What is the treatment for pseudogout?

Treatment for Pseudogout

The first-line treatment for acute pseudogout includes NSAIDs, low-dose colchicine, or glucocorticoids (oral or intra-articular injection), with the specific choice based on patient comorbidities and contraindications. 1

Acute Management Options

First-line Treatments

1. NSAIDs

   • Effective for pain and inflammation control
   • Consider gastric protection if needed
   • Use with caution in patients with gastrointestinal, cardiovascular, or renal issues 2, 1

2. Colchicine

   • Low-dose regimen preferred: 1.2 mg initially, followed by 0.6 mg one hour later (total 1.8 mg)
   • Must be started within 36 hours of symptom onset for maximum effectiveness
   • Avoid high doses due to significant gastrointestinal side effects (diarrhea, nausea, vomiting) 1
   • Traditional high-dose regimens are no longer recommended due to toxicity 2

3. Glucocorticoids

   • Intra-articular injection: Highly effective for monoarticular attacks 2, 1
   • Aspiration of joint fluid prior to injection provides immediate pain relief and confirms diagnosis
   • Systemic steroids: Useful for polyarticular attacks or when other treatments are contraindicated

4. Adjunctive Therapy

   • Topical ice application can provide additional symptom relief 1
   • Rest and elevation of the affected joint

Severe or Resistant Cases

• Combination therapy may be used for severe attacks (pain ≥7/10) or polyarticular involvement 1
• IL-1 inhibitors (anakinra) have shown effectiveness in treatment-resistant pseudogout 3

Prophylactic Treatment

For patients with recurrent attacks of pseudogout:

• Low-dose colchicine (0.6 mg once or twice daily) has been shown to reduce attack frequency from 3.2 to 1 attack per patient per year 4
• NSAIDs at lower doses can also be used for prophylaxis
• Prophylaxis duration: Usually 3-6 months, depending on clinical response 1

Special Considerations

Post-surgical Pseudogout

• Pseudogout can occur as a complication after surgeries, particularly parathyroidectomy and knee arthroplasty 5, 6
• Prophylactic colchicine (1 mg/day) may prevent post-surgical attacks in at-risk patients 6

Addressing Underlying Conditions

• Evaluate for and treat associated conditions that can trigger pseudogout:
  • Hyperparathyroidism
  • Hemochromatosis
  • Hypophosphatasia
  • Hypomagnesemia

Common Pitfalls to Avoid

1. Misdiagnosing as infection: Always consider joint aspiration and crystal analysis to differentiate pseudogout from septic arthritis 5

2. Using high-dose colchicine regimens: These cause significant toxicity with minimal additional benefit 2, 1

3. Inadequate treatment duration: Premature discontinuation of therapy can lead to symptom recurrence

4. Overlooking prophylaxis: Patients with frequent recurrences benefit from preventive therapy 4

5. Neglecting lifestyle modifications: Weight loss (if obese), adequate hydration, and dietary modifications should be incorporated into the management plan 1