Pseudogout

What is pseudogout?

Pseudogout is a type of arthritis. It is sometimes called calcium pyrophosphate dihydrate crystal deposition disease. This condition causes painful swelling in one or more of your joints. It can lead to joint damage if left untreated.

Pseudogout is similar to a condition called gout. However, gout typically affects the joint in the big toe.

Pseudogout usually affects larger joints, such as your knees. Also, pseudogout is caused by the build up of calcium pyrophosphate dihydrate crystals in your joints, while gout is caused by a build up of uric acid.

Pseudogout is a clinical term reflecting synovitis related to CPPD deposition. This refers to the radiologic diagnosis of calcium pyrophosphate arthropathy.

On imaging, the findings appear similar to those of OA but characteristically affect non-weight-bearing joints (wrist, elbow, knee [especially patellofemoral], and shoulder [glenohumeral]), sometimes in association with chondrocalcinosis.

In the hand, the MCP joints may be affected, resulting in presence of hooked osteophytes.

In the wrist, this disorder can lead to scapholunate dissociation and proximal migration of the capitate bone between the scaphoid and lunate bones, which is called scapholunate advanced collapse (SLAC) or a SLAC wrist.

What are the symptoms of pseudogout?

Pseudogout causes pain, swelling, stiffness and warmth in large joints. It most commonly affects the knees, but it can also affect the elbows, ankles, wrists, shoulders or hands. Pseudogout attacks can be sudden, and the symptoms may last for days or weeks.

Some people who have pseudogout don’t have any symptoms between attacks. In other cases, pseudogout can cause constant pain and discomfort. This chronic (long-lasting) pseudogout may seem similar to osteoarthritis or rheumatoid arthritis.

What causes pseudogout?

Pseudogout develops when deposits of calcium pyrophosphate dihydrate crystals build up in the cartilage (tissue that protects your bones) of a joint. The cause of this build up is often unknown.

The crystals are then released into the fluid in your joint. This causes joint pain and swelling.

Who is at risk of pseudogout?

The following factors increase a person’s risk of pseudogout:

• Older than 70 years of age
• A history of pseudogout in your family
• Underactive thyroid (called hypothyroidism)
• Too much iron in your blood (called hemochromatosis)
• Low magnesium levels
• Overactive parathyroid (called hyperparathyroidism)
• Too much calcium in your blood (called hypercalcemia)
• Osteoarthritis

How is pseudogout diagnosed?

Your doctor may draw fluid from your joint to check for the crystals that cause pseudogout. X-rays can show any buildup of crystals or signs of joint damage. Your doctor will probably want to rule out other possible causes of your symptoms, such as gout or rheumatoid arthritis.

Prevention

How can I prevent pseudogout attacks?

Treatment can relieve the symptoms of pseudogout and slow or prevent damage to your joints. Unfortunately, no treatment can get rid of the crystal deposits that cause pseudogout. Taking low doses of colchicine may help to reduce your risk of future attacks. Your doctor can talk to you about the risks and benefits of taking this medicine.

If another condition, such as a thyroid problem, caused your pseudogout, treating that condition may help to make the symptoms of pseudogout less severe.

How is pseudogout treated?

Your doctor may suggest using a nonsteroidal anti-inflammatory drug (called an NSAID), such as ibuprofen (two brand names: Advil, Motrin) or naproxen (one brand name: Aleve), to treat pain and swelling. For severe attacks, your doctor may prescribe a prescription-strength NSAID such as indomethacin. For people who can’t take NSAIDs, a prescription medicine called colchicine may be used to reduce pain and swelling.

People who have kidney problems or a history of stomach ulcers and people who are taking blood thinners cannot take anti-inflammatory medicines. In these cases, the doctor may inject the affected joint with a shot of cortisone. Cortisone is a type of steroid that reduces pain and swelling.

Your doctor may drain fluid from your joint to relieve your symptoms. This method is called joint aspiration. It is often used along with cortisone shots.

Your doctor may recommend that you limit physical activity while you are having symptoms of a pseudogout attack.

If your joints become badly damaged by pseudogout, surgery may be necessary to repair or replace them.

Questions to ask your Doctor

• What treatment is best for me?
• When can I expect my symptoms to improve?
• Am I at risk for long-term joint damage?
• Am I at risk for other types of arthritis?
• What lifestyle changes can I make at home to relieve my pain and slow joint damage?