From the Guidelines
Pseudogout, or Calcium Pyrophosphate Dihydrate (CPPD) crystal deposition disease, is diagnosed through a combination of clinical presentation, imaging findings, and synovial fluid analysis, with the definitive diagnosis requiring identification of rhomboid-shaped, weakly positively birefringent calcium pyrophosphate crystals in synovial fluid under polarized light microscopy. The diagnostic criteria for pseudogout include acute arthritis attacks, especially in the knee, wrist, or other large joints, radiographic evidence of chondrocalcinosis, and age over 50 years 1.
Diagnostic Approach
- Clinical presentation: Acute arthritis attacks, joint pain, and swelling
- Imaging findings: Radiographic evidence of chondrocalcinosis
- Synovial fluid analysis: Identification of calcium pyrophosphate crystals under polarized light microscopy
- Supporting diagnostic criteria: Age over 50 years, presence of underlying metabolic conditions such as hyperparathyroidism or hemochromatosis
Treatment Options
- For acute flares, NSAIDs like naproxen (500mg twice daily) or indomethacin (25-50mg three times daily) are first-line treatments for 7-14 days 1
- Colchicine can be used at 0.6mg once or twice daily for patients who cannot tolerate NSAIDs
- Joint aspiration with intra-articular corticosteroid injection provides rapid relief
- For polyarticular flares or when other options are contraindicated, a short course of oral prednisone may be used
- Long-term management includes addressing underlying metabolic conditions and prophylactic use of low-dose colchicine in patients with frequent attacks.
From the Research
Diagnostic Criteria for Pseudo Gout (Calcium Pyrophosphate Dihydrate Crystal Deposition Disease)
- The diagnosis of pseudo gout is based on synovial fluid analysis, which involves the visualization of positively birefringent CPPD crystals using compensated polarized light microscopy 2.
- X-rays can also be used to diagnose pseudo gout, with punctate and linear radiodense areas in fibrocartilage and hyaline cartilage being indicative of the disease 2.
- Ultrasound can be a useful tool in the diagnosis of crystal deposition diseases, including pseudo gout, as it allows for the detection of aggregates of microcrystals at multiple anatomical sites 3.
- The identification of CPPD crystals in synovial fluid by polarized light microscopy is the gold standard for diagnosing pseudo gout 4, 5.
Treatment Options for Pseudo Gout
- Treatment for pseudo gout is primarily symptomatic, as there is no known drug that can prevent the progression of joint destruction 2.
- Nonsteroid anti-inflammatory drugs (NSAIDs) and intra-articular or systemic glucocorticoids are the most useful treatments for pseudo gout 2.
- Colchicine can be effective in recurring pseudo gout, and magnesium can be used prophylactically 2.
- In some cases, methotrexate may be effective in treating pseudo gout, although this is typically used when other treatments fail 2.
- Treatment of acute pseudo gout is similar to treatment of gout attack and consists of physical measures and medication with NSAIDs, colchicine, or sometimes steroids 6.
Clinical Forms of Pseudo Gout
- Pseudo gout can manifest in three clinical forms: asymptomatic, acute, and chronic 6.
- The asymptomatic form is the most common, while the acute form is characterized by severe inflammatory arthritis 6.
- The chronic form of pseudo gout can lead to degenerative changes in cartilage and bone 6.