Treatment of Pseudogout Flares

First-Line Treatment Options

The European League Against Rheumatism recommends oral NSAIDs at full FDA-approved doses as a first-line treatment option for pseudogout flares, particularly when started early in the course of the flare 1, 2
Colchicine is most effective when given within 12 hours of symptom onset at a loading dose of 1.2 mg followed by 0.6 mg one hour later on day 1 2
The American College of Rheumatology recommends oral corticosteroids (prednisone/prednisolone 30-35 mg daily for 3-5 days) for patients with contraindications to NSAIDs or colchicine 1, 2
Joint aspiration and intra-articular corticosteroid injection is highly effective for monoarticular or oligoarticular pseudogout flares, especially for large accessible joints 1
Temporary rest and application of ice or cool packs to the affected joint can provide additional symptomatic relief 1

Early treatment initiation is crucial for optimal effectiveness; the "pill in the pocket" approach is recommended for fully informed patients to self-medicate at the first warning symptoms 1, 2
For patients with particularly severe acute pseudogout involving multiple joints, combination therapy can be considered 1, 2
For patients unable to take oral medications, parenteral glucocorticoids (intramuscular, intravenous, or intra-articular) are strongly recommended 1, 2

NSAIDs should be used with extreme caution in elderly patients and those with peptic ulcer disease, renal failure, uncontrolled hypertension, or cardiac failure 1

For monoarticular or oligoarticular pseudogout affecting accessible joints: joint aspiration followed by intra-articular corticosteroid injection is the preferred approach 1
For polyarticular pseudogout or inaccessible joints: if within 12 hours of symptom onset, colchicine 1.2 mg followed by 0.6 mg one hour later; if beyond 12 hours of symptom onset or colchicine contraindicated, NSAIDs at full dose or oral prednisone 30-35 mg daily for 3-5 days 1, 2

Failing to start treatment early significantly reduces effectiveness; acute pseudogout should be treated as soon as possible 1, 2
Using traditional high-dose colchicine regimens can lead to 100% incidence of marked side effects; lower-dose regimens are now recommended 1
Treating only the acute flare without addressing modifiable risk factors (if present) may lead to recurrent attacks 1

Continue treatment until the pseudogout attack has completely resolved 2
A 3-5 day course at full dose is typically sufficient for oral corticosteroids 2