Elderly Patients with Acute Arthritis due to Calcium Pyrophosphate Dihydrate Crystal Deposition

Abstract

Objective: Pseudogout is an acute arthritis induced by calcium pyrophosphate dihydrate (CPPD) crystal deposition. This form of arthritis frequently develops in the elderly population. Although the etiology of attacks is unclear, risk factors include osteoarthrosis and hyperparathyroidism. In addition, a relationship with ‘heart/brain disease’ has been reported. In our hospital, in which the Departments of Neurosurgery and Cardiology respectively account for 70% of the total number of beds, we investigated patients with pseudogout.

Methods: There were 21 patients (8 males; 13 females) with a mean age of 83.5 years, referred to our department with symptoms of acute arthritis, and who were subsequently diagnosed with pseudogout. A diagnosis of pseudogout was made based on intra-articular calcification on plain radiography or the presence of CPPD crystals in articular fluid.

Results: The most frequent site of pseudogout was the knee, followed by the wrist. Most patients showed arthritis symptoms consisting of fever and severe pain. The mean interval from admission until onset was 5.1 days. In all subjects, non-steroidal anti-inflammatory drugs (NSAIDs) were administered, which led to remission within one week. However, an improvement was achieved the following day in patients using NSAIDs combined with intra-articular steroid injections.

Conclusion: In elderly patients with acute arthritis, pseudogout should be considered and investigated. Radiological chondrocalcinosis is suggestive, but the diagnosis is confirmed by the presence of CPPD crystals from a joint aspirate. Early treatment should be performed once pseudogout is diagnosed, ensuring that infection is definitively ruled out.