Osteoarthritis vs Pseudogout
Osteoarthritis and Pseudogout are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Osteoarthritis vs Pseudogout at a glance
- Osteoarthritis: Non-inflammatory degenerative joint disease driven by progressive articular cartilage loss.
- Pseudogout: Acute crystal arthritis from calcium pyrophosphate deposition; classic site is the knee with chondrocalcinosis.
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Side-by-side comparison
| Feature | Osteoarthritis | Pseudogout |
|---|---|---|
| At a glance | Non-inflammatory degenerative joint disease driven by progressive articular cartilage loss. | Acute crystal arthritis from calcium pyrophosphate deposition; classic site is the knee with chondrocalcinosis. |
| Classic presentation | Heberden nodes (DIP) and Bouchard nodes (PIP); squared first CMC joint; medial knee joint-line tenderness.; Insidious joint pain worse with activity and improved by rest; Brief morning stiffness (<30 minutes) and gel phenomenon after inactivity; Reduced range of motion, crepitus, functional limitation; Knee: medial joint-line pain,… | Acute monoarticular or oligoarticular swelling, pain, and warmth — most often knee or wrist; Onset over hours to a day; often precipitated by surgery, trauma, or acute medical illness; Less severe than typical gout but can be incapacitating; Chronic forms: insidious polyarticular arthritis mimicking RA or OA; Warm, swollen joint with… |
| Workup / key labs | ACR clinical criteria for knee OA: knee pain plus at least 3 of: age >50, stiffness <30 min, crepitus, bony tenderness, bony enlargement, no palpable warmth. Radiographic hallmarks (Kellgren-Lawrence): joint-space narrowing, subchondral sclerosis, subchondral cysts, marginal osteophytes.; Generally not required for diagnosis when… | ACR/EULAR 2023 classification criteria for CPPD use clinical features + imaging + crystal identification.; Arthrocentesis with polarized microscopy — rhomboid or rod-shaped, POSITIVELY birefringent CPP crystals; inflammatory fluid; Gram stain and culture to exclude septic arthritis; Screen for underlying metabolic disease in patients… |
| Imaging | Weight-bearing plain radiographs of the affected joint — first-line; MRI reserved for atypical presentations, suspected meniscal or ligamentous injury, or possible avascular necrosis; Ultrasound can detect effusion and osteophytes but is not routinely needed | Plain radiographs — linear calcification within hyaline or fibrocartilage (chondrocalcinosis), classically in knee menisci, triangular fibrocartilage complex of wrist, symphysis pubis; Ultrasound — hyperechoic deposits within cartilage; DECT — less established than for gout |
| First-line treatment | Patient education and self-management programs; Exercise: low-impact aerobic, strengthening (quadriceps for knee OA), aquatic therapy; Weight loss (5-10% body weight) for knee or hip OA in overweight patients; Topical NSAIDs (diclofenac gel) — preferred initial pharmacotherapy for hand and knee OA; Acetaminophen up to 3 g/day (modest… | Acute flare: Intra-articular corticosteroid injection (triamcinolone 40 mg) — preferred when septic excluded, especially for knee; Acute flare: Oral NSAIDs — ibuprofen, naproxen, indomethacin (full anti-inflammatory dose, short course); Acute flare: Colchicine 1.2 mg, then 0.6 mg one hour later, then 0.6 mg BID-TID; Acute flare:… |
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