Pseudogout

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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
Symptoms

Intermittent episodes of pain that come out of the blue, assc with redness and swelling of joints
Triggers
- Intercurrent infection
- Dehydration
- Local trauma
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
Polarised Light Microscopy

Calcium pyrophosphate dihydrate = weakly positively birefringent rhomboids
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