pseudogout

Question 1

define pseudogout

Answer 1

A type of arthritis where calcium pyrophosphate crystals are deposited in joints.

Question 2

risk factors for psuedogout

Answer 2

• Advanced age
• Injury/previous joint surgery
• Hyperparathyroidism
• Haemochromatosis
• Hypomagnesaemia
• Hypophosphatemia
• Intercurrent infection
• diabetes

Question 3

what are the 2 ways pseudogout is presented as

Answer 3

1. typically presents asymptomatically and is incidentally picked up on an x-ray,
2. t can present as monoarthritis (pain and swelling in a single joint) or as chronic pain and stiffness of a joint.

Question 4

what is a typical acute presentation of a patient with pseudogout

Answer 4

a patient over 65 years old with a rapid-onset hot, swollen, stiff and painful knee (can occur in any joint)

Question 5

signs and symptoms of psuedogout

Answer 5

• Acute Monoarthritis
• Acutely inflamed, swollen, warm, and tender joint
• Acute Systemic Illness
• Chronic Joint Disease

Question 6

what disease must be excluded when investigating pseudogout

Answer 6

septic arthritis as it is a medical emergency

Question 7

what is psuedogout treatment targeted at

Answer 7

managing the symptoms

Question 8

3 treatment options for pseudogout

Answer 8

1. NSAIDS (+PPI)
2. Colchicine
3. Intra-articular/oral steroids

Question 9

are symptoms of pseudogout worse or milder compared to septic arthritis and goat

Answer 9

milder

Question 10

2 investigations for pseudogout

Answer 10

1. joint aspiration - diagnostic
2. x ray signs

Question 11

what does joint aspiration for pseudogout show

Answer 11

Fluid shows rhomboid calcium pyrophosphate crystals that are positively birefringent of polarised light. There are no bacteria present.

Question 12

what does x ray for pseudogout show

Answer 12

Chondrocalcinosis (calcium deposits in the joint cartilage)

+LOSS mnemonic (see osteoarthritis)

Question 13

do asymptomatic changes found on an x ray for pseudogout require treatment

Answer 13

no!

Question 14

does psuedogout have a prevention drug

Answer 14

no

Question 15

how to differentiate between gout and pseudogout regarding joints affected

Answer 15

gout - small joints

pseudogout - large joints (most commonly knee)

Question 16

how to differentiate between gout and pseudogout regarding clinical features

Answer 16

gout - severe joint pain & swelling

pseudogout - moderate joint pain & swelling

Question 17

how to differentiate between gout and pseudogout regarding radiological features

Answer 17

gout - soft tissue swelling (not seen until 6-12 years after initial attack)

pseudogout - chondrocalcinosis and calcification of articular cartilage mensici