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Pseudogout — SCE Rheumatology MCQ

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EasyCrystal ArthropathyPseudogoutSCE Rheumatology

A 65-year-old woman with previously crystal-confirmed calcium pyrophosphate deposition disease presents with a typical acute flare affecting one knee. She has a large effusion and cannot take oral NSAIDs because of a previous peptic ulcer bleed. Which is the most appropriate treatment for this acute attack?

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Correct answer: D — Aspirate the affected knee and inject an intra-articular corticosteroid once infection is excluded

Option D is correct. In acute monoarticular CPP crystal arthritis, aspiration permits assessment of the effusion and helps exclude infection; once septic arthritis has been excluded, an intra-articular corticosteroid provides rapid local anti-inflammatory treatment and is particularly suitable when NSAIDs are contraindicated. CPPD differs from gout because no available treatment removes CPP crystals or lowers a causal serum crystal precursor. Febuxostat and allopurinol inhibit urate production, probenecid is uricosuric, and pegloticase enzymatically lowers urate; none treats an acute CPPD flare. Oral colchicine or a short course of systemic corticosteroid can be used when joint injection is unsuitable, and low-dose colchicine may reduce recurrent flares, but these are not offered here.

Reference: Zhang W et al. EULAR recommendations for calcium pyrophosphate deposition. Part II: management. Annals of the Rheumatic Diseases. 2011;70:571–575. https://pubmed.ncbi.nlm.nih.gov/21257614/