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

pseudogout

In general, you need to see a doctor who can determine whether you have pseudogout or gout. Clues will be in the history, your medical history, and your imaging.

For example. Pseudogout X-ray often shows calcification of the cartilage, a term known as chondrocalcinosis. Similarly, ultrasound will often show bright calcium crystals in the middle of the articular cartilage.

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. This fluid is sent quickly to a laboratory to see if the fluid 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 usually occurs in younger men in their 50s and initially affects one joint at a time – usually the toe or ankle. Second, pseudogout usually affects older people and can affect more than one joint of 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 and are often referred to as 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 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, we should do cortisone shots under ultrasound to improve accuracy and effect.

Finally, surgery and joint replacement might be needed in cases of sere cartilage disease.

Frequently asked questions 

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 can mimic other diseases such as gout or rheumatoid arthritis. Generally, we suggest you see a doctor with expertise in diagnosing and managing this condition.

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Dr Masci is a specialist sports doctor in London. 

He specialises in muscle, tendon and joint injuries.