September 15, 2023

Inflammatory Disorders of Joints - Clinical Patient Case of the Week

By Andrea Eberly, MD, MS, FAAEM · 2 minute read

Inflammatory Disorders of Joints - Clinical Patient Case of the Week

Try this free Inflammatory Disorders of Joints Case Q&A courtesy of Med-Challenger.

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Try this case and test your knowledge of inflammatory disorders of joints.

A 52-year-old man with a history of obesity and hyperlipidemia has developed pain in his right knee.

He tells you that he has been experiencing this pain for several months and has been treating himself with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs).

However, he recently experienced a flare-up of the symptoms with increased pain and swelling.

X-ray of his knee is shown (see Figure).

Question:

The most likely diagnosis is...

Answer Options:

osteoarthritis

gout

asymptomatic cartilage calcification

pseudo-osteoarthritis

The correct answer is:

pseudo-osteoarthritis

Educational Objective:

Recognize signs and symptoms of pseudo-osteoarthritis.

Key Point:

Pseudo-osteoarthritis is caused by calcium pyrophosphate crystal deposition and is associated with chondrocalcinosis.

Explanation:

This patient has pseudo-osteoarthritis, one of the manifestations of calcium pyrophosphate crystal deposition (CPPD).

It is classically associated with chondrocalcinosis, as seen in the x-ray.

Symptoms may involve multiple joints not commonly associated with osteoarthritis (ie, wrist, metacarpophalangeal joints, shoulder) and tend to be chronic.

Monoarticular arthritis due to calcium pyrophosphate crystals may behave more like gout and is usually referred to as pseudogout.

A definitive diagnosis of this disease is made by finding calcium pyrophosphate crystals on joint aspiration.

NSAIDs are usually effective in treating the symptoms of CPPD, as is colchicine.

In acutely inflamed joints, intra-articular steroids may be helpful.

Asymptomatic cartilage calcification differs from chondrocalcinosis and is not accompanied by pain.

Neither gout nor osteoarthritis has the characteristic chondrocalcinosis of CPPD, nor do they show calcium pyrophosphate crystals on examination of joint fluid.

References:

Edwards NL. Crystal deposition diseases (chapter 257). In: Goldman L, Schafer A. Goldman-Cecil Medicine. 25th ed., 2020:1767-1774.e2.

Choi HK. Gout and other crystal-associated arthropathies (chapter 372). In: Loscalzo J, et al, eds. Harrison’s Principles of Internal Medicine. 21st ed., 2022.

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Inflammatory Disorders of Joints - Clinical Patient Case of the Week