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Pseudogout

Introduction

The clinical course regarding pseudogout is very similar to gout, except that the symptoms are not as acute as with gout. It appears that CPPD crystals are a byproduct of degenerative or metabolic tissue changes.

This explains why pseudogout is often associated with other rheumatological diseases such as calcific rotator cuff tendinitis, calcific bursitis, degenerative arthritis and gout. There are also associations with metabolic diseases such as hypothyroidism, hemochromatosis, hyperparathyroidism and amyloidosis (Ref. 2). CCPD crystal disease is a disease of persons older than 60 years of age.

Signs and symptoms

Pseudogout presents as an acute attack similar to gout, affecting mainly the knee, wrist or shoulder. The diagnosis is often more difficult than that of gout as the CPPD crystals are not as concentrated in the synovial fluid. However, with centrifugation and a lab that specializes in its detection the diagnosis is now easier to make.

Diagnostic Tests For Pseudogout

This is described in detail on another page (under “Diagnosis Of Pseudogout “, see Related Page links below).

Treatment of pseudogout

The acute joint pain responds very well to colchicine therapy. Antiinflammatories such as NSAIDs or Cox-2 inhibitors will help very well for arthritis of joints and for calcific tendinitis or bursitis cases affected by pseudogout. Maintenance therapy on low dose colchicine can be used longterm, but must be balanced by the physician and patient against the toxic side-effects on the bone marrow and kidneys. Occasionally there is a patient where all therapies fail and severe joint destruction results.

 

References:

1. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 55.

2. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999.

3. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders

4. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

5. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier

Last modified: November 14, 2014

Disclaimer
This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.