Pseudogout

Question 1

Which groups of people are vulnerable to pseudogout?

Answer 1

More common in elderly women, affects wrist and knee
- In the wrist: commonly affect triangular fibrocartilage

In young people, a/w hemochromatosis, hyperparathyroidism, Wilson’s disease

Precipitated by illness, surgery, trauma

Question 2

What are the clinical features of pseudogout?

Answer 2

• Acute pain (severe), redness and swelling: similar presentation to gout, thus pseudogout is DDx
• Usually affects knees or wrist (especially 2nd and 3rd MCP joint)
• Joint space narrowing, sub-chondral new bone formation and osteophytes may be seen on X-ray
• May be a/w fever and ↑ WCC -> must r/o SA
• May be a/w SLAC (scapholunate advanced collapse) wrist (can by damage to scapholunate ligament), though it is most commonly due to trauma

Question 3

What are the investigations required for pseudogout?

Answer 3

• Joint fluid (usually purulent): rhomboidal, weakly positive bi-refringent crystals
• XR: Chondrocalcinosis
• Exclude septic arthritis by sending joint fluid for culture

Question 4

What is the management of pseudogout?

Answer 4

Acute

• Cool packs, rest, splint
• Joint aspiration -> dramatically reduces pain
• Intra-art GC (exclude infections first)
• NSAIDs +- colchicine – colchicine is given for acute attacks, to prevent lymphocyte migration

Chronic Recurrent
- MTX/hydroxychloroquine – only if severe; Not commonly used