutely hot, painful, swollen joint

Question 2

What should be done for all acutely hot, swollen joints?

Answer 2

Aspirate- also rule out a septic joint as this is an emergency

Question 3

What should be done if wanting to investigate an aspirate for features of gout/pseudogout?

Answer 3

Birefringent light microscopy

Question 4

What is seen for gout on birefringent light microscopy?

Answer 4

Negatively birefringent urate crystals

Question 5

What is seen for pseudogout on polarised light microscopy?

Answer 5

Positively birefringent crystals

Question 6

What causes pseudogout?

Answer 6

Calcium pyrophosphate

Question 7

What are some risk factors for developing pseudogout?

Answer 7

Hyperparathyroidism
Hypothyroidism
Haemochromatosis
Low magnesium, low phosphate
Wilson's disease

Question 8

What joints are most commonly affected by pseudogout?

Answer 8

Knee
Wrist
Shoulder

Question 9

What might be seen on an X-ray in someone with pseudogout?

Answer 9

Soft tissue calcium deposition

Question 10

What is the management of pseudogout?

Answer 10

For any acute inflamed swollen joint aspirate to exclude septic arthritis

Acute Attack: NSAIDs, cooling packs, Steroid injections.

Long Term- Methotrexate and hydroxychloroquine may be considered for CCP inflammatory arthritis