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Pseudogout (Calcium Pyrophosphate Arthropathy) (Risk Factors (Metabolic…
Pseudogout (Calcium Pyrophosphate Arthropathy)
Deposition of calcium pyrophosphate crystals on joint surface
Epidemiology
Affects elderly women in particular
Risk Factors
Osteoarthritis
Joint trauma/injury
Diabetes
Metabolic Disease
Hyperparathyroidism
Haemochromatosis
Old age
Pathophysiology
Deposition of calcium pyrophosphate in articular cartilage and periarticular tissue producing the radiological appearance of chonedrocalcinosis (linear calcification parallel to the articular surfaces)
Clinical Presentation
The attacks are very painful
Acute, hot, swollen wrist or knee
Shedding of crystals into a joint produces acute synovitis that resembles ACUTE GOUT but is more common in elderly women and usually affects the knee or wrist
Presents with hot joint and fever - can be mistaken for septic arthritis
Diagnosis
X-ray
Shows chonedrocalcinosis - linear calcification parallel to the articular surfaces
Bloods
Raised WCC count
Joint fluid aspiration & microscopy
Positively bifringent crystals under polarised light
Joint fluid look purulent so should be sent for culture to exclude septic arthritis
Small rhomboidal crystals under microscopy
Treatment
If NSAIDs not tolerated well or due to contraindication due to renal impairment then colchicine
Corticosteroids
High dose NSAIDs or COX inhibitor
Aspiration of the joint reduces pain dramatically