From the Guidelines
The treatment of choice for pseudogout is NSAIDs or oral colchicine, with a recommended lower-dose regimen of colchicine (0.5 mg up to three to four times daily) due to the high incidence of side effects with traditional regimens. When considering treatment options, it's essential to weigh the benefits against the potential risks, particularly in older patients with comorbidities 1. The use of NSAIDs, such as indomethacin, naproxen, or ibuprofen, is effective in relieving symptoms, but their use is restricted due to the risk of gastrointestinal bleeding, cardiovascular events, and renal impairment 1.
Some key points to consider when treating pseudogout include:
- The length of treatment with NSAIDs or colchicine depends on symptom relief and side effects 1
- Colchicine is effective at relieving symptoms of acute crystal synovitis, but its use is limited by the risk of side effects, such as diarrhea 1
- Intravenous colchicine is no longer recommended due to the high risk of serious toxicity and fatality 1
- For patients who cannot tolerate NSAIDs or colchicine, alternative treatments, such as oral corticosteroids or intra-articular corticosteroid injections, may be considered 1.
From the Research
Treatment of Pseudogout
The treatment of pseudogout is primarily focused on relieving the symptoms of joint inflammation. According to 2, current treatment approaches are mainly directed at relieving the symptoms of joint inflammation.
- NSAIDs are commonly used to treat acute pseudogout, as they are effective in reducing inflammation and pain, similar to their use in acute gout 3, 4, 5.
- Colchicine can be used as a prophylactic agent in managing recurrent attacks of pseudogout, and its effects on the NALP-3 inflammasome of the innate immune system are highlighted 2.
- In severe, refractory cases of pseudogout, agents that directly target the inflammasome, such as drugs that inhibit the interleukin 1 pathway, may be used 2.
- There is no standard regimen for long-term chronic therapies of pseudogout, unlike gout, where urate-lowering therapy is used to prevent recurrent attacks 3.
Comparison with Gout Treatment
The treatment of pseudogout is similar to that of acute gouty arthritis, with NSAIDs being a common treatment option for both conditions 3, 4, 5. However, unlike gout, there are no agents available that have been shown to decrease crystal load in CPPD-related joint disease 2.