What are the symptoms and treatment options for pseudogout?

Symptoms and Treatment of Pseudogout

Pseudogout (calcium pyrophosphate deposition disease) presents primarily with acute joint pain, swelling, redness, and warmth, most commonly affecting large joints like the knee, wrist, ankle, and elbow. 1

Clinical Presentation

• Acute attacks characterized by sudden onset of joint pain, swelling, redness, and warmth, typically affecting large joints such as knees, wrists, ankles, and elbows 1, 2
• Joint pain ranges from mild to severe and can be accompanied by limited range of motion and functional impairment 1
• Attacks may last for days to weeks if untreated 1
• Some patients experience recurrent attacks with symptom-free intervals 3
• Chronic forms can present with progressive joint damage and persistent symptoms mimicking osteoarthritis 4
• Less commonly, pseudogout can affect the temporomandibular joint, causing facial pain, swelling, and trismus 5
• Pseudogout flares can occur following parathyroidectomy due to rapid changes in calcium levels 2

Diagnostic Imaging

• X-ray is the first-line imaging method for suspected pseudogout, showing characteristic chondrocalcinosis (calcification in cartilage) 6
• X-ray has the highest rating (9/9) for appropriateness in diagnosing calcium pyrophosphate deposition disease 6
• Other imaging modalities such as CT, MRI, and ultrasound may be appropriate in certain cases but are rated lower (5/9) than X-ray 6
• Triangular fibrocartilage complex chondrocalcinosis on wrist X-rays is a common finding 2

Treatment of Acute Pseudogout Attacks

• NSAIDs at full anti-inflammatory doses are effective first-line agents for acute attacks when there are no contraindications 1
• Low-dose colchicine (0.5-0.6 mg two to three times daily) is effective with fewer gastrointestinal side effects than traditional high-dose regimens 1
• Corticosteroids are particularly useful in patients with contraindications to NSAIDs and should be considered as first-line therapy due to their favorable safety profile 1
• Joint aspiration and intra-articular injection of long-acting steroids is highly effective for accessible joints 1
• Treatment should be initiated within 24 hours of symptom onset for optimal efficacy 1

Long-term Management

• Prophylactic therapy is recommended for patients with frequent recurrent attacks 1
• Low-dose colchicine (0.5-0.6 mg once or twice daily) is effective for preventing recurrent attacks 1, 3
• Studies show colchicine prophylaxis can reduce attack frequency from 3.2 to 1 attack per patient per year 3
• Low-dose NSAIDs with gastric protection may be used if colchicine is contraindicated 1
• Low-dose corticosteroids (<10 mg/day) can be considered if both colchicine and NSAIDs are contraindicated 1

Patient Education and Lifestyle Modifications

• Patient education about the condition is a core aspect of management 1
• Weight loss is recommended for obese patients 1
• Appropriate dietary modifications and reduced alcohol consumption may be beneficial 1
• Management of associated comorbidities such as hyperlipidemia, hypertension, and hyperglycemia is important 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
• Unlike gout, there is no standard urate-lowering therapy for pseudogout as it involves calcium pyrophosphate crystals rather than uric acid 7
• Pseudogout can be misdiagnosed as septic arthritis due to similar presentation with joint swelling, redness, and pain 2
• Unlike gout, which commonly affects the first metatarsophalangeal joint, pseudogout more typically affects larger joints 4