Windswept Deformity from Pseudogout: A Diagnostic Challenge of an Extreme Presentation, A Case Report
Keywords:Chondrocalcinosis, Calcium Pyrophosphate Deposition Disease, Global Surgery
Background: Twenty percent of the population globally is affected by musculoskeletal conditions. These conditions significantly impair mobility and dexterity. Pseudogout is similarly a debilitating disease that significantly increases morbidity and the disability adjusted life years of a person. We report a case of pseudogout in its advanced stage, causing total joint destruction of the knees and shoulders that manifested and presented as a windswept deformity.
The Case: Our patient is a 69-year-old man who complained of bilateral knee pain, shoulder pain during active flexion, and an obvious knee deformity. His familial history was not significant, and there was no history of injuries, infection, or congenital diseases. His knees were severely deformed, with extremely laxed collateral ligaments. Both of his shoulders had a limited range of movement with coarse crepitation on passive movement. X-ray of his knees showed a destroyed joint, reduced joint space, subchondral cysts, and chondrocalcinosis. X-ray of his shoulder joint showed a subluxated joint, subchondral cyst, and subchondral sclerosis. His joint aspirate was positive for rhomboid crystals in the birefringence test, consistent with pseudogout. Joint replacement surgery is the definitive management for this disease, but the patient and caretaker were not able to afford the implants.
Conclusion: We discussed the diagnosis of pseudogout in this patient and how the policies in place do not provide adequate coverage for these populations. This marginalizes those who need surgery and limits their access to affordable surgical care when needed.
World Health Organization. Musculoskeletal conditions. Available from: https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions. Last updated Feb 8 2021; cited Apr 30 2022.
Derfus BA, Kurian JB, Butler JJ, Daft LJ, Carrera GF, Ryan LM, et al. The high prevalence of pathologic calcium crystals in pre-operative knees. The J Rheumatol. 2002;29(3):570-4.
Rosenthal AK, Ryan LM. Calcium Pyrophosphate Deposition Disease. N Engl J Med. 2016;374(26):2575–84.
Loscalzo, J., Fauci, A., Kasper, D., Hauser, S., Longo, D. and Jameson, J., n.d. Harrison's principles of internal medicine. 20th ed. McGraw Hill.
Christian L, Horst S, Lena P, Uta L, Michael U and Raoul B. Distinguishing gouty arthritis from calcium pyrophosphate disease and other arthritides. J Rheumatol. 2015;42(3):513-20.
Michael B, Tom B and JE Fitzgerald. What is “global surgery”? Defining the multidisciplinary interface between surgery, anaesthesia and public health. BMJ Glob Health. 2019;4:e001808.
Shamsul AB, Sun MML, Eric SA, Thick KP, Sharifah ZSH, Korakit C, etal. Inclusive development for urban poor & bottom 40% communities in Malaysia. Available from: https://www.ohchr.org/Documents/Issues/Poverty/VisitsContributions/Malaysia/Malaysian_CSO_SDG_Alliance_Annex2.pdf. Last updated 2016; cited 2022 Mar 30.
Kumar J and Hussian K. Factors affecting medical tourism destination selection: A Malaysian perspective. IIBA Journal. 2016;1(1):1-10.
Kementerian Kesihatan. Kerjasama Jabatan Kerja Sosial Perubatan Dengan Agensi Bantuan. Available from: http://www.myhealth.gov.my/jaringan-kerjasama-antara-jabatan-kerja-sosial-perubatan-dengan-agensi-agensi-pemberi-bantuan/ Last updated Sept 11 2017; cited Apr 30 2022.
Sidari A and Hill E. Diagnosis and Treatment of Gout and Pseudogout for Everyday Practice. Prim Care. 2018;45(2):213–36.
MacMullan P and McCarthy G. Treatment and management of pseudogout: insights for the clinician. Ther Adv in Musculoskelet Dis. 2011;4(2):121–31.
Rosenthal AK, Gohr CM, Uzuki M, Masuda I. Osteopontin promotes pathologic mineralization in articular cartilage. Matrix Biol 2007; 26:96.
Rosenthal AK(2022). Pathogenesis and etiology of calcium pyrophosphate crystal deposition (CPPD) disease. In: UpToDate, Nicola D and Paul LR(Ed). Retrieved June 26, 2022, from https://www.uptodate.com/contents/pathogenesis-and-etiology-of-calcium-pyrophosphate-crystal-deposition-cppd-disease#H27474517
How to Cite
Copyright (c) 2022 Yuki Julius Ng, Kauseliya Velanthren
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site; with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from the Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Enforcement of copyright
The IJMS takes the protection of copyright very seriously.
If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.
If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to email@example.com
If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to firstname.lastname@example.org