From the Guidelines
Pseudogout treatment should prioritize the use of NSAIDs or colchicine to reduce inflammation and pain during acute attacks, with consideration of potential side effects, as recommended by the EULAR guidelines 1. When managing pseudogout, it is essential to consider the patient's overall health and potential comorbidities that may impact treatment.
- For acute attacks, NSAIDs like naproxen or ibuprofen are first-line treatments, but their use should be carefully considered due to potential side effects such as gastrointestinal bleeding, cardiovascular events, and renal impairment 1.
- Colchicine is an alternative option, with a recommended lower-dose regimen (0.5 mg up to three to four times daily) to minimize side effects like diarrhea 1.
- In cases where NSAIDs or colchicine are not suitable, corticosteroids can be used as joint injections or oral medications, and joint aspiration can provide immediate relief.
- Long-term management involves treating underlying conditions and lifestyle modifications, such as avoiding high-purine foods and maintaining adequate hydration.
- Low-dose colchicine may be effective as a prophylactic agent in recurrent acute attacks of CPP crystal arthritis, as suggested by a study where 90% of patients benefited from the treatment 1.
From the Research
Pseudogout Treatment Options
- Acute pseudogout treatment is similar to acute gouty arthritis treatment, with options including NSAIDs, corticosteroids, and colchicine 2, 3, 4
- There is no standard regimen for long-term chronic therapies of pseudogout 2
- Colchicine may be used as a prophylactic agent in managing recurrent attacks of pseudogout 5
- Agents that directly target the inflammasome, such as drugs which inhibit the interleukin 1 pathway, may be used in the treatment of severe, refractory pseudogout 5
Treatment Considerations
- Treatment approaches are mainly directed at relieving the symptoms of joint inflammation 5
- Unlike gout, there are no agents available that have been shown to decrease crystal load in CPPD-related joint disease 5
- The use of systemic glucocorticoids, NSAIDs, and low-dose colchicine may be effective in treating acute gout, and may also be considered for pseudogout treatment 3, 4