Materiały źródłowe

• #1 Pseudogout- causes, symptoms, diagnosis and treatment | Comprehensive Rheumatology

  https://comprehensiverheumatology.com/index.html@p=251.html

  How is pseudogout diagnosed? The gold standard of pseudogout diagnosis is presence of CPPD crystals in the fluid from a joint. These crystals are rhomboid-shaped structures that look either blue or red- depending on their orientation- under a polarized microscope. To find these crystals, a sample of the fluid is removed from the joint with a needle and looked at under the microscope.

• #1 Pseudogout – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudogout/diagnosis-treatment/drc-20376988

  Pseudogout symptoms can mimic those of gout and other types of arthritis, so lab and imaging tests are usually necessary to confirm a diagnosis. […] Blood tests can check for problems with your thyroid and parathyroid glands, as well as for mineral imbalances that have been linked to pseudogout. […] To test the fluid in your affected joint for the presence of crystals, your health care provider may withdraw a sample of the fluid with a needle. This procedure is called joint aspiration (arthrocentesis). […] X-rays of your affected joint often can reveal joint damage and crystal deposits in the joint’s cartilage. […] A health care provider who sees you for symptoms common to pseudogout may ask a number of questions. You might be asked: What are your symptoms? What part or parts of your body are affected? Do your symptoms come and go? How long do symptoms last? Have your symptoms worsened over time? Does anything seem to trigger your symptoms, such as injury, overuse of the joint, dehydration, recent surgeries or other illnesses? Have you tried any treatments? Has anything helped?

• #1 Calcium Pyrophosphate Deposition (CPPD) Disease Workup: Approach Considerations, Lab Studies, Imaging Studies

  https://emedicine.medscape.com/article/330936-workup

  The diagnosis of acute pseudogout is made by performing compensated polarized microscopy after aspiration of fluid from the involved joint. The most commonly involved joint is the knee, followed by the wrist, the metacarpophalangeal (MCP) joints, the elbows, and the metatarsophalangeal (MTP) joints. Centrifugation of the synovial fluid sample may improve identification of calcium pyrophosphate crystals. The crystals are rhomboid-shaped, weakly positively birefringent, and difficult to see. If intracellular, an acute attack of pseudogout is strongly suggested. Aspiration of the fluid from affected joints during an acute attack usually yields mildly to moderately inflammatory fluid, with 10,000-50,000 WBCs/L, more than 90% of which are neutrophils. […] Gout and pseudogout can coexist, even in the same joint; therefore, the presence of gout does not rule out the possibility of pseudogout and vice versa. Ultrasonography may be helpful in diagnosing pseudogout.

• #1 Pseudogout (Chondrocalcinosis or CPPD): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/pseudogout-chondrocalcinosis-cppd

  Pseudogout is a form of arthritis that causes sudden episodes of pain and swelling in your joints. […] A healthcare provider will diagnose pseudogout with a physical exam and some tests. […] Your provider may do a joint aspiration (arthrocentesis) to confirm that you have extra CPP crystals in your joint fluid. […] Finding excess CPP crystals in your joint fluid after an aspiration is usually the best way to confirm pseudogout. […] Your provider may also use imaging tests to look for chondrocalcinosis (signs of CPP buildup).

• #1 Calcium Pyrophosphate Deposition (CPPD) Disease Workup: Approach Considerations, Lab Studies, Imaging Studies

  https://emedicine.medscape.com/article/330936-workup

  Revised diagnostic criteria for calcium pyrophosphate deposition (CPPD) disease are from the Primer on Rheumatic Diseases (1997) and are used with permission from the Arthritis Foundation. The criteria are as follows: Criterion I – Demonstration of calcium pyrophosphate crystal deposition in tissue or synovial fluid by definitive means (eg, characteristic radiographs, diffraction analysis, or chemical analysis) […] Criterion IIa – Identification of monoclinic or triclinic crystals showing no or weakly positive birefringence by compensated polarized light microscopy […] Criterion IIb – Presence of typical radiographic calcifications […] Criterion IIIa – Acute arthritis, especially of knees or other large joints […] Criterion IIIb – Chronic arthritis, especially of knee, hip, wrist, carpus, elbow, shoulder, or metacarpophalangeal (MCP) joint, particularly if accompanied by acute exacerbation.

• #1 Pseudogout Diagnosis

  https://www.arthritis-health.com/types/pseudogout-cppd/pseudogout-diagnosis

  While there are no blood or urine tests to confirm pseudogout, a doctor may order them to help rule out another potential diagnosis, such as gout. […] The calcium pyrophosphate crystals that cause pseudogout can calcify cartilage. […] Chondrocalcinosis indicative of CPPD and pseudogout can also be seen on a CT scan. […] Traditional magnetic resonance imaging (MRI), while useful for visualizing damage to soft tissue, is not especially useful in diagnosing pseudogout or other forms of CPPD disease.

• #1

  https://arthritis.ca/about-arthritis/arthritis-types-(a-z)/types/pseudogout

  How is pseudogout diagnosed? Physicians can diagnose pseudogout by looking at the synovial fluid in the joint cavity. The standard diagnostic test involves examining fluid from the joint under a microscope to look for the presence of CPPD crystals within inflammatory cells (known as neutrophils). X-rays can also be used in diagnosis. Radiologists can inspect joints for signs of CPPD crystal deposits within joint cartilage, known as chondrocalcinosis. However, this is a common finding and not enough to provide a differential diagnosis of pseudogout. Other features such as squaring of the bone ends and bony outgrowths (osteophytes) at certain joints, such as hook-like osteophytes at the knuckles of the hands, are common findings with CPPD-diseased joints. […] Pseudogout is common but often goes unrecognized. It is more prevalent in the senior population and is strongly associated with osteoarthritis (OA). In fact, joint damage caused by OA can predispose the body to the formation of CPPD crystals.

• #1 Treatment and management of pseudogout: insights for the clinician

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3383522/

  Pseudogout and the associated calcium pyrophosphate dihydrate (CPPD)- crystal-related arthropathies are common conditions that present particular management problems in clinical practice as they often affect older patients with multiple medical comorbidities. […] The epidemiology, metabolic and endocrine disease associations, and routine investigations used in the diagnostic workup are briefly reviewed. […] The definitive diagnosis of pseudogout is most commonly and accurately made by identifying CPPD crystals, by compensated polarized light microscopy, in the SF of affected joints. […] Furthermore, all patients presenting with suspected CPPD deposition can be screened for chondrocalcinosis using certain key radiographs: a nonweight-bearing anteroposterior (AP) view of both knees, an AP view of the pelvis for visualization of the symphysis pubis and hips, and a posteroanterior (PA) view of each hand to include the triangular ligament of the wrists. […] Thus, a probable diagnosis of CPPD arthropathy can be made in patients who present with acute or chronic arthritis of knee, hip, wrist, shoulder or MCP joints in the setting of radiographic features, even without the direct demonstration of CPPD crystals by microscopy.

• #1 Pseudogout Diagnosed By Point-of-care Ultrasound

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6861017/

  Ultrasound for detection of calcium pyrophosphate crystals in pseudogout and chondrocalcinosis has sensitivity of 86.7% and specificity of 96.4%. POCUS is a valuable tool in diagnosing crystalline-induced arthropathy. Emergency physicians should consider using POCUS as an aid in diagnosing microcrystalline disease and guiding joint aspiration, as it may reduce the need for aspiration in the patient previously diagnosed with gout or pseudogout.

• #1 Calcium Pyrophosphate Deposition (CPPD) Disease Workup: Approach Considerations, Lab Studies, Imaging Studies

  https://emedicine.medscape.com/article/330936-workup

  Diagnosing CPPD with US typically requires scanning multiple joints to localize the crystals. The 2 most commonly affected sites where these crystals can be seen are the triangular fibrocartilage complex (TFCC) of the wrist and the knee. US at these sites show thin hyperechoic bands parallel to the surface of the hyaline cartilage. Other findings include a punctate pattern consisting of several hyperechoic spots and homogeneous hyperechoic nodular or oval deposits in the articular surface.

• #1 Pseudogout Diagnosed By Point-of-care Ultrasound

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6861017/

  A 71-year-old male presented to the emergency department (ED) for worsening right knee pain for the prior 34 weeks. Point-of-care ultrasound (POCUS) of the right knee showed a pseudo-double contour sign. Subsequent ultrasound-guided arthrocentesis of the knee joint was performed, and fluid studies showed the presence of calcium pyrophosphate crystals, which was consistent with pseudogout. Ultrasound for detection of calcium pyrophosphate crystals in pseudogout and chondrocalcinosis has sensitivity of 86.7% and specificity of 96.4% making POCUS a valuable tool for diagnosing crystalline-induced arthropathy in the ED. […] In this case, POCUS suggested the diagnosis of pseudogout by demonstrating the pseudo-double contour sign. The joint aspirate contained calcium pyrophosphate crystals, 161 white blood cells per cubic millimeter, no organisms on gram stain, and negative cultures.

• #1 The Ultimate Guide to Pseudogout: Causes, Symptoms, and Treatments | Aaria Rheumatology

  https://aariarheumatology.com.sg/the-ultimate-guide-to-pseudogout/

  X-rays and other imaging techniques like CT scans and ultrasounds are also employed to observe chondrocalcinosis, which appears as calcification in the cartilage and supports the diagnosis of pseudogout. In some cases, MRI may be used to evaluate the extent of calcium pyrophosphate crystal deposition in joint cartilage, providing further diagnostic clarity. These diagnostic tools are crucial for confirming pseudogout and ruling out other potential conditions, ensuring that patients receive the appropriate management for their symptoms.

• #1 Gout and Pseudogout Workup: Approach Considerations, Synovial Fluid Analysis, Serum Uric Acid

  https://emedicine.medscape.com/article/329958-workup

  Arthrocentesis of the affected joint is mandatory for all patients with new-onset acute monoarthritis and is very strongly recommended for those with recurrent attacks whose diagnosis has never been proved by microscopic visualization of crystals. […] Send joint fluid for fluid analysis, including cell count and differential, Gram stain, culture and sensitivity, and microscopic analysis for crystals. If crystals are seen, their shape and appearance under polarized light are diagnostic. […] Microscopic analysis in pseudogout shows calcium pyrophosphate (CPP) crystals, which appear shorter than MSU crystals and are often rhomboidal. […] Pseudogout attacks can be triggered by many metabolic abnormalities. Thus, patients who have an initial attack of arthritis with CPP crystals should have a workup that includes a chemistry screen; serum magnesium, calcium, iron levels; and thyroid function tests.

• #1 All About Pseudogout – Symptoms, Diagnosis, Treatment

  https://www.arthritis-health.com/types/pseudogout-cppd/all-about-pseudogout-symptoms-diagnosis-treatment

  Once lodged in the joints soft tissue(s), the CPP crystals trigger an immune system response. This immune system response produces inflammation, pain, swelling, redness, and warmth, that may be diagnosed as either pseudogout or chronic CPP crystal inflammatory arthritis. […] Because CCP crystals can be associated with metabolic and endocrine disorders, a health care provider may recommend a person diagnosed with CPPD disease be screened for these disorders.

• #1 Calcium Pyrophosphate Deposition (CPPD) Disease Workup: Approach Considerations, Lab Studies, Imaging Studies

  https://emedicine.medscape.com/article/330936-workup

  In 2023, an international group of rheumatologists and musculoskeletal radiologists established consensus definitions of imaging features characteristic of CPPD on conventional radiography, conventional computed tomography (CT), and dual-energy CT. Also in 2023, the American College of Rheumatology (ACR) and the European Alliance of Associations for Rheumatology (EULAR) published validated classification criteria for symptomatic CPPD disease. These comprise the following: Entry criterion: A history of at least one episode of joint pain, swelling, or tenderness […] Absolute exclusion criterion: All symptoms are more likely explained by another condition (eg, rheumatoid arthritis, gout, psoriatic arthritis, osteoarthritis) […] Sufficient criteria: The presence of crowned dens syndrome, or calcium pyrophosphate crystals in synovial fluid from a joint with swelling, tenderness, or pain.

• #1 Pseudogout: Joint Pain, Gout Differences, Treatment

  https://www.verywellhealth.com/pseudogout-8603574

  Your healthcare provider may also perform a joint aspiration procedure. This involves using a needle to take a small amount of fluid from an affected joint and sending it to the laboratory to look for the presence of calcium pyrophosphate crystals. Synovial fluid aspiration and crystal analysis are considered the joint standard for diagnosing pseudogout. […] Blood and urine tests might be done to help your healthcare provider come up with a diagnosis. But, these tests are typically done to rule out other conditions, including RA. […] Pseudogout is sometimes misdiagnosed, leading to its being treated incorrectly. It is often confused with other types of arthritis, including: Gout, Rheumatoid arthritis, Osteoarthritis, Septic arthritis, which is caused by an infection and produces similar symptoms.

• #1 Pseudogout: Symptoms and Treatment | The Hand Society

  https://www.assh.org/handcare/condition/pseudogout

  The diagnosis of pseudogout can be tricky. Your doctor will ask about your pain and medical history. They will examine many of your joints. This will include joints that hurt and ones that do not hurt to look for patterns. The doctor may order x-rays of an involved joint, which may show crystal deposits within the soft tissue. The most definitive way to make the diagnosis is to remove fluid from a joint and analyze it in a lab. This is very important to help distinguish it from an infection. Gout and pseudogout crystals can be seen with a microscope. Each type of crystal looks different when viewed in a special polarized light. Each crystal has a unique shape and appearance. Gout crystals are shaped like a needle, while pseudogout crystals are rhomboid shaped. If there are no bacteria seen under the microscope, it suggests there may not be an infection. With no bacteria, definite calcium crystals, and PMNs, this pattern suggests pseudogout is present. Sometimes both a crystal problem and an infection can coexist. The x-rays can also be helpful, as they show different changes. Gout eats away at the bones and joints of the hand and wrist. This is noticed with many small cystic erosions in the bones at the joint surfaces. An x-ray showing pseudogout may show calcification in the soft tissues around the joints. Blood levels of urate are often elevated in gout, and uric acid is normal in pseudogout. The white blood cell count (WBC) may be elevated in these conditions. Finally, it is helpful to check kidney function. Many of the drug treatments for pseudogout can be impacted by whether kidney function is normal or reduced. Therefore, it is important to know the health of the kidneys when recommending treatments.

• #1 Pseudogout – Zero To Finals

  https://zerotofinals.com/medicine/rheumatology/pseudogout/

  Pseudogout is a crystal arthropathy caused by calcium pyrophosphate crystals collecting in the joints. It is formally known as calcium pyrophosphate deposition disease (CPPD). […] In any patient presenting with a hot, painful and swollen joint, septic arthritis must be excluded as it is a medical emergency. Symptoms of pseudogout tend to be milder than gout or septic arthritis. […] Joint aspiration is used to confirm the diagnosis. Aspirated joint fluid shows calcium pyrophosphate crystals. These are rhomboid-shaped and positively birefringent of polarised light. There should be no bacterial growth. […] Chondrocalcinosis is the classic x-ray change in pseudogout. The calcium deposits in the joint cartilage show up in a thin white line in the middle of the joint space.

• #1

  https://bpac.org.nz/bpj/2013/october/cppd.aspx

  The gold standard for a definitive diagnosis of CPPD disease is the identification of CPD crystals in synovial fluid. […] The characteristic crystals found in CPPD disease are generally rectangular, square, rhomboid or rod-shaped and can be seen using polarised light microscopy. […] CPPD disease can mimic most other forms of inflammatory arthritis, gout and joint infection. […] History and clinical examination may help the clinician to distinguish CPPD disease from these other conditions, however, the clinical picture is usually not sufficiently distinct enough to allow a definite diagnosis to be made on clinical grounds alone. […] If a single joint is involved, septic arthritis should be excluded, however, infection may also occur concurrently with underlying CPPD disease. […] Identification of CPP crystals from synovial fluid is the gold standard for diagnosis.

• #1 Pseudogout (Calcium Phyrophosphate Deposition Disease) – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/dermatology/pseudogout-calcium-phyrophosphate-deposition-disease/

  As with gout, pseudogout has a propensity to attack patients when they are ill or hospitalized for an unrelated reason. […] Patient demographics can be helpful to distinguish between the two conditions. […] The most common area for this rare condition is in the vicinity of the temporomandibular joint. […] A potentially serious consequence of CPPDD is acute inflammation occurring at the level of C1-C2, the crowned dens syndrome. […] The clinical syndrome of pseudogout occurs when previously asymptomatic crystals trigger acute inflammation. […] The classic pseudogout attack is self-limited, but tends to persist longer than the classic gout attack, often lasting several weeks. […] Chondrocalcinosis is typically detectable by plain radiography, although occasionally a patient may present with an attack of pseudogout without enough CPPD deposition in the cartilage to be visible on plain radiographs.

• #1 Gout and Pseudogout | PM&R KnowledgeNow

  https://now.aapmr.org/gout-and-pseudogout/

  In addition to imaging studies, examination of joint fluid under a polarizing microscope can show the weakly positive birefringent, rhomboid-shaped calcium pyrophosphate crystal characteristic of this condition. […] Because pseudogout can mimic many other rheumatic diseases, it is likely underdiagnosed. […] The diagnosis may be suggested by a rather acute onset of neck pain with limitation of motion on rotation, a slightly elevated CRP, and identification of CPPD in other joints. Confirmation of this diagnosis is by computed tomography (CT scan) showing the presence of calcific deposits around the odontoid process (dens) of the axis, appearing as a crowned arrangement around the dens.

• #1 Pseudogout (Calcium Phyrophosphate Deposition Disease) – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/dermatology/pseudogout-calcium-phyrophosphate-deposition-disease/

  Synovial fluid from the joint affected with pseudogout will typically be inflammatory (cell count 1000/mm3), appearing mildly to moderately cloudy. […] CPPD crystals are slightly rectangular or rhomboid in shape, compared to needle-like monosodium urate (MSU) crystals. […] The pseudo-rheumatoid pattern of CPPDD clinically resembles rheumatoid arthritis with polyarticular involvement, often with morning stiffness and chronic joint inflammation. […] Chondrocalcinosis is usually evident. […] Arthrocentesis will show typical intracellular CPPD crystals. […] There are three serious but treatable underlying conditions that should always be considered when making a diagnosis of pseudogout. […] Most cases of pseudogout are idiopathic, especially in the elderly. […] The three most important systemic underlying conditions that should be sought are hyperparathyroidism, hemochromatosis and hypomagnesemia.

• #1

  https://bpac.org.nz/bpj/2013/october/cppd.aspx

  Patients with CPPD disease can be asymptomatic or present with a range of symptoms and signs similar to gout or other forms of inflammatory arthritis, making an accurate clinical diagnosis difficult. […] The deposition of CPP crystals results in an inflammatory reaction within the joint in a similar way that precipitation of monosodium urate monohydrate crystals does in patients with gout. […] Patients with CPPD disease may also present with systemic features, such as neck pain, headache and fever (estimated to occur in up to 50% of people with CPPD), which may make it more difficult to differentiate between infection and inflammation. […] Patients with CPPD disease can be asymptomatic (with the changes detected incidentally on x-ray) or may present with a range of symptoms and signs similar to those found in patients with gout or other forms of inflammatory arthritis (e.g. rheumatoid arthritis) or septic arthritis.

• #1 Calcium Pyrophosphate Deposition (CPPD)

  https://rheumatology.org/patients/calcium-pyrophosphate-deposition-cppd

  CPPD symptoms include severe joint pain, warmth, and swelling. […] A rheumatologist diagnoses CPPD based on symptoms and medical tests. In some cases, joint fluid analysis may be necessary to confirm the presence of CPP crystals. […] Prompt diagnosis and treatment of CPPD may ease symptoms and prevent joint damage. See a rheumatology healthcare professional as soon as symptoms appear to rule out other possible causes and start treatment.

• #1 Pseudogout: Joint Pain, Gout Differences, Treatment

  https://www.verywellhealth.com/pseudogout-8603574

  An early and accurate pseudogout diagnosis is the best way to prevent severe joint and cartilage damage. Pseudogout can mimic other types of arthritis, including RA, OA, and gout, leading to treatment delays. The sooner you see a medical provider, the better your care will be. […] You should see a rheumatologist if you are experiencing ongoing joint pain, swelling, and stiffness. A rheumatologist is a medical doctor specializing in diagnosing and treating arthritis and other rheumatic conditions. […] If healthcare providers suspect pseudogout, they will: Start by asking about your symptoms, including when they started and how long they last; Ask about your personal medical history and family history; Request joint imaging, such as X-rays, ultrasound, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans.

• #1 Calcium Pyrophosphate Arthritis – Musculoskeletal and Connective Tissue Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/crystal-induced-arthritides/calcium-pyrophosphate-arthritis

  Diagnosis requires identification of CPPD crystals in synovial fluid. […] Diagnosis of CPP arthritis is established by identifying rhomboid- or rod-shaped crystals in synovial fluid that are not birefringent or are weakly positively birefringent on polarized light microscopy. […] CPP arthritis should be suspected in older patients with arthritis, particularly those with a history of recurrent inflammatory arthritis. […] Examine joint fluid for characteristic rhomboid- or rod-shaped crystals in synovial fluid that are not birefringent or are weakly positively birefringent, and exclude joint infection.

• #1 Diagnosis and Treatment of Calcium Pyrophosphate Deposition | OARRR

  https://www.dovepress.com/diagnosis-and-treatment-of-calcium-pyrophosphate-deposition-cppd-disea-peer-reviewed-fulltext-article-OARRR

  The era of ultrasound (US) has revolutionised screening peripheral joints. […] In patients with acute mono-oligoarthritis, a targeted ultrasound scanning protocol shows great accuracy for the diagnosis of both gout and CPPD. […] Computed Tomography (CT) is more accurate than conventional radiography, particularly for the axial skeleton and deep anatomic structures. […] One of the biggest barriers in the treatment of CPPD is the paucity of randomised controlled clinical trials to objectively evaluate the currently used treatment options. […] Current therapy is aimed at reducing the acute inflammatory response and thereby lessening symptoms in affected patients. […] Colchicine is recommended by EULAR in the treatment of acute CPPD, acknowledging that evidence is mainly extrapolated from gout treatment. […] Establishing the correct diagnosis is the first obstacle, but synovial fluid aspiration and examination under PLM remains a major facilitator to diagnosis.

• #2

  https://arthritis.ca/about-arthritis/arthritis-types-(a-z)/types/pseudogout

  How is pseudogout diagnosed? Physicians can diagnose pseudogout by looking at the synovial fluid in the joint cavity. The standard diagnostic test involves examining fluid from the joint under a microscope to look for the presence of CPPD crystals within inflammatory cells (known as neutrophils). X-rays can also be used in diagnosis. Radiologists can inspect joints for signs of CPPD crystal deposits within joint cartilage, known as chondrocalcinosis. However, this is a common finding and not enough to provide a differential diagnosis of pseudogout. Other features such as squaring of the bone ends and bony outgrowths (osteophytes) at certain joints, such as hook-like osteophytes at the knuckles of the hands, are common findings with CPPD-diseased joints. […] Pseudogout is common but often goes unrecognized. It is more prevalent in the senior population and is strongly associated with osteoarthritis (OA). In fact, joint damage caused by OA can predispose the body to the formation of CPPD crystals.

• #2 Pseudogout: Joint Pain, Gout Differences, Treatment

  https://www.verywellhealth.com/pseudogout-8603574

  An early and accurate pseudogout diagnosis is the best way to prevent severe joint and cartilage damage. Pseudogout can mimic other types of arthritis, including RA, OA, and gout, leading to treatment delays. The sooner you see a medical provider, the better your care will be. […] You should see a rheumatologist if you are experiencing ongoing joint pain, swelling, and stiffness. A rheumatologist is a medical doctor specializing in diagnosing and treating arthritis and other rheumatic conditions. […] If healthcare providers suspect pseudogout, they will: Start by asking about your symptoms, including when they started and how long they last; Ask about your personal medical history and family history; Request joint imaging, such as X-rays, ultrasound, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans.

• #2 Pseudogout: Symptoms and Treatment | The Hand Society

  https://www.assh.org/handcare/condition/pseudogout

  The diagnosis of pseudogout can be tricky. Your doctor will ask about your pain and medical history. They will examine many of your joints. This will include joints that hurt and ones that do not hurt to look for patterns. The doctor may order x-rays of an involved joint, which may show crystal deposits within the soft tissue. The most definitive way to make the diagnosis is to remove fluid from a joint and analyze it in a lab. This is very important to help distinguish it from an infection. Gout and pseudogout crystals can be seen with a microscope. Each type of crystal looks different when viewed in a special polarized light. Each crystal has a unique shape and appearance. Gout crystals are shaped like a needle, while pseudogout crystals are rhomboid shaped. If there are no bacteria seen under the microscope, it suggests there may not be an infection. With no bacteria, definite calcium crystals, and PMNs, this pattern suggests pseudogout is present. Sometimes both a crystal problem and an infection can coexist. The x-rays can also be helpful, as they show different changes. Gout eats away at the bones and joints of the hand and wrist. This is noticed with many small cystic erosions in the bones at the joint surfaces. An x-ray showing pseudogout may show calcification in the soft tissues around the joints. Blood levels of urate are often elevated in gout, and uric acid is normal in pseudogout. The white blood cell count (WBC) may be elevated in these conditions. Finally, it is helpful to check kidney function. Many of the drug treatments for pseudogout can be impacted by whether kidney function is normal or reduced. Therefore, it is important to know the health of the kidneys when recommending treatments.

• #2 Pseudogout- causes, symptoms, diagnosis and treatment | Comprehensive Rheumatology

  https://comprehensiverheumatology.com/index.html@p=251.html

  How is pseudogout diagnosed? The gold standard of pseudogout diagnosis is presence of CPPD crystals in the fluid from a joint. These crystals are rhomboid-shaped structures that look either blue or red- depending on their orientation- under a polarized microscope. To find these crystals, a sample of the fluid is removed from the joint with a needle and looked at under the microscope.

• #2 Gout and Pseudogout Workup: Approach Considerations, Synovial Fluid Analysis, Serum Uric Acid

  https://emedicine.medscape.com/article/329958-workup

  Arthrocentesis of the affected joint is mandatory for all patients with new-onset acute monoarthritis and is very strongly recommended for those with recurrent attacks whose diagnosis has never been proved by microscopic visualization of crystals. […] Send joint fluid for fluid analysis, including cell count and differential, Gram stain, culture and sensitivity, and microscopic analysis for crystals. If crystals are seen, their shape and appearance under polarized light are diagnostic. […] Microscopic analysis in pseudogout shows calcium pyrophosphate (CPP) crystals, which appear shorter than MSU crystals and are often rhomboidal. […] Pseudogout attacks can be triggered by many metabolic abnormalities. Thus, patients who have an initial attack of arthritis with CPP crystals should have a workup that includes a chemistry screen; serum magnesium, calcium, iron levels; and thyroid function tests.

• #2

  https://step1.medbullets.com/msk/107047/pseudogout

  A 70-year-old man presents to the emergency department for severe left knee pain. Medical history is significant for hyperparathyroidism managed with bisphosphonates. On physical exam, the left knee is erythematous, warm, enlarged, and tender to palpation. Radiography of the affected joint demonstrates chondrocalcinosis. Joint aspiration demonstrates a leukocyte count of 2800/mm3 with 50% polymorphonuclear cells. Polarized microscopy shows weakly positively birefringent rhomboid crystals. […] Arthrocentesis confirms the diagnosis. Gram stain and culture should always be performed since infection could co-exist. […] Polarized microscopy demonstrates weakly positively birefringent rhomboid crystals blue when parallel to light and yellow when perpendicular to light. […] Gout differentiating factor polarized microscopy demonstrates negatively birefringent crystals.

• #2 Pseudogout (Calcium Phyrophosphate Deposition Disease) – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/dermatology/pseudogout-calcium-phyrophosphate-deposition-disease/

  Synovial fluid from the joint affected with pseudogout will typically be inflammatory (cell count 1000/mm3), appearing mildly to moderately cloudy. […] CPPD crystals are slightly rectangular or rhomboid in shape, compared to needle-like monosodium urate (MSU) crystals. […] The pseudo-rheumatoid pattern of CPPDD clinically resembles rheumatoid arthritis with polyarticular involvement, often with morning stiffness and chronic joint inflammation. […] Chondrocalcinosis is usually evident. […] Arthrocentesis will show typical intracellular CPPD crystals. […] There are three serious but treatable underlying conditions that should always be considered when making a diagnosis of pseudogout. […] Most cases of pseudogout are idiopathic, especially in the elderly. […] The three most important systemic underlying conditions that should be sought are hyperparathyroidism, hemochromatosis and hypomagnesemia.

• #2 Pseudogout Diagnosis

  https://www.arthritis-health.com/types/pseudogout-cppd/pseudogout-diagnosis

  A patient exam and interview along with lab analysis of the joint fluid can confirm or disprove a pseudogout diagnosis. […] Pseudogout can be diagnosed by looking for in a small amount of calcium pyrophosphate dihydrate crystals in synovial fluid under a polarized microscope. […] The most dependable way to diagnose pseudogout is through joint fluid analysis. […] During analysis, the fluid will be examined under a polarized microscope. A well-trained expert can identify the calcium pyrophosphate (CPP) crystals that cause pseudogout by their shape, color, and reaction to light. If CPP crystals are found in the fluid sample, then CPPD disease is confirmed and pseudogout may be considered as a diagnosis. […] It is important to note that a joint can contain calcium pyrophosphate crystals as well as other crystals, including gout-causing urate crystals.

• #2 Treatment and management of pseudogout: insights for the clinician

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3383522/

  Pseudogout and the associated calcium pyrophosphate dihydrate (CPPD)- crystal-related arthropathies are common conditions that present particular management problems in clinical practice as they often affect older patients with multiple medical comorbidities. […] The epidemiology, metabolic and endocrine disease associations, and routine investigations used in the diagnostic workup are briefly reviewed. […] The definitive diagnosis of pseudogout is most commonly and accurately made by identifying CPPD crystals, by compensated polarized light microscopy, in the SF of affected joints. […] Furthermore, all patients presenting with suspected CPPD deposition can be screened for chondrocalcinosis using certain key radiographs: a nonweight-bearing anteroposterior (AP) view of both knees, an AP view of the pelvis for visualization of the symphysis pubis and hips, and a posteroanterior (PA) view of each hand to include the triangular ligament of the wrists. […] Thus, a probable diagnosis of CPPD arthropathy can be made in patients who present with acute or chronic arthritis of knee, hip, wrist, shoulder or MCP joints in the setting of radiographic features, even without the direct demonstration of CPPD crystals by microscopy.

• #2 Calcium Pyrophosphate Deposition (CPPD) Disease Workup: Approach Considerations, Lab Studies, Imaging Studies

  https://emedicine.medscape.com/article/330936-workup

  Diagnosing CPPD with US typically requires scanning multiple joints to localize the crystals. The 2 most commonly affected sites where these crystals can be seen are the triangular fibrocartilage complex (TFCC) of the wrist and the knee. US at these sites show thin hyperechoic bands parallel to the surface of the hyaline cartilage. Other findings include a punctate pattern consisting of several hyperechoic spots and homogeneous hyperechoic nodular or oval deposits in the articular surface.

• #2 Pseudogout Diagnosed By Point-of-care Ultrasound

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6861017/

  Ultrasound for detection of calcium pyrophosphate crystals in pseudogout and chondrocalcinosis has sensitivity of 86.7% and specificity of 96.4%. POCUS is a valuable tool in diagnosing crystalline-induced arthropathy. Emergency physicians should consider using POCUS as an aid in diagnosing microcrystalline disease and guiding joint aspiration, as it may reduce the need for aspiration in the patient previously diagnosed with gout or pseudogout.

• #2 The Ultimate Guide to Pseudogout: Causes, Symptoms, and Treatments | Aaria Rheumatology

  https://aariarheumatology.com.sg/the-ultimate-guide-to-pseudogout/

  X-rays and other imaging techniques like CT scans and ultrasounds are also employed to observe chondrocalcinosis, which appears as calcification in the cartilage and supports the diagnosis of pseudogout. In some cases, MRI may be used to evaluate the extent of calcium pyrophosphate crystal deposition in joint cartilage, providing further diagnostic clarity. These diagnostic tools are crucial for confirming pseudogout and ruling out other potential conditions, ensuring that patients receive the appropriate management for their symptoms.

• #2 Pseudogout Causes and Treatment – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/medicine/rheumatology-inflammation-immunity/arthritis-and-joint-diseases-center/pseudogout

  To determine if your joint symptoms are due to CPPD disease or pseudogout, our physicians may perform one or more of the following tests: […] Joint fluid analysis: the physician removes a sample of fluid from the joint and analyzes it for calcium pyrophosphate crystals […] X-ray: to look for chondrocalcinosis (calcium pyrophosphate crystal deposits in cartilage) and/or joint damage […] Musculoskeletal ultrasound: to look for joint inflammation, crystal deposits, and/or joint damage […] Dual-energy CT scan: to look for crystal deposits and/or joint damage.

• #2 Pseudogout – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudogout/diagnosis-treatment/drc-20376988

  Pseudogout symptoms can mimic those of gout and other types of arthritis, so lab and imaging tests are usually necessary to confirm a diagnosis. […] Blood tests can check for problems with your thyroid and parathyroid glands, as well as for mineral imbalances that have been linked to pseudogout. […] To test the fluid in your affected joint for the presence of crystals, your health care provider may withdraw a sample of the fluid with a needle. This procedure is called joint aspiration (arthrocentesis). […] X-rays of your affected joint often can reveal joint damage and crystal deposits in the joint’s cartilage. […] A health care provider who sees you for symptoms common to pseudogout may ask a number of questions. You might be asked: What are your symptoms? What part or parts of your body are affected? Do your symptoms come and go? How long do symptoms last? Have your symptoms worsened over time? Does anything seem to trigger your symptoms, such as injury, overuse of the joint, dehydration, recent surgeries or other illnesses? Have you tried any treatments? Has anything helped?

• #2 Pseudogout and Its Treatment | Orthopedic Center for Sports Medicine

  https://nolasportsmedicine.com/pseudogout-and-its-treatment/

  What is Pseudogout false gout? Calcium Pyrophosphate Deposition (CPPD) also known as Pseudogout, is a joint problem caused by crystals of calcium salt called Pyrophosphate that are deposited in the joint space. A patient can be asymptomatic for many weeks or can experience flare-ups that present with a severe pain, swelling, stiffness, redness and warmth of one or more joints that can last from days to weeks, usually self-limited. The crystals can be deposited in the synovial fluid or the cartilage in an older patient that has no symptoms. The most common affected joint is the knee, but it can also present in the shoulder, elbow, wrist, hand, ankle or other joints. The calcium pyrophosphate crystals will deposit in the cartilage resulting in pain and inflammation. There is no clear evidence of why the crystals will deposit in the cartilage but there has been a direct relationship with increased age especially those over 65 with no major sex predominance. Medical problems that are considered highly possible contributors to pseudogout include Hypomagnesemia (no magnesium in blood), Hyperparathyroidism (increased activity of parathyroid gland), Hemochromatosis (excess iron storage), Hypercalcemia (excess calcium in blood) or Hypothyroidism (under anctive thyroid).

• #2 Pseudogout vs. gout: Understanding the differences

  https://www.medicalnewstoday.com/articles/pseudogout-vs-gout

  Both conditions can cause painful joint swelling. Laboratory tests are necessary to make a definitive diagnosis. […] According to the Arthritis Foundation, doctors use many of the same tools and processes to diagnose pseudogout and gout. Diagnosis may involve: a physical exam, a medical history check, blood work, joint fluid analysis, imaging such as X-ray and ultrasound. […] However, once a doctor determines a diagnosis, they will use specialized treatment for either condition. […] If a person experiences joint pain or swelling, they should consult a healthcare professional. Doctors can use physical exams and medical imaging to diagnose gout and pseudogout.

• #2 Pseudogout – Zero To Finals

  https://zerotofinals.com/medicine/rheumatology/pseudogout/

  Pseudogout is a crystal arthropathy caused by calcium pyrophosphate crystals collecting in the joints. It is formally known as calcium pyrophosphate deposition disease (CPPD). […] In any patient presenting with a hot, painful and swollen joint, septic arthritis must be excluded as it is a medical emergency. Symptoms of pseudogout tend to be milder than gout or septic arthritis. […] Joint aspiration is used to confirm the diagnosis. Aspirated joint fluid shows calcium pyrophosphate crystals. These are rhomboid-shaped and positively birefringent of polarised light. There should be no bacterial growth. […] Chondrocalcinosis is the classic x-ray change in pseudogout. The calcium deposits in the joint cartilage show up in a thin white line in the middle of the joint space.

• #2

  https://bpac.org.nz/bpj/2013/october/cppd.aspx

  Patients with CPPD disease can be asymptomatic or present with a range of symptoms and signs similar to gout or other forms of inflammatory arthritis, making an accurate clinical diagnosis difficult. […] The deposition of CPP crystals results in an inflammatory reaction within the joint in a similar way that precipitation of monosodium urate monohydrate crystals does in patients with gout. […] Patients with CPPD disease may also present with systemic features, such as neck pain, headache and fever (estimated to occur in up to 50% of people with CPPD), which may make it more difficult to differentiate between infection and inflammation. […] Patients with CPPD disease can be asymptomatic (with the changes detected incidentally on x-ray) or may present with a range of symptoms and signs similar to those found in patients with gout or other forms of inflammatory arthritis (e.g. rheumatoid arthritis) or septic arthritis.

• #2 Gout and Pseudogout | PM&R KnowledgeNow

  https://now.aapmr.org/gout-and-pseudogout/

  In addition to imaging studies, examination of joint fluid under a polarizing microscope can show the weakly positive birefringent, rhomboid-shaped calcium pyrophosphate crystal characteristic of this condition. […] Because pseudogout can mimic many other rheumatic diseases, it is likely underdiagnosed. […] The diagnosis may be suggested by a rather acute onset of neck pain with limitation of motion on rotation, a slightly elevated CRP, and identification of CPPD in other joints. Confirmation of this diagnosis is by computed tomography (CT scan) showing the presence of calcific deposits around the odontoid process (dens) of the axis, appearing as a crowned arrangement around the dens.

• #2 Diagnosis and Treatment of Calcium Pyrophosphate Deposition | OARRR

  https://www.dovepress.com/diagnosis-and-treatment-of-calcium-pyrophosphate-deposition-cppd-disea-peer-reviewed-fulltext-article-OARRR

  The pseudogout syndrome was first described by Kohn in 1962 and describes acute attacks of synovitis provoked by CPPD crystals. […] CPPD crystal-related arthropathies can present with varied clinical syndromes which can be a barrier to diagnosis as heterogeneous presentations create diagnostic uncertainty. […] There is ongoing work on new classification criteria by an international data- and expert-driven process to develop CPPD classification criteria. […] Synovial fluid aspiration and crystal analysis under compensated PLM remains the gold standard in facilitating diagnosis. […] Correct identification of CPP crystals in the synovial fluid of a suspected case is a major facilitator in reaching the correct diagnosis. […] The diagnosis of CPPD is strongly supported by the presence of chondrocalcinosis, however conventional radiography only detects 40% of clinically important CPPD.

• #2 Calcium Pyrophosphate Deposition (CPPD)

  https://rheumatology.org/patients/calcium-pyrophosphate-deposition-cppd

  CPPD symptoms include severe joint pain, warmth, and swelling. […] A rheumatologist diagnoses CPPD based on symptoms and medical tests. In some cases, joint fluid analysis may be necessary to confirm the presence of CPP crystals. […] Prompt diagnosis and treatment of CPPD may ease symptoms and prevent joint damage. See a rheumatology healthcare professional as soon as symptoms appear to rule out other possible causes and start treatment.

• #2 Arthritis Medical Clinic

  https://www.arthritismedicalclinic.org/diseases/pseudogout.html

  Pseudogout may be one of the most misunderstood forms of arthritis, often mistaken for gout or other conditions. Proper diagnosis is important, though because untreated pseudogout may lead to a severe form of joint degeneration and on-going inflammation, resulting in chronic disability. […] Proper diagnosis depends on identifying the causative calcium pyrophosphate crystals found in the fluid of an affected joint.

• #2 Causes, symptoms and details of Pseudogout – Pulse Reference

  https://pulsereference.com/diagnoses/gout-pseudogout/

  Pseudogout, also known as calcium pyrophosphate deposition (CPPD), is characterised by the deposition of calcium pyrophosphate dihydrate (CPPD) crystals in the joint tissues. The British Society of Rheumatology outlines that for a definitive diagnosis, the identification of CPPD crystals in the synovial fluid is necessary. The crystals are positively birefringent and rhomboid-shaped under polarised light microscopy. […] Joint fluid analysis is the gold standard for diagnosis, with the identification of positively birefringent, rhomboid-shaped CPPD crystals necessary for a definitive diagnosis.

• #2 Calcium Pyrophosphate Arthritis – Musculoskeletal and Connective Tissue Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/crystal-induced-arthritides/calcium-pyrophosphate-arthritis

  Diagnosis requires identification of CPPD crystals in synovial fluid. […] Diagnosis of CPP arthritis is established by identifying rhomboid- or rod-shaped crystals in synovial fluid that are not birefringent or are weakly positively birefringent on polarized light microscopy. […] CPP arthritis should be suspected in older patients with arthritis, particularly those with a history of recurrent inflammatory arthritis. […] Examine joint fluid for characteristic rhomboid- or rod-shaped crystals in synovial fluid that are not birefringent or are weakly positively birefringent, and exclude joint infection.

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