Small joints affected Pseudogout commonly involves the larger joints.Knee joint is most commonly involved; other sites are wrist, elbow, shoulder, ankele. Involvement of small joints is uncommon. Pseudogout It is one of the forms of "Calcium pyrophosphate dehydrate" (CPPD) ahropathy Age group is > 60 yrs. In CPPD ahropathy, CPPD deposition occurs in aicular tissues. It can present in any of the following three forms 1)Asympatoinatic chonclrocalcinosis 2)Acute synovitis - Pseudogout 3)Chronic pyrophosphate ahropathy The radiologic hallmark of CPPD is "Chondrocalcinosis" Chondrocalcinosis is seen as punctate and/or linear radiodense deposits in fibroc:ailaginous joint menisci or aicular hyaline cailage. Definitive diagnosis is made by synol fluid polarised light microscopy which shows weakly positive, birefringent, rhomboid crystals of CPPD. In acute synovitis form, leucocytosis (thousands to 1 lac cells/g1) is seen in synol fluid examination. It may be associated with ceain underlying disease such as ? - Primary hyperparathyroidism - Hemochromatosis - Hypomagnesemia - Hypophosphatasia - Hypothyroidism Pseudogout can be differentiated from gout as follows - Gout Pseudogout Smaller joints Large joints Intense pain Moderate pain Joint inflammed Swollen joint Hyperuricemia Chondrocalcinosis Uric acid crystals Calcium pyrophosphate dehydrate crystal Treatment The treatment of pseudogout is the same as that of acute gout: rest and high dose anti-inflammatory therapy. In elderly patients, joint aspiration and infra-aicular caicosteroid injection is the treatment of choice as these patients are more vulnerable to the side effects of NSAIDs. Urate lowering therapy is ineffective in CPPD