Reversal of azotemia in lupus nephritis by megadose corticosteroid therapy.

To the Editor: Notable for mimicry of other arthritides ( I ) , pseudogout (PsG) may resemble rheumatoid arthritis (RA) in the hands and wrists, sharing features such as narrowed radiocarpal and metacarpophalangeal joints (2), synovial swelling at the wrists (3-5), interosseous atrophy (6 ) , and ulnar deviation (6 ) . Tenosynovial swelling at the wrist, however, was not observed in one reported series of 18 patients with PsG and synovitis of the wrist (4). A patient has been reported with PsG and a “small ganglion” on the dorsum of the wrist ( I ) . Except for popliteal (Baker’s) synovial cysts (7) , cystic lesions have not been mentioned in clinical descriptions of PsG. This is a report of protuberant, dorsal tenosynovial cystic swelling at the wrists i n two men with PsG (Table I ) . I n both patients, calcium pyrophosphate dihydrate (CPPD) crystals were present in repeated aspirates, whether from the knees or dorsal wrist tenosynov ium (Table 2 ) . Marked by chronic pain in the wrists and knees as well as dorsal tenosynovial swelling at both wrists, the disease in patient A had been diagnosed as RA and treated with corticosteroids for 20 years. When encountered currently, both patients had type I noninflammatory synovial fluids, good mucin clots, negative