Pseudogout is a type of arthritis that can affect any joint in the body. Frequently, pseudogout affects the knee joint, but it can present in the wrists, elbows, hips, shoulders, toes, knuckles, and ankles as well. Typically it only affects one joint at a time.

Pseudogout is caused by the formation of calcium crystals called calcium pyrophosphate dihydrate (CPPD) in joints and the surrounding soft tissues. These crystals cause swelling, severe pain, and sometimes redness and/or heat in the joints. Because pseudogout is often confused for other forms of arthritis like gout, rheumatoid arthritis, and osteoarthritis, proper and timely diagnosis is important. Untreated pseudogout can result in severe joint degeneration, progressive inflammation, and chronic, albeit gradual, disability. This is not typical but, again, early detection and treatment are critical.

Pseudogout, also known as calcium pyrophosphate dihydrate deposition disease, received its name because it presents like pseudo, or fake, gout. Pseudogout is easily mistaken for gout so it is important to differentiate between the two conditions. Like gout, crystals form in the joints. However, in pseudogout, the crystals form from salt. In gout, the crystals form from uric acid. Also, gout is a more severe disease with greater pain and, often, a much worse prognosis.

When calcium pyrophosphate dihydrate deposits in the joint cartilage tissue, the accumulation of crystals causes both swelling and pain, sometimes damaging the joint cartilage, and ultimately causing pseudogout.

Unfortunately, the cause of crystal deposition is still unknown although it is proven that the chances of crystal deposits increase with age. Pseudogout commonly affects the elderly although the reason for the age-related rise is unknown. It can also affect young people who have other conditions.

Risk Factors
Factors that increase the risk of pseudogout include the following:

• Being 70 years of age or older

• A family history of pseudogout

• Hemochromatosis - too much iron in the blood

• Acromegaly – too much growth hormone

• Thyroid disease – increased or decreased hormone production

• Hyperparathyroidism – overactive parathyroid gland

• Wilson disease – too much copper in the body

• Ochronosis – the bluish black discoloration of certain tissues, such as the ear cartilage and the ocular tissue often indicating a metabolic issue

• Lower amounts of magnesium in the blood

• Calcium deposits in the body

• Injury, trauma, or surgery in the affected joint

• Hypercalcemia and other causes of excess calcium in the blood

• Osteoarthritis

• Diabetes

• Kidney failure

Symptoms

The symptoms of pseudogout resemble the symptoms of gout, rheumatoid arthritis, and osteoarthritis so it is important to differentiate it from these other diseases.

Pseudogout often manifests as the sudden onset of severe pain in one joint, usually the knee joint. This attack lasts from a few days to two weeks, and the period between the attacks is usually pain free. Pseudogout usually attacks one joint at a time; however multiple attacks in various joints are possible, just unusual. The affected joint becomes very sensitive to pressure and fluid may accumulate in the joint. The joints may have swelling, redness, and warmth, and may be stiff. Some people may also have fever and malaise.

Sometimes, however, CPPD crystals create less severe, but longer-lasting problems. These symptoms include stiffness, swelling, heat, and pain. The pain is not sudden; instead, it develops over a long period of time and can last many weeks or months. The pain may be worse when the joints move.

The following are the primary symptoms of pseudogout:

• Attacks of joint pain and fluid buildup in the joint, leading to joint swelling

 

• Chronic, or long term, arthritis

 

• No symptoms between attacks

Diagnosis

Diagnosis of pseudogout is determined by examining both the symptoms and medical test results. Initially, tests are performed in order to rule out gout. To confirm pseudogout, the following tests are performed:

• Fluid from the affected joint is aspirated by inserting a needle into the joint, and then the fluid is sent to lab to check for the presence of calcium pyrophosphate crystals.

 

• An X-ray to check for both the presence of crystal deposits in the joint and to assess the severity of joint damage.

 

• A blood test may be performed in order to rule out other possible conditions like gout, rheumatoid arthritis, and osteoarthritis.

The primary goal of treatment for pseudogout is to decrease inflammation and to relieve the patient from pain. Unfortunately, there is no treatment that can prevent the formation and resulting pain of the CPPD crystals.

If pain is severe, a fluid aspiration, when needle is inserted into the joint and the fluid from the joint is aspirated out, may be necessary to relieve the pressure within the joint. A corticosteroid drug to reduce swelling and temporary anesthesia to numb the joint are injected to treat severely inflamed joints.

To reduce inflammation, NSAIDs like ibuprofen, naproxen, and indomethacin are prescribed to ease painful attacks. NSAIDs can cause serious complications especially in older adults; therefore, if the patient has a history of poor kidney function, stomach ulcers, or already takes blood thinners, an alternate treatment plan may need to be established. Colchicine, effective for reducing inflammation, is often prescribed to patients who cannot take NSAIDs.

In the case of multiple joint inflammations, a course of oral steroids may be prescribed. Resting the affected joint by minimizing activities in addition to a medication routine can help improve the condition.

In instances where joint degeneration has already occurred, surgery to repair or replace the damaged joint is often recommended. Fortunately, as most of the joint pain diseases are first treated with steroids and anti-inflammatory drugs, a mistake in early diagnosis does not result in the wrong treatment options.

Prevention

There are no sure-proof preventive strategies in order to avoid the occurrence of pseudogout. However, treating the other diseases that increase the risk of pseudogout may help the patient to prevent pseudogout.

Elderly persons, especially those with a family history of the disease, should take every necessary step to protect joints such as taking an anti-inflammatory medication to prevent the symptoms, avoid putting unnecessary stress or pressure on joints, and eating healthfully to remain height/weight proportionate. Because pseudogout is associated with various other medical conditions, one proactive measure for patients with a high risk of pseudogout is advanced screenings.

Outlook

Pseudogout is a very common condition that is often misdiagnosed or misunderstood. When a patient complains about pain and swelling in the joint, doctors do not always think of pseudogout. Once pseudogout is confirmed, in the case of pseudogout attacks, the following are the recommended steps:

• Rest and elevate the affected area

 

• Apply heat to the affected area

 

• Take few over-the-counter medicines to relieve pain and swelling

With cooperation, care and effort, pseudogout can be managed and treated.