We should touch base just
a little bit about Pseudogout
since we've made mention of it
and it is a crystalline arthropathy.
It has a lot of similar features to gout
and we'll go through them very quickly.
So CPPD stands for calcium
pyrophosphate crystal deposition.
It's called 'pseudogout' because it looks a lot
like gout but it is a different disease process.
Risk factors are similar.
It's gonna be in elderly patients.
The differences are that these are folks who
have hyperparathyroidism oftentimes or perhaps
excess iron like hemochromatosis
or too little phosphate or magnesium.
They're just different in some of
the risk factors that we saw for gout
Unlike gout which can most commonly
cause podagra, again of the first MTP,
pseudogout has a predilection for larger
joints like the knees and perhaps the wrists.
The joint fluid, rather than finding those
negatively birefringent needle-shaped crystals,
for pseudogout, you're gonna see weakly
positive birefringent rhomboid-shaped crystals
that we'll take a look at on the next slide.
Sometimes, you may perform x-ray
of particular joints that are involved
then you might see some chondrocalcinosis
which simply means calcific deposits in the cartiage.
The treatment of acute pseudogout by the way,
is pretty similar to the treatment of gout acutely.
You're trying to decrease
the inflammatory process.
NSAIDS, Colchicine, potentially
intraarticular or systemic steroids.
The trouble with pseudogout is
that for a long term management,
you don't have things like
allopurinol or uricosuric agents.
So you have fewer options
to treat the pseudogout.
Though sometimes, people do use low
dose Colchicine to reduce flares in the future
Here's a picture of those
crystals that we talked about.
You can see that they are more rhomboid in shape
but they are also birefringent on polarized light.
With that, let's just highlight a few
of our keypoints from gout again.
Again, it's caused by deposition of
proinflammatory crystals in the synovial tissues.
There's an abrupt onset
especially for early onset cases.
It's an abrupt case of monoarticular inflammation
with pain, swelling, fluid in the joint.
The diagnosis will require
synovial fluid analysis
both to confirm the diagnosis and also to
exclude other pathology like septic joint.
And the treatment acutely is gonna be Colchicine,
NSAIDS, potentially intraarticular steroids
and then we're gonna focus on
prevention after that initial flare.
Risk factor modification: cut out all of
that seafood, meat, alcohol, etcetera.
try and use some uric acid lowering
medications like Probenecid or Allopurinol
and those are basically the strategies that
we'll use to decrease future episodes of gout.