Pseudogout, also called CPPD disease, occurs when calcium crystals form in joints. This formation of crystals causes joint pain and swelling, often misdiagnosed as gout or rheumatoid arthritis. It is often hard to differentiate pseudogout vs. gout. So, what is pseudogout, and what should we do about it?
Symptoms
Attacks of calcium pyrophosphate crystals can cause sudden pain and swelling of the joint. Typically, the joints affected include the knees, ankle, and wrists. But sometimes, the hips, shoulders, or elbows are affected. Usually, pain can last for days and sometimes up to 3 weeks.
Although CPPD disease can affect all ages, it usually affects those people above the age of 60.
Diagnosis of pseudogout
In general, you need to see a doctor who can determine whether you have pseudogout or gout. The history, medical history, and imaging will provide clues.
For example, a pseudogout X-ray often shows cartilage calcification, known as chondrocalcinosis. Similarly, ultrasound often shows bright calcium crystals in the middle of the articular cartilage. Other conditions, such as haemochromatosis (iron overload), can precipitate pseudogout.
However, in most cases, we make a diagnosis by a joint fluid test.
Joint fluid test is the gold standard.
We draw joint fluid from affected swollen joints and quickly send it to a laboratory to see if it contains typical rod-shaped calcium crystals.
Pseudogout vs. gout: how can we tell?
Generally, it can be challenging to differentiate between pseudogout vs gout. However, there are clues as to whether symptoms are pseudogout or gout.
First, gout typically occurs in men in their 50s and initially affects a single joint, normally the toe or ankle. Second, pseudogout typically affects older adults and can involve multiple joints, including the knees, wrists, and ankles.
Second, diets high in purines can trigger gout, whereas pseudogout is unaffected by diet.
Thirdly, gout attacks usually last for only days and rarely weeks, whereas pseudogout can last up to 3 months.
Finally, tests can give further clues. On ultrasound, uric acid crystals form on the cartilage, often called a ‘double contour’ sign. In pseudogout, we see calcium in the middle of the articular cartilage. When analyzing fluid from joints, uric acid crystals look needle-shaped, while calcium crystals are rod-shaped.
Treatment
Unfortunately, there is no cure. Moreover, diet does not affect the frequency of attacks. Generally, we recommend medications to treat and prevent symptoms.
For acute attacks, we suggest ibuprofen, colchicine or steroid tablets. In a recent study, colchicine and steroid tablets were equally effective.
In severe cases, cortisone shots can effectively control pain and swelling in affected joints. Generally, cortisone injections should be administered under ultrasound guidance to improve accuracy and efficacy.
Finally, surgery and joint replacement might be needed in cases of severe cartilage disease.
Frequently Asked Questions about Pseudogout
Can calcium supplements cause pseudogout?
Although pseudogout is associated with high calcium, calcium supplements will not trigger this condition.
Can diet changes prevent pseudogout?
Overall, there is no evidence that dietary changes prevent pseudogout. However, we suggest weight loss and a generally healthy lifestyle.
Can you get gout and pseudogout together?
Yes, gout and pseudogout can occur together. Generally, taking fluid from the knee can determine whether you have both conditions.
Final word from sportdoctorlondon
Diagnosing pseudogout can be tricky. Often, symptoms mimic other diseases, such as gout or rheumatoid arthritis. We suggest you see a doctor with expertise in diagnosing and managing this condition.
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