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Pseudogout

Pseudogout is a common crystal-induced arthropathy caused by calcium pyrophosphate (CPP) crystals.


Presentation

The following are the signs and symptoms of pseudogout:

  • Affected joints are painful.
  • There is fluid buildup in the joints.
  • Affected area is warm to touch.
  • Pseudogout may sometimes present with tophi [9].
Fever
  • The patient exhibited severe neck pains, headache, high fever and a pain in his knee joints together with symptoms of the central nervous system. The patient's cerebrospinal fluid was almost clear and showed no sign of viral infection.[ncbi.nlm.nih.gov]
  • She had a moderately high fever (37.5 C), and her neck pain was so severe that she could not move her neck in any direction.[ncbi.nlm.nih.gov]
  • He denies any fevers or chills. His exam reveals a moderate knee effusion and diffuse pain and tenderness with palpation and range of motion. Weightbearing radiographs are shown below.[orthobullets.com]
  • Attacks may be associated with fever and raised white cell count. Chronic CPP crystal arthritis Destructive changes like OA (but more severe). It may progress to cause a destructive arthropathy producing a neuropathic joint.[patient.info]
Swollen Knee
  • Some of the most common signs include: A swollen knee joint that feels warm when touched and extremely tender Episodes of intense and sudden joint pain Chronic arthritic pain Fluid accumulating around the joint.[hrosm.com]
  • Wondering about that suddenly painful and swollen knee, elbow, or wrist? The cause of your troubles may be pseudogout, or calcium pyrophosphate dihydrate (CPPD) deposition disease.[everydayhealth.com]
  • Bass III, MD, MPH Wondering about that suddenly painful and swollen knee, elbow, or wrist? The cause of your troubles may be pseudogout, or calcium pyrophosphate dihydrate (CPPD) deposition disease.[everydayhealth.com]
Chest Pain
  • We present the case of a 72-year-old man with 6 months of left chest pain; magnetic resonance imaging revealed a T9/T10 herniated disc. Intraoperatively, the material was sent for pathological analysis revealing pseudogout.[ncbi.nlm.nih.gov]
Trismus
  • METHODS AND RESULTS: We present a case of a 71-year-old woman who presented with worsening facial pain, trismus, and a large mass in her infratemporal fossa with minimal associated temporomandibular joint destruction.[ncbi.nlm.nih.gov]
Knee Pain
  • BACKGROUND: Symptomatic knee joint effusion is frequently observed after hip fracture, which may lead to postoperative knee pain during rehabilitation after hip fracture surgery.[ncbi.nlm.nih.gov]
  • (SBQ07SM.13) A 53-year-old male laborer presents to his primary care physician with complaints of acute onset of left knee pain. He has had mild episodes of knee pain in the past and is two years status post a left partial medial meniscectomy.[orthobullets.com]
  • At the 2-year follow-up, the patient could walk independently without knee pain or swelling, although his range of knee motion was slightly limited due to joint contracture that developed before surgery.[ncbi.nlm.nih.gov]
  • Abstract We report the case of a 74-year-old woman who presented with acute-onset right groin pain irradiating to the thigh anteriorly after having suffered for a few weeks from slight knee pain.[ncbi.nlm.nih.gov]
Joint Swelling
  • This leads to attacks of joint swelling and pain in the knees, wrists, ankles, and other joints. Among older adults, CPPD is a common cause of sudden (acute) arthritis in one joint.[mountsinai.org]
  • The "attacks" of joint inflammation, characterized by acute joint swelling, warmth, stiffness, and pain, may last for days to weeks and can resolve spontaneously. The inflammation leads to loss of range of motion and function of the involved joint.[medicinenet.com]
  • The "attacks" of joint inflammation, characterized by acute joint swelling, warmth, stiffness, and pain , may last for days to weeks and can resolve spontaneously. The inflammation leads to loss of range of motion and function of the involved joint.[medicinenet.com]
  • Pseudogout signs and symptoms include: Acute joint swelling Warmth Stiffness Pain As it was already mentioned above, duration of these “episodes” can vary from a few days to several months.[jointhealthmagazine.com]
Arthralgia
  • In this case, a 56-year-old caucasian male presented with right sided preauricular swelling, temporomandibular joint arthralgia and restricted mouth opening; he developed identical symptoms on the left side two days later.[ncbi.nlm.nih.gov]
  • These joint symptoms include : Pain in the joints (arthralgia) Swelling of the joints Warmth of the joint The symptoms may resolve and a person may be asymptomatic until another attack recurs.[healthhype.com]
  • In addition, induction of transient arthralgias in some patients is a well-recognized adverse effect of MTX [ 18 ], which could have further obscured a potential beneficial effect.[ncbi.nlm.nih.gov]
Knee Effusion
  • Knee effusion was assessed on admission and at the operating room before the surgery.[ncbi.nlm.nih.gov]
  • Knee effusion: sensitivity and specificity of ultrasound for the identification of calcium pyrophosphate crystals [abstract]. Arthritis Rheum 2013; 65 (Suppl 10) :859. [ Google Scholar ] 27. Zhang W, Doherty M, Pascual E et al.[ncbi.nlm.nih.gov]
Joint Effusion
  • Treatment with non-steroidal anti-inflammatory drugs and aspiration of the joint effusion had not been effective. The mass continued to enlarge, and the patient had difficulty walking.[ncbi.nlm.nih.gov]
  • METHODS: An axial magnetic resonance imaging scan demonstrated joint effusion at the level of the bilateral L4-L5 facet joint. Aspiration of the left L4-L5 facet joint yielded 1.5 mL of pus-like synovial effusion.[ncbi.nlm.nih.gov]
  • BACKGROUND: Symptomatic knee joint effusion is frequently observed after hip fracture, which may lead to postoperative knee pain during rehabilitation after hip fracture surgery.[ncbi.nlm.nih.gov]
Preauricular Swelling
  • In this case, a 56-year-old caucasian male presented with right sided preauricular swelling, temporomandibular joint arthralgia and restricted mouth opening; he developed identical symptoms on the left side two days later.[ncbi.nlm.nih.gov]

Workup

Signs and symptoms of pseudogout are similar to those of gout. Therefore, it is necessary to carry out various tests to arrive at a definitive conclusion. The following methods are employed to diagnose pseudogout:

  • Laboratory tests to detect the presence of crystals in the joints are done. In this, fluid is retrieved from the joints and is tested for the presence of crystals. In addition, blood tests may also be carried out to determine other underlying conditions such as thyroid disorders or mineral imbalances that can give rise to pseudogout.
  • Imaging studies such as X-ray of the affected joint is done to determine the extent of damage to the joint. An X-ray examination of the joint would also reveal deposition of crystals.

Treatment

Pseudogout cannot be cured, however various treatment methods can help in effective management of the condition. Treatment regime is geared towards relieving the symptoms and discomfort experienced due to the arthritic attack. The following methods are employed for management of pseudogout:

  • Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids and colchicines are administered for relieving the inflammation and the associated pain in the affected joint. Individuals who are prone to suffer from recurrent attacks of pseudogout are advised to take colchicines as prophylactic measure.
  • There is accumulation of fluid in the affected joint that leads to pain and inflammation. This fluid is drained with the help of a needle or scalpel (surgical decompression) which is inserted into the affected area to aid in fluid removal [10]. Such a kind of process also helps in removing significant amount of crystals from the joints.

Prognosis

Prognosis of the condition is usually favorable with timely initiation of treatment. Affected individuals are reported to do well with medications and other therapies. Acute attacks are known to resolve within 10 days of receiving treatment.

Complications

Complications occur when the individuals do not seek proper medical treatment. In such cases, the joint undergoes constant and permanent damage by the deposited crystals.

Etiology

The deposition of calcium pyrophosphate crystals in the joints gives rise to development of pseudogout. What triggers the deposition of calcium salts is not known, but advancing age is thought to be the major factor. More than 50% of individuals aged 85 years and above have deposits of calcium salts in their joints. However, not all of them develop pseudogout. The reason behind this is still not understood. Genetic transmission has also been implicated in the expression of pseudogout [2].

Some of the risk factors contributing to development of deposition of calcium pyrophosphate crystals include the following:

Epidemiology

Pseudogout is a common occurrence affecting about 1.3 per 1000 adult individuals. Incidence of pseudogout varies with age and older aged individuals, especially women, are known to be more affected by this condition.

It has also been estimated that about 30% of individuals above the age of 60 years and 50% individuals above 90 years were found to have deposits of calcium crystals in their joints. In addition, there is a considerable amount of risk associated with onset of pseudogout and development of heart diseases in the affected individuals.

Sex distribution
Age distribution

Pathophysiology

Deposition of calcium pyrophosphate (CPP) crystals in the joints of individuals gives rise to pseudogout [7]. The exact factor that triggers such a kind of event is yet to be figured out. The deposition of the calcium pyrophosphate crystals in the joints causes the area to swell and be painful. The affected area also feels warm when touched.

The knee is the most common joint for development of pseudogout; however other areas such as ankle and wrist can also be affected. There are crystal arthropathies that involve both pseudogout and gout at the same time [8].

Prevention

Pseudogout cannot be prevented. However, the various conditions that can give rise to development of such a condition should be treated to avoid the onset of pseudogout.

Summary

Pseudogout also known as calcium pyrophosphate deposition disease is caused due to deposition of calcium pyrophosphate crystals in the joints [1]. It is a type of arthritis significantly affecting the knee and other joints. Pseudogout is a serious condition causing pain and inflammation and the attacks can last for several days to weeks, severely affecting the patients life.

Pseudogout needs appropriate diagnosis and prompt treatment to avoid worsening of the condition. Women fall easy prey to this arthritic condition as compared to males. Pseudogout received its identity in the year 1962 when the condition was described to have independent characteristic features from gout.

Patient Information

Definition

Pseudogout is a type of arthritis that severely affects the joints causing inflammation and pain. In this condition, crystals of calcium pyrophosphate get deposited in the joint. Females are more prone to contract this condition than males.

Cause

Age is known to be the most common factor for pseudogout. As individual ages, the crystals get deposited into the joints giving rise to arthritic pain. Certain underlying conditions are also known to give rise to pseudogout. These are thyroid disorders, parathyroid diseases, Wilson disease, acromegaly and hemochromatosis.

Symptoms

Symptoms of pseudogout precipitate as pain and inflammation in the affected joints. The affected area is also warm to touch. An attack of pseudogout lasts for several days and should usually resolve with prompt initiation of treatment. 

Diagnosis

Diagnosis of pseudogout is carried out by an X-ray examination of the joints that reveal the presence of crystals and damage to the area. In addition, laboratory tests are also conducted to determine the presence of any underlying disease conditions. In many cases, the fluid from the joint is also tested for the presence of crystals.

Treatment

Pseudogout cannot be cured. With appropriate medications and therapies the condition can be effectively managed and symptoms kept under control. Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids are employed for relieving the pain and inflammation in the joint. Individuals prone to frequent attacks are given colchicines as a preventive regime. Fluid that gets accumulated in the joints can also be removed to reduce the associated pain and inflammation.

References

Article

  1. Currie WJ. The gout patient in general practice. Rheumatol Rehabil. Nov 1978; 17(4):205-17.
  2. Ciancio G, Bortoluzzi A, Govoni M. Epidemiology of gout and chondrocalcinosis. Reumatismo. Jan 19 2012; 63(4):207-20.
  3. Rho YH, Zhu Y, Zhang Y, Reginato AM, Choi HK. Risk factors for pseudogout in the general population.Rheumatology (Oxford). Nov 2012; 51(11):2070-4.
  4. Watanabe H, Yamada S, Anayama S, Sato E, Maekawa S, Sugiyama H, et al. Pseudogout attack induced during etidronate disodium therapy. Mod Rheumatol. 2006; 16(2):117-9.
  5. Taggarshe D, Ng CH, Molokwu C, Singh S. Acute pseudogout following contrast angiography. Clin Rheumatol. Feb 2006; 25(1):115-6.
  6. Ogawa Y, Nagatsuma M, Kubota G, Inoue G. Acute lumbar spinal pseudogout attack after instrumented surgery. Spine (Phila Pa 1976). 2012; 37(24):E1529-33 (
  7. Busso N, Ea HK. The mechanisms of inflammation in gout and pseudogout (CPP-induced arthritis). Reumatismo. 2011; 63(4):230-7 
  8. Yoo Y, Seo YJ, Huh M. Gout and coexisting pseudogout in the knee joint. Knee Surg Sports Traumatol Arthrosc. 2011; 19(4):553-5
  9. Srinivasan V, Kesler H, Johnson M. Tophaceous pseudogout of the thoracic spine. Acta Neurochir (Wien). 2012; 154(4):747-50; discussion 750
  10. Lin SH, Hsieh ET, Wu TY, Chang CW. Cervical myelopathy induced by pseudogout in ligamentum flavum and retro-odontoid mass: a case report. Spinal Cord. Nov 2006; 44(11):692-4.a

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Last updated: 2017-08-09 17:46