Pseudogout

Pseudogout is a disease that is characterized by infrequent acute attacks of arthritis and is characterized by rather strong pain sensations. As a rule, this disease develops because of the deposition of calcium pyrophosphate salts in the joints.

[1]

Epidemiology

Frequency of occurrence of pseudogout depends on age. Equally often affects women and men. The annual incidence of acute attacks of joint pain and periarticular edema is about 1.3 per 1000 adults, almost 50% of adults develop radiographic changes characteristic of pseudogout.

[2], [3], [4], [5]

Causes of the pseudogout

The most common reasons for the appearance of a pseudogout are:

1. When the blood level of calcium rises due to too high a level of parathyroid hormone (this disease is called "hyperparathyroidism").
2. If the tissues have elevated levels of iron ("hemochromatosis").
3. In the blood, a reduced level of magnesium ("hypomagnesion").

[6], [7]

Risk factors

Many cases of pseudogout in the elderly are idiopathic, but it is also often associated with trauma. Often, the risk factors are surgical operations on the joints, trauma, metabolic diseases. The genetic predisposition to the development of pseudogout is proved.

The risk factors for pseudogout are also:

• Use of non-diazetic diuretics diuretics and proton pump inhibitors that cause hypomagnesemia.
• Therapy with etidronate and angiography.

[8], [9]

Pathogenesis

The early stage of pseudogout is characterized by the fact that crystals of calcium pyrophosphate begin to be deposited in articular cartilages. Inorganic pyrophosphate is synthesized with the participation of phosphodiesterase pyrophosphatase (ENPP1), a catalytic enzyme contained in cartilage chondrocytes.

Due to the accumulation of calcium pyrophosphate crystals in the joint cavity, the matrix is destroyed.

[10]

Symptoms of the pseudogout

Symptoms of this disease can vary - from minor pain to an acute attack resembling the signs of gout. Some patients suffer from frequent attacks of acute pain from arthritis (usually they occur in the knee joint, carpal joints), others complain of dull and persistent pain, which prevents them from moving normally with their hands and feet. The last symptoms are very similar to rheumatoid arthritis.

It should be noted that the pseudogout is characterized by less severe attacks than gout. It happens that there are no symptoms between attacks. Also sometimes pseudogout occurs asymptomatically.

First signs

At the first stages the patient can face such signs of the disease:

1. In the joints there are painful sensations that appear in the evening, in the morning or after physical exertion.
2. The skin reddens in the affected area.
3. The skin becomes hot.
4. Pain gets worse if you press on the joint.
5. The area of the lesion swells, the joint can grow, cones often appear on the site of the inflammation.

[11], [12], [13], [14], [15]

Stages

There is an acute and chronic stage of pseudogout. At the acute stage of the development of the disease, as a rule, only one joint is affected (usually, the knee joint). The pain develops swiftly, the joint begins to swell, often accompanied by fever, an increase in ESR, a chill. The acute stage lasts from four to six days, after which all of its symptoms disappear completely.

The chronic stage of the disease is different in that the patient complains of constant aching pain. In the morning hours the joints are bound and slightly swollen. From time to time, acute attacks may occur, which quickly disappear. As a rule, shoulder, hip, wrist, ulnar joints are affected. Sometimes on a background of the disease, radiculitis of a secondary type can develop.

[16], [17], [18], [19], [20]

Forms

There are two types of pseudogout:

1. Primary, idiopathic (familial).
2. Secondary.

Primary pseudogout is diagnosed in 90% of patients. Her etiology is still unknown to this day.

The development of secondary pseudogout is due to a variety of diseases that are associated with improper metabolism of inorganic phosphate and calcium. It is believed that calcium pyrophosphate is deposited in the joints due to a violation in the cells of the cartilage metabolism, in particular, the phosphodiesterase pyrophosphatase enzyme. Because of this, pyrophosphate crystals begin to accumulate.

[21]

Complications and consequences

If you do not undergo timely diagnosis and do not start the correct treatment, pseudogout can lead to irreversible damage to the joints, ankylosis.

[22], [23], [24]

Diagnostics of the pseudogout

To diagnose this disease, an X-ray examination of the affected joint is performed. Due to it it is possible to reveal deposits of calcium pyrophosphate in the joints. It is also important to conduct a microscopic examination of synovial fluid, which is taken with a special needle from the joint that was inflamed. If calcium pyrophosphate is found in the liquid, and not urate, then the patient has a pseudogout.

[25], [26], [27]

Analyzes

In addition to microscopic examination of synovial fluid, patients often undergo blood tests for specific markers, hormone assays to diagnose pseudogout, so that other diseases (rheumatoid arthritis, gout, hyperparathyroidism, hemochromatosis) can be excluded.

[28], [29], [30], [31]

Instrumental diagnostics

The most popular method of instrumental diagnosis of pseudogout is the radiography of the affected joint. With the help of this study, the doctor can correctly diagnose, exclude other diseases with similar symptoms, identify possible complications, and decide on the treatment technique.

Differential diagnosis

Differentiate this disease with such diseases:

1. Hydroxyapatite atropathy.
2. Gout.
3. Septic arthritis.
4. Reiter's syndrome.
5. Rheumatoid arthritis.
6. Lyme disease.
7. Injuries of joints.

[32], [33], [34], [35], [36]

Treatment of the pseudogout

Unfortunately, completely cure pseudogout is impossible, since the crystals of calcium pyrophosphate can not be removed from the joint. But modern methods of medical measures help make attacks less painful and not so long. There are such directions in the therapy of pseudogout:

1. Inflammation is removed with non-steroidal anti-inflammatory drugs. If their effect is insufficient, corticosteroid preparations are given in the form of tablets or injections inside the joint (eg, hydrocortisone).
2. To ease pain, you can use popular pain killers.
3. Avoid sudden movements.
4. Physiotherapeutic procedures bring some efficiency.
5. In rare cases, surgery may be necessary.
6. During the remission, you can conduct special physical exercises, therapeutic gymnastics.

Medications

• Indomethacin. A non-steroidal anti-inflammatory drug that is an indoleacetic acid derivative. It differs in analgesic, anti-inflammatory, antipyretic effect. When using tablets or injections helps reduce pain, especially in joints.

Dosage is set by the doctor individually. It depends on the severity of the disease. The standard dose is not more than 25 mg of the drug two to three times a day. When applying the remedy, these side effects are possible: vomiting, headaches, dizziness, allergic reactions, convulsions, drowsiness, fatigue.

The drug is not recommended for taking with intolerance of its components, with gastric ulcer, hemopoiesis and hepatic insufficiency.

• Cortisone. A hormonal steroid drug that affects electrolyte, carbohydrate and water metabolism. It has a powerful anti-inflammatory, antiallergic and desensitizing effect. Increases excretion of calcium from the body.

The dosage is individual. But the daily dose should not exceed 300 ml calculated for several injections. Children need to reduce the dose.

Admission of this remedy can cause such side effects: osteoporosis, increased appetite, weight gain, puffiness, stomach ulcers, mental illnesses, hyperhidrosis. The drug is contraindicated for: ulcer duodenum and stomach, Cushing's disease, thromboembolism, osteoporosis, glaucoma, systemic mycosis, pregnancy.

• Ibuprofen. Non-steroidal anti-inflammatory drug. The active ingredient is ibuprofen. It differs in analgesic, anti-inflammatory and antipyretic effect.

Appointed with 12 years. The standard dosage is as follows: two to three tablets per day. To quickly achieve a therapeutic effect, the dose can be increased to two tablets at a time. Therapy lasts no more than five days.

When taking the drug, these side effects are possible: bronchospasm, toxic hepatitis, hearing impairment, vomiting, headaches, allergies, cystitis.

The drug is contraindicated in: stomach ulcer, hemophilia, inflammatory bowel disease, internal bleeding, kidney disease, intolerance of components, during pregnancy, children under 12 years.

• Diprospan. Active active ingredients are betamethasone sodium phosphate and betamethasone dipropionate. It is a hormonal steroid drug that is used for injections. Can be used intraarticular or periarticularly. If injected into large joints, the dosage may be up to 2 ml. In small - up to 0.5 ml.

Side effects from the use of the remedy: chronic heart failure, stomach ulcer, muscle weakness, rupture of tendons, convulsions, atrophy of limbs, allergies. The drug is contraindicated in: systemic mycosis, infectious arthritis, intolerance of components, children under 6 years of age, pregnant.

Alternative treatment and herbal treatment

One of the methods of alternative treatment is the use of heat on the affected joint. For this purpose, it is recommended to use special compresses made from birch leaves (suitable dry or fresh). In order to prepare a decoction, it is necessary to brew them in boiling water, and then allow to cool. These leaves should be applied to the joint and carefully secured with a bandage. To obtain therapeutic effect, the compress is kept for at least half an hour. Repeat the procedure every ten days.

No less effective in this case will be the following recipes:

1. Leaves of nettle, stigma of corn, fruits of beans, flowers of tri-colored violets. These plants are used to prepare decoctions and compresses.
2. Tinctures are made from the flowers of elderberry or black currant leaves.
3. You can make infusion of St. John's wort, oregano, yarrow, elecampane root, linden and calendula. You need to drink it twice a day.

[37]

Operative treatment

In severe cases, when other conservative methods of treatment are not effective, an operative treatment of pseudogout is carried out, which consists in replacing damaged joints with artificial joints.

Diet for pseudogoduggets

Diet with pseudogout noticeable effect does not. Despite the fact that the basis of the crystals that damage the joints of the patient - inorganic calcium, the use of products with a high content (cottage cheese, milk) does not affect the clinical picture of the disease.

[38],

Prevention

Doctors recommend following the following guidelines to avoid pseudogout:

1. It is worth not to allow fast weight gain, so watch for proper nutrition.
2. You need to lead an active lifestyle, exercise.
3. Do not expose your joints to too much strain.
4. If you notice the first signs, immediately contact a doctor, rheumatologist.

[39], [40],

Forecast

If the correct diagnosis is made in time and the treatment is started, the prognosis is favorable.

[41], [42], [43], [44]