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Gout/Pseudogout (CPPD)

These diseases are also referred to as crystalline arthropathies primarily because they are due to deposits of crystals in and around joints. They are characterized by acute or chronic arthritis. The key in diagnosis is fluid aspiration from the joint to identify crystals.

Gout is caused by excess uric acid in the body and can be deposited in various sites including joints. Middle-aged men are most commonly affected but gout can occur at any age. Women may also be affected by gout, usually after menopause.
The deposition of monosodium urate crystals can lead to acute gout and chronic tophaceous gout. The presentation of acute gout is that of extreme pain which occurs suddenly. The most common joint involved is the big toe with symptoms of redness, swelling, and extreme pain. However, other joints can be involved also. Recurrent gout or persistently elevated uric acid levels can lead to joint destruction and deposition of urate crystals under the skin. Theses “lumpy” deposits are referred to as tophi.

Pseudogout, also known as chondrocalcinosis, is due to calcium pyrophosate dehydrate (CPPD) crystals deposition. This is a chronic condition that can be precipitated after surgery or direct trauma to the joint. Most attacks present similarly to acute gout but are typically in the knee, wrist, or ankle. The elderly are most commonly affected.