Pseudogout (CPPD)

00:00 We should touch base just a little bit about Pseudogout since we've made mention of it and it is a crystalline arthropathy.

00:07 It has a lot of similar features to gout and we'll go through them very quickly.

00:10 So CPPD stands for calcium pyrophosphate crystal deposition.

00:16 It's called 'pseudogout' because it looks a lot like gout but it is a different disease process.

00:21 Risk factors are similar.

00:23 It's gonna be in elderly patients.

00:25 The differences are that these are folks who have hyperparathyroidism oftentimes or perhaps excess iron like hemochromatosis or too little phosphate or magnesium.

00:36 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.

00:51 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.

01:05 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.

01:14 The treatment of acute pseudogout by the way, is pretty similar to the treatment of gout acutely.

01:19 You're trying to decrease the inflammatory process.

01:22 NSAIDS, Colchicine, potentially intraarticular or systemic steroids.

01:27 The trouble with pseudogout is that for a long term management, you don't have things like allopurinol or uricosuric agents.

01:35 So you have fewer options to treat the pseudogout.

01:38 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.

01:46 You can see that they are more rhomboid in shape but they are also birefringent on polarized light.

01:53 With that, let's just highlight a few of our keypoints from gout again.

01:58 Again, it's caused by deposition of proinflammatory crystals in the synovial tissues.

02:04 There's an abrupt onset especially for early onset cases.

02:09 It's an abrupt case of monoarticular inflammation with pain, swelling, fluid in the joint.

02:17 The diagnosis will require synovial fluid analysis both to confirm the diagnosis and also to exclude other pathology like septic joint.

02:25 And the treatment acutely is gonna be Colchicine, NSAIDS, potentially intraarticular steroids and then we're gonna focus on prevention after that initial flare.

02:34 Risk factor modification: cut out all of that seafood, meat, alcohol, etcetera.

02:39 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.