Pseudogout

Question 1

define pseudogout and brief pathophysiology

Answer 1

• This is a crystal arthropathy caused by calcium pyrophosphate crystals.
• Calcium pyrophosphate crystals are deposited in the joint causing joint problems.
• This is also known as chondrocalcinosis.

Question 2

how does pseudogout commonly present?

Answer 2

• An older adult with a hot, swollen, stiff and painful knee.
• Other joints commonly affected  shoulders, wrists and hips.
• Can also be asymptomatic and picked up incidentally on X-ray.

Question 3

how is pseudogout diagnosed?

Answer 3

• Always exclude septic arthritis.
• To establish a definitive diagnosis, the joint needs to be aspirated for synovial fluid

Chondrocalcinosis is the classic x-ray change in pseudogout  appears as a thin white line in the middle of the joint caused by calcium deposit. This is diagnostic of pseudogout.

Question 4

what would you see on aspirate for pseudogout?

Answer 4

1) No bacterial growth
2) Calcium pyrophosphate crystals
3) Rhomboid shaped crystals
4) Positive birefringent of polarised light.

Question 5

how is pseudogout managed?

Answer 5

• Usually resolve spontaneously over several weeks.
• Symptomatic management involves:
  1) NSAIDs
  2) Colchicine
  3) Joint aspiration
  4) Steroid injections
  5) Oral steroids
  6) Joint washout (arthrocentesis) is an option in severe cases.