Pseudogout

Pseudogout (SOO-doe-gout) is a type of arthritis that causes sudden and painful swelling in one or more of the joints. Episodes can last for days or weeks.

The medical term for pseudogout is calcium pyrophosphate deposition disease, often shortened to CPPD. But the condition commonly is called pseudogout because its symptoms are similar to those of gout. In both conditions, crystals deposit in the joints, but the types of crystals differ. Pseudogout is caused by calcium crystals while uric acid crystals cause gout.

It isn't clear why crystals form in joints and cause pseudogout, but the risk increases with age. Treatment options are available to help relieve pain and lessen inflammation.

Pseudogout typically affects the knees. Less often, it affects the wrists and ankles. It also may affect large joints, such as the hips. And pseudogout can affect small joints, such as in the fingers and toes. When a pseudogout attack occurs, the affected joints typically are:

• Swollen.
• Warm.
• Very painful.
• Difficult to move or to put weight on.

When to see a doctor

Seek medical care if you have sudden, intense joint pain and swelling.

Pseudogout has been linked to calcium pyrophosphate dihydrate crystals forming in the joints. These crystals become more common as people age, appearing on X-rays in nearly half of those over 85. The medical term for this is chondrocalcinosis. But most people who have these crystal deposits never develop symptoms of pseudogout. It's not clear why some people develop symptoms while others don't.

Factors that can increase the risk of pseudogout include:

• Age. The likelihood of pseudogout rises with age.
• Joint injury or surgery. Trauma to a joint, such as a serious injury or surgery, increases the risk of pseudogout in that joint.
• Family history. Some families have a higher risk of developing pseudogout, which suggests that genetics may play a role. This inherited tendency also may cause the condition to appear at a younger age. And a genetic condition called hemochromatosis causes the body to store too much iron, which can increase the risk of developing pseudogout.
• Mineral imbalances. The risk of pseudogout is higher for people who have too much iron in their blood, called hemochromatosis, or too little magnesium, called hypomagnesemia.
• Other medical conditions. Pseudogout also has been linked to an underactive thyroid gland or an overactive parathyroid gland.

The crystal deposits associated with pseudogout can damage joints, causing symptoms similar to those of osteoarthritis or rheumatoid arthritis.

Pseudogout symptoms are similar to those of gout and other types of arthritis, so lab and imaging tests typically are necessary to confirm a diagnosis.

Tests

Blood tests assess the function of your thyroid and parathyroid glands. And they can find mineral imbalances linked to pseudogout.

To test the fluid in your affected joint for the presence of crystals, your healthcare professional may withdraw a sample of the fluid with a needle. This procedure is called joint aspiration. It's also known as arthrocentesis.

X-rays can show joint damage and crystal deposits in the joint's cartilage.

There's no cure for pseudogout, but a combination of treatments can help relieve pain and improve the joint's function.

Medications

Pseudogout is treated with medicines that lessen pain and swelling during flare-ups and help prevent future episodes. If pain medicines you buy without a prescription don't lessen your pain, your healthcare professional may prescribe one or more of these medicines:

• Prescription-strength nonsteroidal anti-inflammatory drugs, also called NSAIDs. Prescription-strength NSAIDs include naproxen (Aleve, Naprosyn, others) and indomethacin (Indocin, Indocin SR, others). NSAIDs can cause stomach bleeding and lessen kidney function, especially in older adults.
• Colchicine. During a flare-up, colchicine (Colcrys, others) may help reduce pain and inflammation. And if you have frequent episodes of pseudogout, your healthcare professional may prescribe a low daily dose of colchicine to prevent future attacks.
• Corticosteroids. If you can't take NSAIDs or colchicine, your healthcare professional may suggest taking corticosteroid pills, such as prednisone, to reduce inflammation and end the attack. Long-term use of corticosteroids can weaken bones and cause cataracts, diabetes and weight gain. And long-term use may cause a number of other side effects. Use corticosteroids only as your healthcare professional tells you.

Joint drainage

Removing fluid from a swollen joint may help ease pain and pressure. During this procedure, a healthcare professional uses a needle to withdraw a sample of fluid from the joint. This is called joint aspiration or arthrocentesis. This not only relieves discomfort but also removes some of the crystals that may cause inflammation. After the fluid is removed, a numbing medicine and a corticosteroid may be injected into the joint to relieve pain and lessen inflammation.

Home treatments may help lessen pain and inflammation during pseudogout flare-ups. Examples include:

• NSAIDs you can buy without a prescription. NSAIDs you can buy without a prescription, such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), often are helpful.
• Rest the joint. Try not to use the affected joint for a couple of days. This can lessen inflammation and help healing.
• Apply ice. Using cold packs on the inflamed joint may provide relief by numbing the area and lessening swelling. Apply an ice pack wrapped in a thin cloth to the joint for 15 to 20 minutes several times a day.

You'll likely first see your primary healthcare professional. After an initial exam, your healthcare professional may refer you to a rheumatologist. A rheumatologist is a doctor who specializes in the diagnosis and treatment of arthritis and other inflammatory joint conditions.

Here's some information to help you get ready for your appointment.

What you can do

Before your appointment, you may want to write a list of answers to the following questions:

• When did your symptoms begin?
• Have you had these symptoms before?
• Does any activity or position make your joint feel better or worse?
• Have you ever injured this joint?
• Do you have any other medical conditions?
• Has anyone in your family had joint conditions?
• What medicines or supplements do you take regularly?

What to expect from your doctor

A healthcare professional who sees you for symptoms common to pseudogout may ask several questions. You may be asked:

• What are your symptoms?
• What part or parts of your body are affected?
• Do your symptoms come and go?
• How long do symptoms last?
• Have your symptoms worsened over time?
• Did anything seem to trigger your symptoms, such as injury, overuse of the joint, dehydration, recent surgeries or other illnesses?
• Have you tried any treatments? Has anything helped?