Pseudogout Flashcards
What is it?
Pseudogout is a crystal arthropathy caused by calcium pyrophosphate crystals. Calcium pyrophosphate crystals are deposited in the joint causing joint problems. It is also known as chondrocalcinosis.
Presentation?
A typically presentation of pseudogout is an older adult with a hot, swollen, stiff, painful knee. Other joints that are commonly affected are the shoulders, wrists and hips.
It can be a chronic condition and affect multiple joints. It can also be asymptomatic and picked up incidentally on an xray of the joint.
Diagnosis?
In any patient presenting with a hot, painful and swollen joint, septic arthritis needs to be excluded as it is a medical emergency that is joint and life threatening. It tends the be milder in presentation compared with gout and septic arthritis.
To establish a definitive diagnosis the joint needs to be aspirated for synovial fluid.
Aspirated fluid will show:
No bacterial growth
Calcium pyrophosphate crystals
Rhomboid shaped crystals
Positive birefringent of polarised light
What x ray changes do you see?
Other joint xray changes are similar to osteoarthritis. Remember the mnemonic LOSS:
L – Loss of joint space
O – Osteophytes
S – Subarticular sclerosis
S – Subchondral cysts
Management?
Chronic asymptomatic changes found on an xray do not require any action.
Symptoms usually resolve spontaneously over several weeks. Symptomatic management involves:
NSAIDs
Colchicine
Joint aspiration
Steroid injections
Oral steroids
Joint washout (arthrocentesis) is an option in severe cases.
