Pseudogout...Outsmart this common type of arthritis
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Pseudogout, also known as calcium pyrophosphate deposition disease (CPPD), is a condition where crystals of calcium pyrophosphate deposit in joint tissue.
Information from the American College of Rheumatology
Like its cousin, gout, pseudogout causes erosion of cartilage and bone and is also associated with inflammation of the synovium (lining of the joint).
This disease is most common in the 65 to 75 year age group. Females are affected more often than males in a 5:1 ratio.
Other diseases associated with pseudogout include hyperparathyroidism, hemochromatosis, hypothyroidism, gout, and osteoarthritis.
Pseudogout may occur as an acute type of arthritis.
Self-limited attacks last anywhere from a day to several weeks. They may resemble gout attacks in their intensity. Attacks are triggered by medical illnesses and surgery. The most common joint involved is the knee. Other joints affected include the wrist, shoulder, ankle, elbow, and hands.
Podagra (arthritis affecting the great toe joint) may occur. As many as 20 per cent of patients will also have elevated serum uric acids and monosodium urate crystals can be found in the joint fluid of about 5 per cent of patients who have acute pseudogout. This obviously leads to confusion with diagnosis. It is important to look for calcium pyrophosphate crystals. An experienced lab tech or rheumatologist should evaluate the fluid. X-rays showing calcium deposits in the cartilage of affected joints may offer a clue to diagnosis.
Chronic calcium pyrophosphate arthritis is a progressive, often symmetric disease affecting multiple joints including the knees, wrists, knuckles, hips, shoulder, spine, elbows, and ankles. Patients will complain of morning stiffness, restricted range of motion, and will also have functional impairment.
Laboratory tests often reveal an increase in white blood cell count and erythrocyte sedimentation rate (ESR)
Joint fluid abnormalities include an elevation of white blood cell count (usually polymorphonuclear leukocytes) and the presence of calcium pyrophosphate crystals.
Calcium deposits in the cartilage can be seen in the knee, wrist, discs of the spine, symphysis pubis of the pelvic bone, shoulder, and hip.
Goals of treatment include relief of discomfort of acute attacks, identifying underlying triggering factors, restoring joint function, improving quality of life, and preventing chronic deformity.
Analgesics and non steroidal anti inflammatory drugs may help with symptoms. In acutely inflamed joints, withdrawing joint fluid and injecting the joint with glucocorticoid preparations may help tremendously with symptoms.
Unfortunately, there are no effective disease modifying anti- rheumatic drugs that are specifically targeted against CPPD.Some clinicians have used drugs such as Plaquenil and methotrexate with some reports of success.
Chronic CPPD is usually progressive with joint replacement surgery often required.
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