Doc: Treatment available for pseudogout
Dear Dr. Roach: In your recent column on pseudogout, you didn’t discuss treatment. I had it earlier this year, and after a while it went away. It was very painful. Is there any medication to help it?
Dear D.B.: Pseudogout, like gout, is caused by the deposition of crystals inside a joint. But rather than the uric acid crystals of regular gout, the crystals in pseudogout are made from calcium pyrophosphate (which gives it its other name, calcium pyrophosphate deposition disease, or CPDD). It happens in the knee, but also can affect the wrists, ankles, feet and elbows.
Remedy for an acute attack can involve treatment of the affected joint directly — removing the crystal-laden joint fluid with a needle and then injecting an anti-inflammatory steroid into the joint. More frequently, however, they are treated conservatively with oral anti-inflammatory medicines like ibuprofen, cold packs and two to three days of immobilization.
For people with many recurrences of CPDD, I normally recommend colchicine, an extract from autumn crocus, used for centuries to prevent and treat attacks. However, the price of generic colchicine in the U.S. has risen (about $5 a pill recently) for complex reasons involving the Food and Drug Administration and the manufacturer. The maker has an assistance program for some patients.
Dear Dr. Roach: My doctor refuses to prescribe prednisone for my problem. My feet, hands and knees are stiff. She says my problem isn’t bad enough.
Dear M.M.: Joint stiffness is a sign of many illnesses. Osteoarthritis is the leading cause in older people. Rheumatoid arthritis is another illness featuring stiff joints. Shortly after the discovery of cortisone (prednisone is a cortisone drug), it was used for the treatment of rheumatoid arthritis with great success. However, side effects from giving the drug in high doses for prolonged periods of time created more problems than the illness itself. Prednisone isn’t used for the more common osteoarthritis. Tylenol, Advil, Aleve and many other similar drugs are. Hot packs are another useful treatment. If you give me the diagnosis your doctor has made for your stiffness, I can expand on it for you.
Email questions to ToYourGoodHealth@med.cornell.edu.