Pseudogout Treatment and Management

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Table of Contents

Problems, Differential Diagnoses, and a Primary Diagnosis
Pharmacological Plan for a Primary Diagnosis
Education for a Patient with Pseudogout
References

Problems, Differential Diagnoses, and a Primary Diagnosis

Problems

The main concern of the 56-year-old patient is severe pain and inflammation in the knee. During the last three weeks, the pain was consistent. Physical examination shows swollen and erythematous with periarticular involvement. Regarding the laboratory results, several differentials and one primary diagnosis are defined.

Differential Diagnoses

Osteoarthritis of the knee, unspecified (ICD-10: M17.9) is one of the frequent forms of arthritis that bothers many people around the whole world and is characterized by severe joint pain (Silverwood et al., 2015). Among the main risk factors for the disease, the patient has several, including older age (56 years) and obesity (310 pounds). He has not addressed the doctors in the last 6-7 years. It is hard to research his history.

Hypertension (ICD-10: I10) is a common condition among older adults that lead to the development of numerous diseases and health problems such as infarction, strokes, and even death (James et al., 2014). Physical examination identifies BP 191/112. The results are higher than their normal values. Besides, the patient is at risk due to the presence of such factors as obesity (310 pounds) and age (above 45).

Obesity (ICD-10: E66) is defined as a disorder that is usually characterized by an extensive presence of fact in a body. The patient’s weight is 310 pounds, and his height is 5’8’’. BMI is 47.1. It is an evident sign of obesity. High cholesterol level (300 mg/dL is another sign.

Hypercholesteremia (ICD-10: E78.0) is a condition when the level of cholesterol is high than usual. The normal range should be from 100 to 130 mg/dL. The patient’s level of cholesterol is 300 mg/dL. Obesity is the main risk factor.

Primary Diagnosis

Pseudogout of the knee (ICD-10: M11.2) is also known as chondrocalcinosis and is characterized by severe pain in knee joints, inflammation processes, and changes in the laboratory tests. The patient’s complaint includes pain in the knee, and the examination proves inflammation. This disease is characterized by sudden pain and swelling. Besides, the high levels of cholesterol and Calcium should be taken into consideration because pseudogout results in joint inflammation caused by crystals of calcium pyrophosphate induction (Goroll & Mulley, 2014).

Pharmacological Plan for a Primary Diagnosis

The goal of the pharmacological plan is to remove or, at least, prevent the development and formation of new calcium pyrophosphate dehydrate crystals. No particular cure for this disease exists. Therefore, it is necessary to combine treatments and therapies. NSAIDs (nonsteroidal anti-inflammatory drugs) and colchicine should be offered to the patient at the first stage of the treatment (MacMullan & McCarthy, 2012).

A low dose of colchicine (0.5 mg) is suggested twice per day. These drugs should be taken orally. The number of times could be increased in case pain bothers a patient frequently.
Naproxen, as one of the possible NSAIDs, could be offered: 500 mg two types per day orally to relieve knee pain.

If the chosen drugs do not lead to the level of cholesterol is decreased, the use of such medications as Colestid or Lipitor two times per day should be prescribed.

Education for a Patient with Pseudogout

It is easy to cause a new cycle of an inflammation process in the knee. Therefore, the patient has to be properly educated about the main changes in the style of life and the risks of misunderstanding the main idea of treatment. The clarifications of appropriate diet should be given. The patient is obese, and much pressure on the knee is observed while walking. Diet and a healthy style of life are offered. Besides, the patient should make the joint rest for several days and use ice packs to reduce the inflammation process.

References

Goroll, A.H., & Mulley, A.G. (2014). Primary care medicine: Office evaluation and management of the adult patient (7^th ed.). China: Wolters Kluwer.

James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J.,… Smith, S. C. (2014). 2014 evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA, 311(5), 507-520.

MacMullan, P., & McCarthy, G. (2012). Treatment and management of pseudogout: Insights for the clinician. Therapeutic Advances in Musculoskeletal Disease, 4(2), 121-131.

Silverwood, V., Blagojevic-Bucknall, M., Jinks, C., Jordan, J. L., Protheroe, J., & Jordan, K. P. (2015). Current evidence on risk factors for knee osteoarthritis in older adults: A systematic review and meta-analysis. Osteoarthritis and Cartilage, 23(4), 507-515.

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