Pseudogout

Question 1

Definition of pseudogout

Answer 1

Pseudogout is a form of microcrystal synovitis caused by the deposition of calcium pyrophosphate dihydrate crystals in the synovium. For this reason, it is now more correctly termed calcium pyrophosphate crystal deposition disease.

Question 2

Mean age of presentation for pseudogout/ alcium pyrophosphate crystal deposition disease

Answer 2

65-75yo

Question 3

Clinical presentations of pseudogout/ calcium pyrophosphate crystal deposition disease

Answer 3

Calcium pyrophosphate deposition is often asymptomatic, but can present clinically as:

osteoarthritis with calcium pyrophosphate deposition

acute calcium pyrophosphate crystal arthritis (formerly known as pseudogout), which is the most common cause of an acute monoarthritis in older people = acutely inflammed joint -gout mimick- knee and wrist
= crowned dens syndrome - females, acute neck pain and stiffness, fever, elevated inflammatory markers

chronic calcium pyrophosphate crystal inflammatory arthritis = chronic oligoarthritis or polyarthritis with inflammatory features, and superimposed flares. It may involve the knees, second and third metacarpophalangeal joints, wrists, shoulders, elbows, hips and midtarsal joint

Question 4

Dx of pseudogout/ calcium pyrophosphate crystal deposition disease

Answer 4

calcium pyrophosphate dihydrate crystals in synovial fluid
Microscopy and culture of the synovial fluid should also be undertaken to exclude septic arthritis.

XR: chondrocalcinosis - supportive but not sensitive or specific

Question 5

management of pseudogout/ calcium pyrophosphate crystal deposition disease

Answer 5

Rapid symptom relief: local CS injection at up to 2 affected sites or PO prednisolone. Can also use NSAIDS or cochicine.

No current long term treatment