Treatment for Pseudogout
NSAIDs at full anti-inflammatory doses are recommended as effective first-line agents for acute pseudogout attacks when there are no contraindications. 1
Acute Attack Management
First-Line Options
- NSAIDs at full anti-inflammatory doses are effective for acute pseudogout attacks, but carry risks of gastrointestinal bleeding and cardiovascular toxicity, particularly in elderly patients 1
- Low-dose colchicine (0.5-0.6 mg two to three times daily) is an effective treatment with fewer gastrointestinal side effects than traditional high-dose regimens 1
- Corticosteroids should be considered as first-line therapy due to their favorable safety profile, particularly in patients with contraindications to NSAIDs 1
- Treatment should be initiated within 24 hours of symptom onset for optimal efficacy 1
Joint-Specific Treatment
- Intra-articular aspiration and injection of long-acting steroids is an effective and safe treatment for acute pseudogout affecting accessible joints 1
- This approach provides targeted relief while minimizing systemic medication exposure 1
Long-term Management
Prophylactic Therapy
- For patients with frequent recurrent attacks, prophylactic therapy with low-dose colchicine (0.5-0.6 mg once or twice daily) is recommended 1
- Low-dose NSAIDs with gastric protection may be used if appropriate 1
- Low-dose corticosteroids (<10 mg/day) are an option if colchicine and NSAIDs are contraindicated 1
Colchicine Dosing Considerations
- The FDA-approved colchicine dosing for gout flare prophylaxis is 0.6 mg once or twice daily, with a maximum recommended dose of 1.2 mg/day 2
- Dose adjustments are necessary for patients with renal or hepatic impairment and those taking interacting medications 2
- For patients with severe renal impairment (CrCl <30 mL/min), the starting dose should be reduced to 0.3 mg/day 2
- For patients undergoing dialysis, the recommended starting dose for prophylaxis is 0.3 mg twice weekly 2
Special Populations
Elderly Patients
- Dose selection for elderly patients should be cautious, reflecting the greater frequency of decreased renal function, concomitant disease, or other drug therapy 2
- Monitor closely for adverse effects, particularly with NSAIDs and colchicine 1, 2
Patients with Comorbidities
- In patients with renal impairment, colchicine dosing must be individualized according to the patient's renal function 2
- For patients with severe hepatic impairment, dose reduction should be considered with careful monitoring 2
- Address associated comorbidities such as hyperlipidemia, hypertension, and hyperglycemia as part of comprehensive management 1
Common Pitfalls and Caveats
- High doses of colchicine lead to significant gastrointestinal side effects; low doses are generally sufficient and better tolerated 1
- NSAIDs carry risks of gastrointestinal bleeding and cardiovascular toxicity, particularly in elderly patients 1
- Treatment with corticosteroids appears to have a more favorable safety profile compared to NSAIDs for selected adverse events including indigestion, nausea, and vomiting 3
- Unlike gout, there are currently no agents available that have been shown to decrease crystal load in pseudogout 4
- Colchicine should be used with caution in breastfeeding women as it is excreted into human milk 2
Patient Education and Lifestyle Modifications
- Patient education about the condition and appropriate lifestyle advice are core aspects of management 1
- Weight loss if obese, appropriate diet modifications, and reduced alcohol consumption are recommended 1
- Understanding the difference between pseudogout and other forms of arthritis is important for appropriate long-term management 5