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Monday, June 22, 2009

Some aspects of “ Pseudogout ” with homoepathic mode of treatment


Also known as Calcium pyrophosphate deposition (CPPD) disease, pseudogout is an arthrpathy due to deposition of calcium pyrophosphate dihydrate (CPPD) crystals in articular cartilage & periarticular tissue & has many similarities with gout. Pseudogout has been reported to occasionally coexist with gout. This means that the two types of crystals can sometimes be found in the same joint fluid.

Sex- It occurs slightly more commonly in men.

Age- It usually occurs after the age of 60 years. But those with familial chondrocalcinosis may be affected at younger ages.

Aetiology- Aetiology of pseudogout is unknown but there is an association with primary hyperparathyroidism, haemochromatosis, ochronosis, amyloidosis, & hypothyroidism


Risk factors-
(1) Older age- Chance of developing the disease increases with age.
(2) Joint trauma- Trauma to a joint such as a serious injury or a joint replacement surgery, increases the risk of deposition CPPD crystals in the joints.
(3) Family history -Chance of developing pseudogout increases in case of a family history of the disease.

Site of lesion - Larger joints are more affected. In a majority of patients the knee joints are involved. Other areas commonly involved are elbows, wrists, ankles, shoulder & hip.

Associated medical conditions- Hyperparathyroidism, haemochromatosis, amyloidosis, hypothyroidism, hypophosphatasia & true gout.

Clinical Features- The clinical presentation is similar to that of normal gout, however, the onset is much slower, & its course is much milder. The attack begins suddenly with pain & swelling. The affected joint is warm & swollen with a large effusion. The pain may last for days to weeks & can resolve spontaneously. Pseudogout tends to be polyarticular but symmetrical involvement of joints is usually unlikely. Occasionally pyrophosphate deposition may be totally asymptomatic.

Investigations-
(1) Blood test- Serum calcium is normal. ESR may be raised during an attack.
(2) Analysis of Joint fluid- Joint fluid from an affected joint examined under a polarizing microscope if reveals the presence of calcium pyrophosphate crystals, diagnosis is confirmed.
(3) X-ray & MRI - X-ray & MRI, though cannot provide diagnostic confirmation of the disease, may be advocated to rule out other causes of pain & presence of associated medical conditions. They are also helpful to evaluate the extent of the disease & to detect possible damage to bone & surrounding structures. X –ray may also show calcifications in cartilage of joints referred to as chondrocalcinosis.

Differential Diagnosis- Pseudogout is to be differentiated from rheumatoid arthritis, osteoarthritis, gout, psoriatic arthritis, septic arthritis etc।

Treatment-

[A]
General measures to be taken are-

(1) Cold compresses on painful joints.
(2) Complete rest.
(3) Exercise after the pain subsides.

[B] Homeopathic medicines to be used – Of the different homeopathic medicines commonly used, Aconite, Benzoicum acidum, Bryonia, Calcarea phos, Colchicum, Formica rufa, Rhus toxicodendron (Rhus.tox),ledum pal, etc. need to be mentioned. The use of the medicines is more or less the same as that in gout. The potency & frequency of dosage as well as duration of treatment varies with the severity of the condition & the individual along with type of gout whether it is acute or chronic. Lower potency is to be used at the beginning. If response is not satisfactory a second dose should be used. If desired effect is still not noticed, it is better to switch over to a new medicine.

Prevention-It is not known how to prevent pseudogout. If the condition has developed because of some other medical conditions, such as haemochromatosis, treatment of that condition may prevent progression of other features of that potentially dangerous illness & may in some cases, slow the development of pseudogout.

Prognosis- Often the inflamed joints heal without any residual damage but in many people permanent damage may occur with severe destruction of some joints. Pseudogout often complicates osteoarthritis, particularly in the knees & hips.


In short,
pseugout is manifested by intense joint pain & swelling involving a single or multiple joints, & is to be treated by Aconite, Benzoicum acidum, Bryonia, Calcarea phos, Colchicum, Formica rufa, Rhus.tox etc.

But in every case, a doctor should be consulted.


3 comments:

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Virgie Aungst said...

Too bad there is yet not known way to prevention of this Pseudogout. What's left for us to learn ist on how to cure it. I hope that someday someone will find a way on how to prevent this dreaded illness.
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