From the Guidelines
Pseudogout, also known as calcium pyrophosphate deposition disease (CPPD), is a condition that presents with symptoms similar to gout but is caused by calcium pyrophosphate crystal deposits rather than uric acid, and its diagnosis and management should be guided by the most recent evidence-based recommendations. The main symptoms of pseudogout include sudden, severe joint pain, typically affecting the knee, wrist, or other large joints, accompanied by swelling, warmth, and redness 1. Unlike gout, pseudogout more commonly affects older adults and can be triggered by surgery, trauma, or certain medical conditions like hyperparathyroidism or hemochromatosis.
Diagnosis
Diagnosis of pseudogout requires joint fluid analysis to identify the characteristic rhomboid-shaped calcium pyrophosphate crystals under polarized light microscopy, which appear weakly positive birefringent (blue when parallel to the axis) 1. X-rays may show chondrocalcinosis (calcification in joint cartilage), and imaging modalities such as ultrasound, CT, and dual-energy CT can also be used to detect and quantify crystal deposition 1. Blood tests are performed to rule out other conditions and identify underlying metabolic disorders.
Treatment
Treatment of pseudogout typically involves a combination of non-pharmacological and pharmacological treatments, including NSAIDs like naproxen or indomethacin for pain and inflammation, joint aspiration to remove fluid, and corticosteroid injections for severe cases 1. Colchicine may be used for prevention in recurrent cases, and addressing any underlying medical conditions is essential for comprehensive management of pseudogout. The most recent guidelines recommend the use of evidence-based treatments, and the strength of recommendations varies from 79% to 95% 1.
Some key points to consider in the management of pseudogout include:
- The use of cool packs, temporary rest, and joint aspiration combined with steroid injection for acute CPP crystal arthritis 1
- The use of oral non-steroidal anti-inflammatory drugs with gastroprotective treatment and/or low-dose colchicine for prophylaxis or chronic inflammatory arthritis with CPPD 1
- The importance of addressing underlying medical conditions, such as hyperparathyroidism or hemochromatosis, in the management of pseudogout 1
From the Research
Pseudo Gout Symptoms
- Pseudo gout, also known as calcium pyrophosphate deposition (CPPD) disease, can present with symptoms similar to gout, including joint pain and swelling 2.
- A painful mass or swelling with or without pain is a common symptom of tophaceous pseudogout (tumoral calcium pyrophosphate dihydrate crystal deposition disease) 3.
- The temporomandibular joint, metatarsophalangeal joint of the great toe, hip joint, and cervical spine can be involved, with patients presenting with a mass or swelling with or without pain 3.
Diagnosis of Pseudo Gout
- Diagnosis of pseudo gout can be made through cytological examination, such as fine needle aspiration cytology (FNAC), which can show numerous extracellular rods shaped and rhomboid blunt-ended crystals along with foreign body type of giant cells 4.
- Radiology and histopathology may not always be able to diagnose pseudo gout, emphasizing the importance of cytological examination in accurately diagnosing the disease 4.
- Histologically, the lesions of tophaceous pseudogout show small or large deposits of intensely basophilic calcified material containing needle shaped and rhomboid crystals with weakly positive birefringence characteristic of CPPD 3.
- The presence of concomitant CPPD and gouty crystals in the same tophaceous deposits can be observed in some patients, with CPPD deposits intimately associated with the gouty tophi 5.