MANUAL MINORS
Pseudogout, or chondrocalcinosis, is a form of arthritis caused by the deposition of calcium pyrophosphate crystals in the joints, leading to acute inflammation, pain, swelling, and joint stiffness.
Unlike gout, which is caused by urate crystals, pseudogout commonly affects the knees, wrists, and other large joints. It typically occurs in older individuals and may be associated with metabolic disorders such as hyperparathyroidism or haemochromatosis.
Diagnosis
The diagnosis is primarily made through joint aspiration and synovial fluid analysis, where calcium pyrophosphate crystals with weakly positive birefringence are identified under polarised light. X-rays often show calcium deposits in the articular cartilage (chondrocalcinosis), which is a characteristic finding. Clinical symptoms include an acute joint attack with signs of inflammation and functional limitation, similar to a gout attack.
Differential Diagnosis
Condition | Distinctive Features |
|---|---|
Gout | Urate crystals with negative birefringence in synovial fluid, typically affects the big toe (podagra). |
Septic arthritis | Fever, purulent synovial fluid, positive culture, systemic signs of infection. |
Osteoarthritis | Progressive chronic pain, associated with degenerative changes on X-rays, no crystal deposits. |
Rheumatoid arthritis | Symmetrical polyarthritis, positive serological tests (RF, anti-CCP), systemic involvement. |
Reactive arthritis | History of previous infection, asymmetrical, typically affects the lower limbs. |
Emergency Management
Emergency treatment for an acute pseudogout attack focuses on controlling pain and inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as indomethacin or naproxen, are commonly used. Colchicine can also be used to reduce inflammation in the early days of an attack.
In severe cases or in patients who cannot tolerate NSAIDs, oral or intra-articular corticosteroids may be administered. Arthrocentesis can help relieve joint pressure and pain, while also providing a sample for analysis.
Definitive Treatment
There is no definitive cure for pseudogout, but long-term management includes controlling predisposing factors, such as underlying metabolic diseases. In some cases, low-dose colchicine may be used to prevent future attacks. Effective management of pain and inflammation is essential, along with joint exercises to maintain mobility and prevent functional deterioration.
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