Pseudogout

• Pseudogout is a crystal arthropathy caused by calcium pyrophosphate crystals collecting in the joints. 
• It is formally known as calcium pyrophosphate deposition disease (CPPD). It may also be called chondrocalcinosis.
• Presents similarly to gout but with usually milder symptoms and tends to affect larger joints
• Joint aspiration:

  • Calcium pyrophosphate crystals
  • Rhomboid shaped
  • Positively birefringent of polarised light
  • Should not be any bacterial growth
• Chondrocalcinosis is the classic x-ray change in pseudogout. The calcium deposits in the joint cartilage show up in a thin white line in the middle of the joint space.
• Other joint x-ray changes are similar to osteoarthritis, which can be remembered with the “LOSS” mnemonic:

  • L – Loss of joint space
  • O – Osteophytes (bone spurs)
  • S – Subarticular sclerosis (increased density of the bone along the joint line)
  • S – Subchondral cysts (fluid-filled holes in the bone)
• Treatment is targeted at symptoms:

  1. NSAIDs + PPI
  2. Colchicine
  3. Intra-articular steroid injections
  4. Oral steroids
• Symptoms usually resolve spontaneously over several weeks.
• There is no prophylaxis for pseudogout