Also known as Chondrocalcinosis or Calcium Pyrophosphate Deposition Disease, (CPPD).

Pseudogout is a form of arthritis characterized by the sudden onset of pain, swelling & redness or warmth in a joint.

The pain may be severe keeping one awake at night.

It usually occurs in older patients.

These episodes can last for days or weeks.

The most commonly affected joint is the knee but it is commonly also seen by hand surgeons in the wrist.

It presents like an acute attack of gout but it is due to a different crystal.
Gout – Uric Acid Crystals
Pseudogout - Calcium Pyrophosphate crystals

It is not due to excessive alcohol intake.

Symptoms

- Acute Severe pain enough to prevent sleep
- Swelling & redness in joint
- Limitation in movement

The Cause is unknown.

Calcium pyrophosphate dihydrate crystals crystals become more common as people age.

One can see evidence of the crystals on Xrays in almost half the population by age 85.

Most people who have these crystal deposits never develop pseudogout.

It's still unclear why some people have symptoms and others don't.

Risk factors

Factors that can increase your risk of pseudogout include:
- Old Age. The risk of developing pseudogout increases with age.
- Genetic
- Joint trauma. Sometimes pseudogout follows minor trauma.
- Mineral imbalances. eg excessive calcium or iron or too little magnesium.
- Hormonal conditions eg underactive thyroid gland, overactive parathyroid gland.

Diagnosis

Need to confirm the diagnosis & exclude Infection & Gout

1. History Acute severe joint pain, swelling, redness , limited movement

2. Examination – Temperature often not markedly elevated

3. Xrays showing calcification in the TFC and joint cartilage.

4. Fluid from the joint showing CPPD crystals . . A needle can be used to drain a sample of the fluid from the wrist joint. This fluid can be tested for the presence of crystals and sent for culture to exclude infection.

5. Blood tests FBC, ESR , CRP, Uric Acid, Ca, PO4, Thyroid & Parathyroid function

Treatment

1. NSAIDS

2. Injection Cortisone into the joint

3. Wrist brace

There is no cure for pseudogout.


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