### Date : 2024-06-16 09:30 ### Topic : Pseudogout (가성통풍) #medicine #rheumatology ---- ### Pseudogout Overview **Pseudogout**, also known as **calcium pyrophosphate dihydrate (CPPD) deposition disease**, is a type of arthritis caused by the deposition of calcium pyrophosphate dihydrate crystals in the joints. It is often mistaken for gout due to the similarity in symptoms, but the underlying cause and treatment can differ. ### Pathophysiology Pseudogout occurs when calcium pyrophosphate crystals accumulate in the cartilage of joints. These crystals can then shed into the joint space, causing inflammation and pain. The exact cause of CPPD crystal formation is not always known, but it can be associated with joint trauma, aging, genetic factors, and other metabolic conditions like hyperparathyroidism, hemochromatosis, and hypomagnesemia. ### Clinical Features - **Acute Attacks:** Sudden onset of joint pain, swelling, and warmth. The ==knee== is the most commonly affected joint, but pseudogout can also affect wrists, shoulders, ankles, and other joints. - **Chronic Symptoms:** Some patients experience chronic, less severe symptoms similar to osteoarthritis, with joint stiffness and pain. - **Joint Damage:** Repeated attacks can lead to joint damage and chronic arthritis. ### Diagnosis Diagnosis is based on clinical presentation, imaging, and laboratory tests: - **Joint Fluid Analysis:** Aspiration of the affected joint fluid and examination under a microscope for calcium pyrophosphate crystals, which appear as positively birefringent, rhomboid-shaped crystals.  <Photo from: https://o.quizlet.com/BZ1Uk.yRtq7fvkIOulsyHA.png> - **X-rays:** Can show calcification in the cartilage (chondrocalcinosis), which is indicative of CPPD crystal deposition.  - **Blood Tests:** To rule out other conditions and check for associated metabolic disorders. ### Example Case Study **Patient Profile:** - **Name:** Dr. Jee Hoon Ju - **Age:** 65 - **Gender:** Female - **Occupation:** Retired Teacher **Medical History:** - **Symptoms:** Jee Hoon Ju reports sudden pain and swelling in her left knee. The knee is warm to the touch and very tender. She has had similar episodes in her wrist and ankle over the past year. - **Health Background:** She has a history of osteoarthritis and hypothyroidism. **Physical Examination:** - **Knee:** Swelling, redness, and warmth in the left knee. Limited range of motion due to pain. - **Other Joints:** Mild swelling and tenderness in the right wrist. **Laboratory Tests:** - **Joint Fluid Analysis:** Presence of calcium pyrophosphate crystals. - **Blood Tests:** Normal serum uric acid levels, normal calcium, phosphate, and magnesium levels. **Imaging:** - **X-ray:** Chondrocalcinosis in the knee joint. **Diagnosis:** Based on Jee Hoon Ju’s symptoms, physical examination, joint fluid analysis, and imaging results, he is diagnosed with pseudogout. ### Management 1. **Acute Attack Treatment:** - **NSAIDs:** Indomethacin, naproxen, or ibuprofen to reduce pain and inflammation. - **Colchicine:** Can be used to treat acute attacks and prevent recurrent episodes. - **Corticosteroids:** Oral or intra-articular corticosteroids for patients who cannot take NSAIDs or colchicine. 2. **Chronic Management:** - **Joint Protection:** Physical therapy to maintain joint function and strength. - **Pain Management:** Regular use of NSAIDs or acetaminophen for chronic pain. - **Treatment of Underlying Conditions:** Address any associated metabolic disorders. 3. **Monitoring and Follow-Up:** - Regular follow-up visits to monitor symptoms and joint health. - Periodic re-evaluation of joint fluid if symptoms recur or worsen. ### Conclusion Pseudogout is a manageable condition with appropriate treatment and lifestyle adjustments. Early diagnosis and intervention can help prevent joint damage and improve the quality of life for patients like Sarah. Understanding the differences between pseudogout and gout is crucial for effective management and treatment planning.