Pseudogout

About

Pseudogout

What is pseudogout?

Pseudogout, also called calcium pyrophosphate deposition disease or CPPD,  is another type of inflammatory arthritis. It produces sudden episodes of intense pain and swelling to one or more joints which may last days to weeks at a time. Pseudogout is similar to gout as it involves crystals settling into the affected joint and surrounding tissues. The difference between the two is the type of crystal in pseudogout is calcium pyrophosphate dihydrate crystals and not the traditional urate crystals found in gout.

Who can develop pseudogout?

Pseudogout appears to be more prominent in older populations. 50% of those with pseudogout are over the age of 85. This is due to the calcium pyrophosphate dihydrate crystals increasing with age.

Where does pseudogout occur?

The knees are usually the joints that are affected by a pseudogout attack. However, there are cases where other areas are affected by this inflammatory condition. They include:

  • Shoulders
  • Elbows
  • Hands
  • Ankles
  • Wrists

Causes

What is the cause of pseudogout?

The exact cause of how and why someone develops pseudogout is still not well understood. However, it is believed to develop similarly to gout, but differs as it involves the accumulation of calcium pyrophosphate dihydrate crystals in the body. 

What risk factors are there for developing pseudogout?

Here are some risk factors associated with the development of pseudogout:

  • Trauma- traumatic events have been linked to the occurrence of pseudogout. Examples include fractures or surgical procedures.
  • Genetics- Sometimes there may be a hereditary predisposition for the development of pseudogout. This inflammatory condition is usually seen in younger populations when genetics are linked.
  • Age- the chance of developing pseudogout increases with age.
  • Mineral imbalances- Increased calcium or iron or too little magnesium found in the blood have been associated with developing pseudogout.
  • Medical conditions- An overactive parathyroid or an underactive thyroid have been known to be linked to the development of pseudogout.

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Symptoms

What are the symptoms of pseudogout?

In many incidents, there may not be any symptoms associated with pseudogout. Although there may be an accumulation of calcium pyrophosphate dihydrate crystals, this does not result in symptoms in some individuals. If symptoms do occur, the most common symptoms include:

  • Joint swelling
  • Severe pain
  • Warmth
  • Joint stiffness
  • Fever
  • Fatigue  

What other medical conditions can mimic pseudogout?

Because the symptoms associated with pseudogout may be found in other inflammatory conditions, many other conditions may be misdiagnosed instead of pseudogout. These conditions include:

  • Gout
  • Osteoarthritis
  • Rheumatoid arthritis

Diagnosis

How is pseudogout diagnosed?

Diagnosing pseudogout can be challenging. Trained healthcare professionals at TeleMed2U may be able to help confirm your diagnosis if pseudogout is suspected. Usually, a medical history and physical exam will be performed. Because pseudogout mimics other arthritic conditions, diagnostic tests are important to help with confirmation as examination alone may not be sufficient.

Are there any diagnostic tests that can be performed to confirm pseudogout?

Tests used to help with the diagnosis of pseudogout includes:

  • Joint analysis- this test involves removing fluid from the inflamed joint to determine if there are any crystals in the joint and the type. This is the most definitive test that can be used.
  • Blood test-  used to check the thyroid, parathyroid, and the minerals in the body to see if there are any deficiencies.
  • X Rays- used to examine the joint for damage or crystal deposits from arthritis.

Treatment

What are treatment options for pseudogout?

As with many arthritic conditions, there is no cure for pseudogout. Treatment focuses on managing the symptoms to alleviate pain and improve the function of the joint involved. Currently, there are no treatments available to dissolve the crystals associated with pseudogout.

The medications used for the treatment of pseudogout is similar to gout: 

  • Colchicine (Colcrys)- an anti-inflammatory specifically for gout but has been shown to be equally effective in pseudogout when over-the-counter medications fail. If frequent flare-ups of pseudogout occur, sometimes your healthcare provider may decide to have you take this medication daily for prevention.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)- Over-the-counter formulations are usually recommended first. But, if these options are not successful in combating the symptoms of pseudogout, prescription preparations can be used as a stronger alternative. 
  • Corticosteroids- another option if colchicine or NSAIDs have not been successful in managing symptoms of pseudogout. This medication has both oral and injectable options.
  • Disease-modifying antirheumatic drugs (DMARDs)- reserved for severe cases of pseudogout flare-ups. Examples include:
  1. hydroxychloroquine (Plaquenil)
  2. methotrexate (Rheumatrex, Trexall, Otrexup, Rasuvo)
  3. azathioprine (Imuran)

Other treatments include:

  • Joint aspiration- this treatment involves removing the inflamed fluid from the joint with a needle. Many times a corticosteroid and numbing agent will also be injected into the joint after the fluid has been removed to provide temporary relief of symptoms. 
  • Joint surgery-  helpful when conservative treatments have failed. This treatment involves surgical removal of the damaged joint to improve mobility and function to the damaged area. An implant may sometimes be used, or fusion of the joint may be performed.

Research shows maintaining a healthy diet and weight may also be effective in managing pseudogout symptoms. Pseudogout can be tricky to treat as it can sometimes be overlooked as a possible cause of someone’s symptoms. Having trained specialists like ours at TeleMed2U may sometimes be the first step in receiving a definitive diagnosis. There are several treatment options available to help manage your symptoms, and our healthcare team is always available to help.

Information

Medically reviewed by:

Dr Roy Kedem, MD

Dr Zenon Andreou studied medicine at University College London, graduating in 2006. His postgraduate training was in hospitals in and around London and he trained for four years in Otolaryngology before completing his training in General practice

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