What is the first-line treatment for pseudogout?

• A. NSAIDs
• B. Colchicine
• C. Steroids
• D. Joint immobilization

Answer: (A)

Pseudogout presents as an acute inflammatory arthritis caused by calcium pyrophosphate crystal deposits, so the goal is to rapidly control joint inflammation and pain. Nonsteroidal anti-inflammatory drugs work by inhibiting COX enzymes and reducing prostaglandin-mediated inflammation in the joint, which often provides quick and effective relief during an acute attack. This makes NSAIDs the best initial therapy for most patients. Colchicine is a reasonable alternative when NSAIDs are not suitable, but it can have slower onset and more GI side effects, and steroids are typically reserved for cases where NSAIDs can’t be used or when there’s an inadequate response (either systemic therapy or intra-articular injections for a single joint). Joint immobilization doesn’t address the inflammation and can impede function, so it isn’t a first-line approach.