T&O: gout and pseudogout Flashcards
60 yr old pt presents with a knee that is swollen, stiff, ++ painful and hot. Says he thinks its happened before but can’t remember when. Pt temp is 38
You get follwing Xray, what is the diagnosis?
Calcium pyrophosphate deposition disease - CPPD (Pseudo Gout)
Rhombioid shaped calcium pyrophosphate crystals can be seen on xray in menisci
Distinguish between Gout and Pseudo-Gout
Gout: uric acid crystals
Pseudo -Gout: calcium pyrophosphate crystals (rhomboid)
What are some differencials for a patient presenting with an acutely swollen joint?
Septic Arthritis (*** exlude! ***especially if 1 joint)
Trauma - Haemarthrosis
Crystal arthropathies - Gout & Pseudo-Gout
Rheumatological - RA
Spondyloarthropathies - Psoriatic Arthritis, ankylosing spondylisits, Reactive Arthritis
Osteoarthritis
MSK injuries (brusitis, ligament / tendon injury)
How does pseudo gout mimic RA and OA over time?
Worse in the morning - stiffness / fatigue
knobbly, deformed joint e.g. knee, elbow, wrist etc
Low grade fever
Reduced joint movement
Pain
What investigations would you do to diagnose pseudo gout?
Xray - see calcium pyrophosphate crystals and exclude other cause
Aspirate knee - find crystals (exclude gout crystals)
Full blood count - exclude other diseases
What are some risk factors for psudeo - gout?
Advanced age
Injury or previous joint surgery
Hyperparathyroidism
Hypophosphataemia
Haemochromatosis
Hypomagnesaemia
What are some treatments for Pseudo - Gout
NSAIDS (- pain / inflammation )
Colchicine if NSAIDs contraindicated
Corticosteroid interarticular injection / short course oral steroids if above contraindicated
Ice / rest etc
What is pseudo gout?
Deposition of calcium pyrophosphate within the joint space which causes inflammatory arthritis
How does pseudo gout present?
Acute onset joint swelling. Usually in knee or wrist.
What is seen on XR of knee with pseudo gout?
Cloudy appearance in the joint space.
What is seen in aspirate of joint with pseudo gout ?
Rhomboid shape crystals
How is pseudo gout managed?
NSAIDs and treat underlying cause
