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Clinical Presentation
- an aggressive form of nodal OA - most will have a background Hx of nodal OA - effects hands esp DIP with Heberden's and Bouchard's nodes
- Intermittent flares of inflammatory arthritis in medium and large joints (wrists, knees, shoulders, and elbows)
- 'flares of OA' likely to be episodes of pseudogout
- epidosdes can last weeks vs days (can last for 1/12) before returning to normal, although pt may be left with some mechanical symptoms assc with nodal OA) but not EMS or other inflammatory symptoms
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Symptoms
Intermittent episodes of pain that come out of the blue, assc with redness and swelling of joints
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Triggers
- Intercurrent infection
- Dehydration
- Local trauma
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Investigations and possible findings
- FBC: neutrophil leucocytosis
- CRP/ESR: both high
- Uric acid: normal
- Blood cultures: negative
- Xray: chondrocalcinosis - useful as calcium pyrophosphate crystals are radioopaque
- Synovial fluid analysis: key investigation to rule out septic arthritis
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Polarised Light Microscopy
Calcium pyrophosphate dihydrate = weakly positively birefringent rhomboids
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Management: Acute and Prophylaxis
- Acute attacks: fire extinguisher i.e. NSAIDs, local injection of corticosteroids, oral steroids --> CPPD reduction
- Prophylaxis: Colchicine 2-3 x per day - anecdotal evidence suggests it can decrease the severity and frequency of pseudogout
- No treatment to decrease the amount of CPPD
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