From the Guidelines
Pseudogout treatment should prioritize the use of oral NSAIDs or oral colchicine for acute attacks, with a recommended colchicine dose of 0.5 mg up to three to four times daily, due to the high incidence of side effects with traditional regimens 1. When managing pseudogout, it is essential to consider the potential side effects of treatment options, as they can greatly restrict their use, especially in older patients with chronic renal impairment and other comorbidities.
- Key treatment options for acute pseudogout attacks include:
- Oral NSAIDs, which can provide effective relief but may cause gastrointestinal bleeding, cardiovascular events, and renal impairment
- Oral colchicine, which is effective at relieving symptoms of acute crystal synovitis but can cause diarrhea and other side effects
- The length of treatment with colchicine depends on symptom relief and side effects, and a lower-dose regimen is recommended to minimize toxicity 1.
- In cases where NSAIDs or colchicine are contraindicated, alternative options such as joint aspiration followed by intra-articular corticosteroid injection or systemic corticosteroids may be considered.
- Preventing future episodes is also crucial, and low-dose colchicine or low-dose NSAIDs may be used in recurrent cases, along with treating underlying conditions that contribute to calcium pyrophosphate crystal formation 1.
From the Research
Pseudogout Treatment Overview
- Pseudogout, also known as calcium pyrophosphate dihydrate (CPPD) crystal-related arthropathy, is a condition that presents management challenges in clinical practice, particularly in older patients with multiple medical comorbidities 2.
- The treatment approaches for pseudogout are mainly directed at relieving the symptoms of joint inflammation, with no agents available that have been shown to decrease crystal load in CPPD-related joint disease 2.
Acute Pseudogout Treatment
- Acute pseudogout treatment is similar to acute gouty arthritis treatment, with the use of anti-inflammatory medications such as NSAIDs and corticosteroids 3.
- Colchicine has been shown to be effective in relieving symptoms of acute pseudogout, and may also have a prophylactic effect in managing recurrent attacks 2.
Long-term Pseudogout Treatment
- There is no standard regimen for long-term chronic therapies of pseudogout, and treatment is often focused on managing symptoms and preventing recurrent attacks 3.
- Novel insights into the pathogenesis of crystal-induced joint inflammation and subsequent joint degeneration have highlighted the potential of targeted therapies, such as agents that directly target the inflammasome and inhibit the interleukin 1 pathway, in the treatment of severe, refractory pseudogout 2.
Comparison to Gout Treatment
- Unlike gout, there are no urate-lowering therapies available for pseudogout, and treatment is primarily focused on relieving symptoms and managing inflammation 4, 3.
- However, similar anti-inflammatory medications such as NSAIDs and corticosteroids are used to treat both gout and pseudogout, with colchicine also being effective in relieving symptoms of both conditions 4, 5.