From the Guidelines
The most effective treatment for pseudogout is the use of nonsteroidal anti-inflammatory drugs (NSAIDs) or colchicine to relieve pain and inflammation during acute attacks. For acute attacks, NSAIDs like naproxen (500mg twice daily) or indomethacin (25-50mg three times daily) are first-line treatments, typically continued for 7-10 days until symptoms resolve 1. Colchicine is an effective alternative, usually given at 0.5mg up to three to four times daily with or without a loading dose of 1mg, as recommended by expert opinion due to the high incidence of side effects with traditional regimens 1.
Key Considerations
- The length of treatment depends on symptom relief and side effects, and it is crucial to carefully consider the potential side effects of NSAIDs and colchicine, especially in older people with chronic renal impairment and other comorbidities that increase the likelihood of toxicity or drug interaction 1.
- For patients who cannot tolerate oral medications or have contraindications, joint aspiration followed by intra-articular corticosteroid injection may provide rapid relief.
- Systemic corticosteroids like prednisone may be used for polyarticular attacks or when other options are contraindicated.
Long-term Management
- For long-term management in patients with recurrent attacks, prophylactic low-dose colchicine (0.6mg daily) may be considered, as suggested by a study that found it to be efficacious in reducing the frequency of acute attacks of CPP crystal arthritis 1.
- The use of low-dose NSAIDs for prophylaxis remains to be investigated, and their potential side effects need to be carefully considered if used for this purpose 1.
From the Research
Treatment Options for Pseudogout
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat acute pseudogout, as they are for acute gout 2, 3.
- Colchicine may also be used for treatment, although its role is more established in gout management 4, 5.
- Corticosteroids can be an alternative for patients who cannot tolerate NSAIDs or colchicine 2, 5.
Management Strategies
- The treatment approach for pseudogout is similar to that of acute gouty arthritis, focusing on relieving short-term symptoms 6.
- There is no standard regimen for long-term chronic therapies of pseudogout, unlike gout where urate-lowering therapy is a cornerstone of long-term management 6, 5.
- Identifying and managing underlying conditions, such as inflammatory diseases, is crucial in the elderly, as pseudogout can occur in succession to these conditions 3.
Considerations in Elderly Patients
- Pseudogout can be an important cause of febrile illness in elderly patients and may be overlooked until joint symptoms become apparent 3.
- It is essential to consider pseudogout in the differential diagnosis of fever of unknown origin in this population 3.
- The use of NSAIDs, while common, should be carefully considered due to potential side effects and interactions, especially in elderly patients with comorbidities 2.