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.

Some aspects of “Trigger finger” with homoepathic mode of treatment

Also known as ‘Flexor Tenosynovitis’, it is a stenosing tenovaginitis, in which the sheath of a flexor tendon thickens, apparently spontaneously, so as to entrap the tendon. It is more common in dominant hand & most often affects the thumb or middle or ring finger.

Sex- More common in women than men.

Age- Occur most frequently between the ages of 40 to 60 years.

Aetiology-Exact cause is not known. It is usually found in those with repetitive gripping actions. Diabetics are also more prone to this disease. Diabetics can have several fingers involved.

Aggravating factors- Prolonged, strenuous grasping may aggravate the condition.

Associated medical condition- Rheumatoid arthritis, gout, hypothyroidism, amyloidosis, diabetes mellitus.

Pathophysiology-The protective sheath surrounding the tendon in the affected finger if becomes inflammed due to any cause, the space within the tendon sheath may become narrow & constricting। As a result, the tendon cannot glide through the sheath easily & at times there is catching of the finger in a bent position। With each catch, the tendon itself becomes irritated & inflammed, worsening the condition। With passage of time inflammation becomes prolonged & there is scarring & thickening & occasional formation of nodules. As a result the gliding of the tendon becomes more difficult & the tendon may momentarily be stuck at the mouth of the sheath as the finger is extended. A pop may be felt as the tendon slips past the tight area. This causes pain & catching as the finger is moved.

Presentation- Pain & limitation of the movements of the involved tendons are the presenting features.

Clinical features- Patients frequently note catching or triggering of the affected finger or thumb after forceful flexion। In some instances, the opposite hand must be used to passively bring the finger or thumb into extension. In more severe cases, the finger may become locked in a flexed position. Triggering is often more pronounced in the morning than later in the day. Stiffness & catching tend to be worse after inactivity. A nodule or tenderness is noticed at the base of the affected finger. The nodule generally moves with finger flexion & extension.

Investigations- No X-rays or laboratory investigations are usually needed for its diagnosis। But blood sugar examination to rule out diabetes mellitus & other investigations to see the presence of associated medical conditions like rheumatoid arthritis, gout are to be done. Blood sugar estimation is particularly essential if multiple fingers are involved.

Differential Diagnosis- Trigger finger may be confused with Dupuytrens contracture, Carpal tunnel syndrome, Rheumatoid arthritis etc.

Treatment-

[A] General measures to be taken are- Besides treatment of the associated medical conditions, if any the following should be done-
(1) Rest.
(2) Limitation of activities that aggravate the condition.
(3) Occasionally a splint on the affected hand to restrict the joint movement.
(4) Exercise.
(5) Physiotherapy.

[B] Homeopathic medicines to be used – Ruta Graveolens (Ruta) is the specific remedy which is very effective as its remedy. The potency & frequency of dosage as well as duration of treatment varies with the severity of the condition & the individual

Prevention-
(1) Avoidance of repetitive grasping & releasing of objects.
(2) Modification of activity if it can not be avoided.
(3) Proper selection of tools for the job.
(4) Minimization of repetition. Periodical rest of the hands briefly during repetitive or stressful activity.
(5) Frequent stretching during repetitive activity.

Prognosis- Trigger finger can be effectively managed with homeopathy if treatment is started at the beginning। But patients with diabetes mellitus have a lower response rate.

In short, Trigger finger is a stenosing tenovaginitis which is manifested as a painful condition where a finger or thumb locks when it is bent or straightened & is treated by Ruta.

But in every case, a doctor should be consulted.