From the Guidelines
Pseudogout is a form of inflammatory arthritis caused by calcium pyrophosphate crystal deposition (CPPD) in joints, and the most important point to know is that its management focuses on symptomatic control, as there are no treatments that modify CPP crystal formation or dissolution. Pseudogout typically affects larger joints, particularly the knees, wrists, and ankles, and is more common in older adults. Risk factors include advanced age, previous joint trauma, metabolic disorders like hyperparathyroidism, hemochromatosis, and hypomagnesemia. Diagnosis requires joint aspiration showing weakly positive birefringent rhomboid-shaped crystals under polarized light microscopy, contrasting with the negatively birefringent needle-shaped urate crystals seen in gout. X-rays may show chondrocalcinosis (calcification of cartilage).
Some key points to consider in the management of pseudogout include:
- Optimal treatment requires both non-pharmacological and pharmacological treatments, tailored according to clinical features, general risk factors, and the presence of predisposing metabolic disorders 1.
- For acute CPP crystal arthritis, treatment options include application of ice or cool packs, temporary rest, joint aspiration, and intra-articular injection of long-acting glucocorticosteroids (GCS), as well as oral NSAIDs or low-dose oral colchicine 1.
- Prophylaxis against frequent recurrent acute CPP crystal arthritis can be achieved with low-dose oral colchicine or low-dose oral NSAID, with gastroprotective treatment if indicated 1.
- The management objectives and treatment options for patients with osteoarthritis (OA) and CPPD are the same as those for OA without CPPD, with a focus on symptomatic control and management of underlying metabolic conditions if present 1.
The most effective treatment approach for pseudogout is a multimodal one, incorporating both non-pharmacological and pharmacological interventions, and tailored to the individual patient's needs and risk factors. This approach is supported by the EULAR recommendations for the management of CPPD, which emphasize the importance of symptomatic control and the need for further research into the pathogenesis and treatment of CPPD 1.
From the Research
Definition and Treatment of Pseudogout
- Pseudogout, also known as calcium pyrophosphate dihydrate (CPPD) crystal-related arthropathies, is a condition that presents particular management problems in clinical practice, often affecting older patients with multiple medical comorbidities 2.
- The acute treatment of pseudogout is similar to that of acute gouty arthritis, with a focus on relieving the symptoms of joint inflammation 3, 2.
- There is no standard regimen for long-term chronic therapies of pseudogout, unlike gout, where urate-lowering therapy can prevent recurrent attacks 3.
Key Points to Know
- Pseudogout is characterized by the deposition of CPPD crystals in and around joints, leading to joint inflammation and degeneration 2.
- The treatment of pseudogout is mainly directed at relieving the symptoms of joint inflammation, with no agents available that have been shown to decrease crystal load in CPPD-related joint disease 2.
- Colchicine may be used as a prophylactic agent in managing recurrent attacks of pseudogout, and agents that directly target the inflammasome, such as those that inhibit the interleukin 1 pathway, may be used in the treatment of severe, refractory pseudogout 2.