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 Chickenpox with homoeopathic mode of treatment

Chicken pox is an acute, highly infectious disease of childhood caused by varicella zoster virus (VZV) which is a DNA virus belonging to the family of herpesvirus. VZV infects only humans and produces two distinct diseases in man- varicella ( chicken pox) and herpes zoster ( shingles) among which chicken pox is the primary infection occurring usually in the childhood. Chicken pox is the primary infection in the non-immune host. It almost never occurs twice in the same individual. The virus then remains latent in the dorsal root and cranial nerve ganglia for the rest of the life. If immunity is impaired which occurs in elderly persons, the virus replicates and migrates along the sensory nerves to the skin or eye causing the lesions of zoster. There are no animal reservoirs of varicella.

Age- Chicken pox is the disease of childhood. But it can occur at any age and adult chicken pox which is more common in some tropical areas for reasons not understood is much more serious.

Source of infection -The source of infection is a chicken pox or herpes zoster patient. Infectivity is maximum during the initial stages of the disease when the virus is present abundantly in the upper respiratory tract. Infectivity diminishes with the progress of the disease and the scabs are practically non- infectious.

Route of entry-The portal of entry of the virus is the upper respiratory tract.

Incubation Period- 7-23 days, average 2 weeks.

Onset-Acute.

Clinical Features- There are malaise, headache, weakness, fever and prodromal rash. In children the prodromal illness is mild and so the disease is usually noticed only when the skin lesions appear. In adults, however, prodromal fever and malaise with respiratory symptoms lasting 2-3 days are common features. True rash usually appears on the first day of the disease and is vesicular in nature. The rash is centripetal in distribution, affecting mainly the trunk along with face & scalp and sparing the distal parts of the limbs. Moreover, the rash is very superficial and does not involve the deeper layers of the skin. With each fresh crops of rash temperature rises. The vesicles are unilocular and not umbilicated. Fever subsides as soon as new lesions cease to appear. Eventually the pustules crust and heal without scarring. The illness tends to be more severe in older children and can be debilitating in adults. One of the most characteristic features of the rash is pleomorphism and so all stages of the rash that is papules, vesicles and crusts may be seen simultaneously at one time in the same area.

Laboratory Investigations- Laboratory diagnosis is seldom required because of clear-cut clinical signs. Confirmation of the diagnosis is possible by examining the direct scraping of the skin lesion under a microscope, viral cultures or a rising antibody level in convalescing blood samples.

Complications-
Secondary bacterial infection usually due to staphylococci or streptococci may occur.
Varicella pneumonia- It is an important complication that usually 1-6 days after skin eruption. Varicella pneumonia is found mainly in adults where it usually becomes fatal. Besides these, CNS ( Central nervous system) involvement occurs in rare cases. The immunocompromised are susceptible to disseminated infection with multi-organ involvement.

Prevention-Recently a vaccine has been introduced in some countries. The vaccine is effective in preventing chickenpox in a number of cases & is recommended for use between the ages of twelve and eighteen months. In the rest of the cases the severity of a chickenpox infection is lessened by the vaccine.

Prognosis- Chicken pox requires no treatment in healthy children and infection results in life-long immunity. But the disease may be fatal in the immunodeficient or the immunosuppressed. If the primary infection occurs during pregnancy, the virus may cross the placenta with subsequent infection of the foetus. Primary infection of the mother near term may lead to neonatal varicella.

Treatment- Rhus.t ( Rhus toxicodendron) 30 is very effective to cope with skin lesions & should be used six times daily for one week or till the lesions heal & then should be stopped. Dulc (Dulcamara) & Merc.s ( Mercurius –Hydrargyrum ) be also used especially for high temperature.

Labels- Microscope, Infection, Centripetal, Laboratory Investigations, Laboratory diagnosis, Chicken pox, DNA virus, Dulc (Dulcamara), Immunocompromised, Immunodeficient, Immunosuppressed, Lesion, Merc।s ( Mercurius –Hydrargyrum ), Microscope, Pleomorphism, Varicella pneumonia, Foetus, Neonatal varicella, CNS ( Central nervous system), Pleomorphism,Pustule, Rash, Multi-organ, Staphylococci, Streptococci, Incubation Period, Prevention, Complications,Clinical Features.

IN SHORT- Chicken pox is an acute, highly infectious viral disease of childhood which begins with malaise, headache, weakness, fever and a characteristic type of rash appearing mainly the trunk with pleomorphism. Treatment is as mentioned above.

But in every case a doctor should be consulted।