Condition: Pseudogout (Calcium Pyrophosphate Deposition Disease - CPPD)
Brief Overview: Pseudogout is an inflammatory arthritis caused by the deposition of calcium pyrophosphate dihydrate crystals in the joints. It mimics gout but often affects larger joints such as the knees, wrists, and shoulders.
Prevalence: Pseudogout primarily affects older adults, with increasing prevalence after the age of 60. It is less common than gout.
Etiology: The exact cause of CPPD crystal deposition is unclear, but it may result from cartilage degeneration, genetic predisposition, or metabolic disturbances.
Risk Factors:
• Advanced age
• Joint trauma or surgery
• Genetic predisposition
• Metabolic conditions (e.g., hyperparathyroidism, hemochromatosis, hypomagnesemia, hypothyroidism)
• Osteoarthritis
Commonly Associated Conditions:
• Osteoarthritis
• Gout
• Hypothyroidism
• Hyperparathyroidism
• Hemochromatosis
Common Medications:
• NSAIDs for pain and inflammation
• Corticosteroids (oral or intra-articular injections)
• Colchicine for acute episodes or prophylaxis
• Low-dose colchicine for recurrent attacks
Common Labs, Imaging, and Tests:
• Synovial fluid analysis (presence of calcium pyrophosphate crystals with rhomboid shapes under polarized light)
• X-rays (chondrocalcinosis or calcification in cartilage)
• Blood tests for associated metabolic conditions
Common Symptoms:
• Acute onset of joint pain and swelling
• Joint stiffness and tenderness
• Redness and warmth in the affected joint
• Episodes often triggered by trauma, illness, or surgery
• Fever may or may not be present
Common Treatments:
• NSAIDs for mild to moderate inflammation
• Corticosteroid injections for severe inflammation
• Colchicine for acute attacks or prevention
• Treatment of underlying metabolic conditions
• Rest and elevate affected joint(s) during acute flare.
• Apply ice/cool compresses to affected joints during acute flare.
• Non–weight-bearing on affected joint while painful; use crutches or a walker.
Physical Findings:
• Swollen and tender joints, often the knee or wrist
• Warmth and erythema over the affected joint
• Limited joint range of motion
Potential Complications and Contraindications:
• Chronic arthritis in untreated cases
• Joint damage over time with recurrent episodes
• NSAID contraindications (e.g., peptic ulcer disease, renal impairment)
General Health and Lifestyle Guidance:
• Maintain a healthy weight to reduce joint stress
• Stay hydrated to support joint health
• Manage underlying conditions (e.g., thyroid or parathyroid disorders)
• Engage in low-impact exercises to maintain joint function
Suggested Questions to Ask Patients:
• Have you experienced sudden joint pain or swelling in large joints?
• Do you have a history of metabolic conditions and are you getting treatment for them?
• Are there specific activities or events that trigger your symptoms?
• Have you noticed a pattern to the frequency of your episodes?
Suggested Talking Points:
• Explain the difference between pseudogout and gout (calcium vs urate).
• Highlight the importance of treating metabolic conditions to prevent flare-ups.
• Reassure patients about the availability of effective treatments for pain relief.
• Discuss the importance of follow-up care as progressive joint damage and functional limitations may occur with recurrent attacks.