Unfortunately, there is no treatment to remove or dissolve the calcium pyrophosphate crystals in the joint once they are there. When pseudogout is caused by a known condition, such as hypothyroidism, then treating the primary condition might reduce or prevent episodes of pseudogout. However, pseudogout is often idiopathic - meaning the cause is unknown - and treatment focuses on easing symptoms rather than prevention.
By controlling inflammation and other symptoms a patient can limit the amount of damage a joint incurs from pseudogout episodes.
Treatment of pseudogout may include:
Ice. A cool compress applied to the affected joint can help relieve discomfort and decrease swelling.
Rest. It is usually painful to use the affected joint, and resting it will help alleviate pain, swelling and other symptoms.
Elevation. If possible, elevate the affected limb to help reduce swelling. If is the knee is affected, sit down with the foot resting on a footstool or lie down with the foot propped up on a pillow.
Aspiration. A doctor can aspirate a joint by inserting a needle into the affected joint and removing some of the synovial fluid that has accumulated. Aspiration relieves pressure in the joint, making the patient more comfortable. This treatment is often used along with a steroid injection.
Corticosteroids injections. A doctor may inject the inflamed joint with corticosteroids to relieve the pain. This treatment is particularly useful for people with sensitivities to certain medications.
Oral steroids. If more than two joints are affected then corticosteroid injections might become impractical and oral steroids may be prescribed. Oral steroids are also useful if the individual cannot tolerate NSAIDs or colchicine.
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Over-the-counter medication. Over-the-counter non-steroidal anti-inflammatory medications (NSAIDS) such as ibuprofen and naproxen can be used to relieve pseudogout pain.
Colchicine. If NSAIDs cannot be used or are ineffective, a prescription drug called colchicine may be prescribed to treat a pseudogout attack. If pseudogout attacks occur more than a few times a year then small daily doses (0.5 to 1.0 mg) of colchicine may be prescribed to prevent attacks from occurring. Colchicine has gastrointestinal side effects, such as vomiting or diarrhea.
Treat the underlying condition. If the accumulation of calcium pyrophosphate crystals has been triggered by an underlying condition, such as hemochromatosis, then the individual should seek specific therapy for that condition. Though the existing calcium pyrophosphate crystals in the joint cannot be removed, treating the underlying condition might slow down the progression of pseudogout.
Surgery. Pseudogout cannot be treated with surgery. However, if left untreated, chronic pseudogout can contribute to joint degeneration that requires surgical repair or replacement.
Elderly people are more likely to get pseudogout, but many older people are sensitive to the nonsteroidal anti-inflammatory drugs (such as aspirin and ibuprofen) that can alleviate pseudogout pain. Moreover, many older people may have additional medical conditions that require prescription medications. To avoid problems with drug sensitivities or drug interactions, doctors and patients often decide that aspiration and steroid injections are the most appropriate treatments for pseudogout.
- Mayo Clinic. Psuedogout: Prevention. Updated April 2, 2010. Accessed May 24, 2012. www.mayoclinic.com.
- Zhang et al.. EULAR recommendations for calcium pyrophosphate deposition. Part II. Ann Rheum Dis. 2011 Apr;70(4):571-5. Epub 2011 Jan 20. PubMed PMID: 21257614