From the Research
Treatments for pseudogout should prioritize nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen or indomethacin as first-line treatments for acute attacks, with colchicine and intra-articular corticosteroid injections as alternative options. The management of pseudogout involves reducing inflammation and pain during acute attacks while preventing future episodes. For acute attacks, NSAIDs like naproxen (500mg twice daily) or indomethacin (25-50mg three times daily for 7-10 days) are effective in reducing symptoms 1. Colchicine can be effective at lower doses (0.6mg once or twice daily) to reduce inflammation by preventing neutrophil activation, especially in patients who cannot tolerate NSAIDs 2.
Acute Attack Management
- NSAIDs: naproxen (500mg twice daily) or indomethacin (25-50mg three times daily for 7-10 days)
- Colchicine: 0.6mg once or twice daily
- Intra-articular corticosteroid injection: triamcinolone 40mg or methylprednisolone 40-80mg for patients who cannot take NSAIDs or colchicine
- Systemic corticosteroids: prednisone (30-40mg daily, tapered over 7-10 days) for polyarticular attacks or when other treatments are contraindicated
Long-term Management
- Low-dose colchicine: 0.6mg daily
- Low-dose NSAIDs
- Medications that lower uric acid: allopurinol (starting at 100mg daily, titrated as needed)
- Addressing underlying conditions: hyperparathyroidism or hemochromatosis that contribute to calcium pyrophosphate crystal formation
Additional Measures
- Joint rest, ice application, and elevation during acute attacks can provide additional symptomatic relief. The most recent and relevant study on the treatment of pseudogout, 1, supports the use of NSAIDs and colchicine as primary treatments, with a focus on managing acute attacks and preventing future episodes.