In this episode, we review gout and pseudogout, two common crystal-induced arthropathies that frequently present with acute monoarticular arthritis. We discuss the underlying pathophysiology of monosodium urate crystal deposition in gout and calcium pyrophosphate crystal deposition in pseudogout, highlighting the key differences in risk factors, joint involvement, and disease progression. The episode covers classic clinical presentations—such as first metatarsophalangeal joint involvement in gout and knee involvement in pseudogout—along with the diagnostic gold standard of synovial fluid crystal analysis. We also review evidence-based management strategies for acute flares and long-term prevention, including NSAIDs, colchicine, corticosteroids, and appropriate use of urate-lowering therapy. Practical clinical pearls help clinicians differentiate these conditions and recognize when joint aspiration is critical to rule out septic arthritis.

References

1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.

2) Afzal M, Rednam M, Gujarathi R, et al. Gout. [Updated 2025 Jun 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546606/

3) Mikuls TR. Gout N Engl J Med. 2022; 387(20):1877-1887.

4) Azam A, Minalyan A, Naik R. Calcium Pyrophosphate Deposition Disease. [Updated 2025 Dec 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK540151/