From the Research
Allopurinol is not typically used as a first-line treatment for pseudogout (calcium pyrophosphate deposition disease). While allopurinol effectively lowers uric acid levels and is useful for treating gout, pseudogout involves calcium pyrophosphate crystals rather than uric acid crystals, making allopurinol generally ineffective for this condition 1. Acute pseudogout attacks are typically treated with NSAIDs like naproxen or ibuprofen, colchicine (0.6 mg once or twice daily), or corticosteroids (oral prednisone or intra-articular injections). For recurrent pseudogout attacks, low-dose daily colchicine (0.6 mg once or twice daily) may be used as prophylaxis. In some cases where hyperparathyroidism or hemochromatosis contributes to pseudogout, treating these underlying conditions may help. The fundamental difference in crystal composition between gout (uric acid crystals) and pseudogout (calcium pyrophosphate crystals) explains why medications that target uric acid metabolism like allopurinol don't address the underlying problem in pseudogout.
Some studies have explored the use of other treatments for pseudogout, such as anakinra, an IL-1 receptor antagonist, which has shown promise in treating resistant pseudogout 2. However, the most recent and highest quality studies do not support the use of allopurinol as a first-line treatment for pseudogout. The current international guidelines recommend allopurinol as first-line treatment for gout, but this does not apply to pseudogout 3.
Key points to consider when treating pseudogout include:
- Acute pseudogout attacks are typically treated with NSAIDs, colchicine, or corticosteroids
- Recurrent pseudogout attacks may be prevented with low-dose daily colchicine
- Treating underlying conditions such as hyperparathyroidism or hemochromatosis may help in some cases
- Allopurinol is not typically used as a first-line treatment for pseudogout due to the difference in crystal composition between gout and pseudogout.