Isolated pseudogout diagnosed on hip arthroscopy

Acute monoarticular hip joint pseudogout masquerading as septic arthritis

Monoarticular pseudogout of the hip joint is rare and to the best of our knowledge only four other cases exist in the literature. We present a case of primary monoarticular pseudogout affecting the right hip in a patient in his 50s. The diagnosis was confirmed through ultrasound-guided synovial fluid aspiration and crystal analysis. The patient was treated conservatively with analgesia and after hip joint aspiration resulted in dramatic symptomatic resolution. Acute attack of pseudogout is a rare cause of acute hip pain. The clinical features may mimic hip joint septic arthritis and should be considered in the differential diagnosis of any presentation of acute joint pain. Diagnosis is important to avoid unnecessary medical and surgical intervention reducing hospital stay.

Patients Presenting with a Hot, Swollen Joint: A Single-Centre Retrospective Analysis

BACKGROUND

A hot, swollen joint is a common clinical condition encountered in the ED and elective orthopaedic and rheumatology clinics. These patients can be difficult to manage and properly treat.

AIMS AND OBJECTIVES

The aim of this study was to report a single centre retrospective analysis of patients presenting to our institution for a hot, swollen joint over a three-month period.

METHODS

The study included patients presenting with a hot, swollen joint to ED or electively to clinics. The synovial fluid was aspirated and sent for microbiological and cytological investigation. P value was set to < 0.001. 36 patients (22 M, 14 F) with a mean age of 72.8 ± 17.4 years met our criteria. 20 cases (55.6 %) involved the knee joint, the wrist in 10 cases (27.8%), the elbow in 3 cases (8.3%) and the shoulder in 3 cases (8.3%).

RESULTS

Of the 36 synovial fluid samples collected, only 7 (19.4%) reported evidence of infection. On cytological examination of the synovial fluid, 21 (58.3%) reported presence of calcium pyrophosphates crystals (Pseudogout), 4 (11.1 %) reported presence of uric acid crystals (Gout) and 11 (30.5%) reported absence of crystals. We found a significant correlation between age and the diagnosis of pseudogout and between previous antibiotic treatment and ED presentation. Our study sheds light on the high incidence of crystal-related pathologies.

CONCLUSION

In order to improve our management of this common condition and enhance our understanding of the clinical diagnosis in certain patient population, further high-profile clinical studies are needed.

Monoarticular hip involvement in pseudogout

Pseudogout is the acutest form of arthritis in the elderly. Although clinical manifestations vary widely, polyarticular involvement is typical mimicking osteoarthritis or rheumatoid arthritis. Monoarticular involvement is relatively rare and is generally provoked by another medical condition. There are reported cases of hip involvement by pseudogout in monoarticular form. However, all of the cases were presented as septic arthritis. In this report, we present a case of monoarticular hip involvement mimicking soft tissue abscess. We confirmed the pseudogout diagnosis after ultrasonographic evaluation of the involved hip joint and pathological and biochemical analysis of synovial fluid analysis. Diagnosis is important to avoid unnecessary medical and surgical treatment in cases of the bizarre involvement of hip in pseudogout.

Calcium pyrophosphate dihydrate deposition in the trochanteric hip bursa presenting as acute hip pain

Acute hip pain is a common reason for attendance to hospital. Immediate diagnoses include occult fractures, infectious and non-infectious inflammatory processes such as gout and pseudogout. Calcium pyrophosphate deposition disease (CPDD) is a rheumatological syndrome affecting articular cartilage and/or synovial fluid. It can occur as a clinical presentation (pseudogout) where calcium pyrophosphate dihydrate (CPPD) crystals are deposited within the joint space or radiographically, as chondrocalcinosis (CC), where CPPD crystals are deposited onto articular cartilages. Extraarticular manifestations of CPDD are rare. The authors report a case of CPPD deposition in the trochanteric bursa of a 35-year-old woman presenting as acute hip pain. The patient was treated successfully during arthroscopy with removal of the deposits and excision of the bursa. The patient remains well at 6 month follow-up.

Monoarticular pseudogout of the hip: a case report

Monoarticular pseudogout is a rare cause of acute hip pain, and may mimic hip joint infection. We present a case of monoarticular pseudogout in an 85-year-old woman. Diagnosis was confirmed with hip joint aspiration and crystal analysis. The patient was treated with intra-articular corticosteroids, and her symptoms resolved.