1.

Definisi
Pseudogout is a type of arthritis that can affect any joint in the body. It occurs when calcium crystals, called calcium pyrophosphates, accumulate in the fluid surrounding joints. The accumulation of these crystals causes inflammation in the cartilage, the material that cushions the bone and allows for smooth joint movement. When this cartilage is weakened, there is swelling and pain in the affected joints, which can lead to chronic disability. Pseudogout occurs most often in the knees, and can be very debilitating. It can also affect the joints in your wrists, hips, shoulders, elbows, ankles, toes, knuckles, and hands. Pseudogout usually affects only one joint at a time, but may uncommonly affect multiple joints simultaneously. The condition is called pseudogout (pseudo means false or fake) because it produces symptoms that are similar to gout . However, pseudogout is caused by the deposition of calcium pyrophosphate crystals, and gout is caused by the deposition of uric acid crystals. Gout also has a more severe disease course and often a worse prognosis. It is important to correctly identify this condition as soon as possible because if left untreated, pseudogout can lead to chronic disability. Pseudogout is a potentially serious condition that requires care from your doctor. The sooner pseudogout is treated, the more favorable the outcome. If you suspect you have this condition, contact your doctor immediately.[9]

3. Epidemiology
All cultural races are affected by CPPD, and in the United States around 50% of the population over 85 years of age are affected.[10] Morbidity is the primary result of CPPD, although mortality is never experienced from the disease itself.[10] Females are at a slightly larger risk than men, with an estimated ratio of occurrence of 1.4:1 respectively

4.Penyebab
Penyebab penimbunan kristal kalsium pirofosfat pada cairan sendi masih belum diketahui, akan tetapi beberapa faktor berperanan dalam timbulnya penyakit ini seperti proses degeneratif akibat proses menua, genetik, dan penumpukan pirofosfat inorganik karena meningkatnya pembentukan atau berkurangnya pengolahan zat ini di dalam tubuh.[4]

5. Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Anyone can develop pseudogout. However, the following factors increase your chances. If you have any of these risk factors, tell your doctor:

Age Risk increases with age Attacks may occur more often and may become more severe with age Family members with pseudogout Hypothyroidism an underactive thyroid Hemochromatosis excess iron storage Overactive parathyroid glandone of four endocrine glands situated above or within the thyroid gland that increases the calcium level in the blood Hypercalcemiaa condition of too much calcium in the blood Kidney failure Diabetes Recent surgerypseudogout sometimes develops after surgery Injuryinjury to the joint, especially in older people, can trigger release of the calcium crystals
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7. Sign and Symptoms

Pseudogout especially affects the knee joints but can also affect joints of the wrists, shoulders, ankles, elbows, and hands. If you experience any of these symptoms do not assume it is due to pseudogout. These symptoms may be caused by other, less serious health conditions. If you experience any one of them, see your physician.

Pain or tenderness in joints o Pain feels like an attack of arthritis o Very sensitive to pressure Stiffness in joints Swollen joints that are warm to the touch Redness of skin around the joint

Without treatment, attacks of pseudogout can last 5-12 days [11] Patients usually present with inflammation of one or more joints often resulting in pain in the affected joint(s).[2] Hyperparathyroidism, hemochromatosis, hypophosphatemia and renal osteodystrophy are often also associated with chondrocalcinosis.[2] Other risk factors for chondrocalcinosis are Wilson's disease and osteoarthritis. In some cases, traumatic arthritis has resulted in chondrocalcinosis.[2][4] In general, the white blood cell count is raised[2]. Rarely, patients may also present with signs of carpal tunnel syndrome.[2]

10. Diagnosis
Your doctor will ask about your symptoms and medical history, and perform a physical exam. To correctly identify and diagnose pseudogout, your doctor must analyze the type of crystals found in the fluid of the joint affected with pseudogout.

Joint aspirationYour doctor may use a needle to remove some of the fluid around the affected joint to determine if the crystals in the fluid are calcium pyrophosphate crystals X-rayYour doctor may also take an x-ray of the affected joint or joints to determine whether calcium crystals are present Blood testsThese tests are used to rule out other conditions, such as gout, rheumatoid arthritis, or osteoarthritis, that may be the cause of the swelling and pain in the joints[10]

Radiography has a large role to play in the diagnosis of chondrocalcinosis with radiographs, CT scans, MRIs, ultrasound and nuclear medicine all having a part.[1] CT scans and MRIs show calcific masses (usually within the ligamentum flavum or joint capsule) however radiography is more successful.[1] As with most conditions, chondrocalcinosis can present with similarity to other diseases such as ankylosing spondylitis or gout.[1][2] Arthrocentesis, or removing synovial fluid from the affected joint, is performed to test the synovial fluid for the calcium pyrophosphate crystals that are present in CPDD[11]

Diagnosis is made on the basis of symptoms and medical tests. The physician will use a needle to take fluid from a swollen or painful joint to determine whether calcium pyrophosphate crystals are present. An X-ray of the joint may be taken to determine whether calcium-containing deposits are present, creating a condition known as chondrocalcinosis. Other potential causes of symptoms, such as gout, rheumatoid arthritis, or infection, must be ruled out. Pseudogout often is present in people who have osteoarthritis. [12]

11. Penatalaksanaan
The doctor may prescribe non-steroidal anti-inflammatory drugs (NSAIDS) such as indomethacin (Indocin) and naproxen (Naprosyn) to treat pain and disability during severe episodes of pseudogout. Then, to prevent further attacks, low doses of colchicine (available only as a generic) or NSAIDs may prove effective. However, no treatment is available to dissolve the crystal deposits, and those with poor kidney function, a history of stomach ulcers and/or on blood thinners often cannot take

NSAIDs. These patients may find a cortisone shot into the affected joint a useful option. Treatments that decrease inflammation may help slow the progression of joint degeneration accompanying pseudogout . Surgery to repair and replace damaged joints is an option should this degeneration occur with time.

Treatment of pseudogout is a matter of managing the discomfort during active pseudogout episodes. There is no cure for pseudogout and nothing is available to dissolve the crystal deposits that already exist. Without treatment the pain and discomfort of pseudogout will go away on its own within 5-12 days. However, with treatment, symptoms can be relieved within 24 hours. Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Medications
Decreasing inflammation may slow the advance of joint deterioration.

Anti-inflammatory medications(eg, aspirin) are administered to decrease inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs)(eg, ibuprofen, naproxen, indomethacin) are given to stop painful attacks quickly and to reduce inflammation. Corticosteroidsused to decrease inflammation. They may be injected into the affected joint or given as pills. Colchicineanother type of anti-inflammatory medicine. Studies have found that colchicine can be used to prevent further attacks.

Steroids Injected into Joint Procedures

Cortisone shotsYour doctor may choose to give you a cortisone shot into the affected joint. Cortisone is a powerful anti-inflammatory medication. It is a synthetic (man-made) version of a type of steroid that is produced naturally by a gland in your body called the adrenal gland. ArthrocentesisThis procedure involves removal of fluid and crystals from the joint through a needle. Removal of the fluid may give you some relief from the pain. Surgerysometimes done to repair or replace any damaged joints.

Rest
It is important for you to protect your joints by giving them a rest.

12. Pencegahan
It is not known how to prevent pseudogout. If the condition has developed because of some other medical conditions, such as hemochromatosis (too much iron stored in the body), or parathyroid problems, treatment of that condition may prevent progression of other features of that potentially dangerous illness and may, in some cases, slow the development of pseudogout.

There is no known way to prevent pseudogout. To help reduce your chances of getting pseudogout or to stop the progression of the condition, take the following steps:

Talk to your doctor about taking an anti-inflammatory medication to prevent the symptoms Protect your jointsdont put extra stress on your joints o Avoid lifting heavy items o Lift and carry things properly, using your back, arms, and legs to distribute the weight o Keep your weight down to avoid putting extra stress on your joints Relax your muscles to reduce the pain

4. bku mbx nova 10. Rothschild, Bruce M. "Calcium Pyrophosphate Deposition Disease (rheumatology)". http://www.emedicine.com/radio/topic125.htm. 9. http://www.rheumatology.org 11. http://www.bchealthguide.org
DIAGNOSIS DAN PENATALAKSANAAN ARTRITIS SEPTIK I Wayan Darya / Tjokorda Raka Putra Bagian / SMF Ilmu Penyakit Dalam FK Unud / RSUP Sanglah Denpasar
e-mail: wayandarya@yahoo.co.id

Harry Isbagio Subbagian Reumatologi, Bagian Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Indonesia/ R.S. Dr. Ciptomangunkusumo, Jakarta