Psuedogout

Question 1

Definition

Answer 1

arthropathy due to crystals of calcium pyrophosphate

Question 2

Causes

Answer 2

• frequently sporadic and idiopathic
• can follow changes in matrix proteins and proteoglycans that can occur with age and in OA
• Secondary to severeal inherited or acquired disease associated with changes in pyrophosphate metabolism
  
  • metabolic- haemochromatosis, Wilsons disease
  • Electrolytes- hypophosphataemia, hypomagnasemia
  • Endocrine- hyperparathyroidism
  • Gout
  • Familial disease

Question 3

Clinical features

Answer 3

• acute monoarthrpathy
• large joints - knee
• severe joint pain, swelling, tenderness and effusion
• systemic symptoms
• old age (65-75 years)
• DM
• Chondrocalcinosis - incidental finding on X-ray

Question 4

Diagnosis

Answer 4

• Synovial fluid examination
  
  • Aspirate (send to micro and patho) - Positvely birefringent rhomboid
  • Gram stain and culture to exclude bacterial infection
• Xray - shows calcium deposit in the joint (chondrocalcinosis)

Question 5

Management

Answer 5

symptomatic

• cool packs
• rest
• aspriation
• intra-articular steroids

Chronic - methotrexate

Question 6

Triggering factors

Answer 6

• intercurrent illness
• trauma to joint
• surgery, parathyroidectomy
• blood transfusions/ IV fluids
• Thyroxine replacement therapy
• Joint lavage

Question 7

Chronic pyrophosphate arthropathy

Answer 7

• often resembles RA, indolent arthritis
• may be persistent subacute inflammatory
• punctuated by acute attacks
• knees most commonly