Windswept Deformity from pseudogout. A Diagnostic Challenge of an extreme presentation, a case report

. 74 Background: 75 Twenty percent of the population globally is affected by musculoskeletal conditions. These conditions 76 significantly impair mobility and dexterity. Pseudogout is similarly a debilitating disease that significantly 77 increases morbidity and the disability adjusted life years. We report a case of pseudogout in its advanced stage, 78 causing total joint destruction of the knees and shoulders, which manifested and presented as a windswept 79 deformity.


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Programming, software development; designing computer programs; implementation of the computer code and supporting algorithms; testing of existing code components.

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Oversight and leadership responsibility for the research activity planning and execution, including mentorship external to the core team.

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• Severely destroyed knee joints can be caused by pseudogout.

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• Policies in place are still not covering the extremely poor population in Malaysia.

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• Transitioning countries to high-income status should reform their policies to ensure adequate health 29 coverage.

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• Companies making implants have a big role in deciding the cost of implants.

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Twenty percent of the population globally is affected by musculoskeletal conditions. These conditions 76 significantly impair mobility and dexterity. Pseudogout is similarly a debilitating disease that significantly 77 increases morbidity and the disability adjusted life years. We report a case of pseudogout in its advanced stage,

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causing total joint destruction of the knees and shoulders, which manifested and presented as a windswept 79 deformity.

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The Case:

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Our patient is a 69 year old man who complained of bilateral knee pain, shoulder pain during active flexion and 82 an obvious knee deformity. His familial history was not significant, and there was no history of injuries, infection

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One in five persons globally is affected by musculoskeletal conditions. 1 These conditions significantly impair 98 mobility and dexterity, causing early retirement and reducing the ability to participate in social activities.

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A 69 year old Chinese ethnic man with underlying hypertension, presented with bilateral knee pain and 114 windswept deformity, associated with right shoulder pain [ Figure 1]. He had no history of fever, numbness, leg 115 weakness, trauma or congenital anomaly.

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The knee pain started 3 years prior to this admission and his windswept deformity progressively worsened over 118 the past 1 year. The bilateral knee pain was sharp in nature, did not radiate and was exacerbated with walking 119 and weightbearing. He scored his pain at 5/10. He was able to ambulate with a walking stick. His shoulder pain 120 progressed over 8 years, and was exacerbated with movement. He was primarily concerned with the prolonged 121 nature of the pain. He was a construction worker before the deformity severely deformed his joints.

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His full blood count, renal profile, electrolytes, liver function, coagulation profile, fasting lipid profile, cortisol and 139 thyroid function tests were within normal ranges.

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The radiographs of his shoulders and knees are described [ Figures 3 and 4].

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This patient was initially planned for bilateral total knee replacement as the definitive treatment, but the patient 145 decided to opt out as this is an expensive procedure. Not only was he within the low socioeconomic group, but 146 the social welfare department was unable to fund 2 knee implants. Arthrocentesis was done over both of his

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The patient was followed up in the rheumatology clinic. Physical examination had similar findings from his initial 155 presentation such as the windswept deformity, joint crepitations and laxed joints. However, his pain was 156 significantly reduced. He has no further complaints and was happy with his current medical management plan.

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He was discharged with the same prescriptions of Prednisolone and Colchicine. However, he expressed his

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Left shoulder subluxed, dislocated with a presence of subchondral cyst and subchondral sclerosis.

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Right shoulder shows subchondral sclerosis and subchondral cysts.

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Bilateral knee Xray shows a completely destroyed knee joint with absent anatomical landmarks of the knee 288 joint.

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Black stardestroyed tibia plateau and reduce joint space.