Pseudogout

Definition

Pseudogout (SOO-doe-gout) is a form of arthritis characterized by sudden, painful swelling in one or more of your joints. These episodes can last for days or weeks. Pseudogout typically occurs in older adults and most commonly affects the knee.

Also called calcium pyrophosphate deposition (CPPD) disease, pseudogout gets its common name from its similarity to gout. Pseudogout and gout both occur when crystals — one type in gout, another type in pseudogout — form in the fluid that lubricates joint linings, causing pain and inflammation. Besides affecting the knees, pseudogout may develop in the ankles, wrists and elbows, while gout tends to affect the big toe.

It isn't clear why crystals form in your joints and cause pseudogout. Although you can't get rid of the crystals, there are treatments to help you relieve the pain and reduce the inflammation of pseudogout.

Symptoms

Pseudogout most commonly affects the knees. Other joints that may be involved include the ankles, hands, wrists, elbows and shoulders.

If you have pseudogout, you might experience:

• Swelling of the affected joint or joints
• Warmth
• Severe joint pain

Some people experience recurring pseudogout attacks.

When to see a doctor
Make an appointment with your doctor if you experience sudden, intense joint pain and swelling.

Causes

Pseudogout occurs when calcium pyrophosphate dihydrate (CPPD) crystals migrate from the cartilage in and around your joints to the lining of your joint (synovium), causing inflammation.

Although it isn't clear why CPPD crystals form, they appear to be associated with the aging process. However, many older people have CPPD crystals in their joints, but most don't experience signs and symptoms of pseudogout. Symptoms may be more likely to develop when CPPD crystals form and you have:

• A family history of pseudogout
• Joint trauma, such as an injury to or surgery on the affected joint
• Certain medical conditions, such as hyperparathyroidism and amyloidosis

Pseudogout is actually just one feature of calcium pyrophosphate deposition disease. This condition can cause calcification of joint cartilage (chondrocalcinosis) and joint degeneration as well as pseudogout, though you won't necessarily experience all of these manifestations.

Risk factors

Several factors are known to increase your risk of developing CPPD crystals that can increase your risk of pseudogout, including:

• Older age. Older adults are more likely to experience pseudogout because CPPD crystals are more commonly found in the joints of older people.
• Joint trauma. Trauma to a joint, such as a serious injury or a joint replacement surgery, increases your risk of developing CPPD crystals in your joints.
• Genetic disorder. Families can pass predisposition to CPPD crystals through their genes. People with familial chondrocalcinosis, the name for the inherited condition, tend to develop signs and symptoms of CPPD disease at younger ages.
• Excess iron stored in your body (hemochromatosis). This inherited disorder causes your body to store excess iron in your organs and the tissues around your joints. It's believed the iron in your joints leads to the development of CPPD crystals.

Complications

The CPPD crystal deposits that cause pseudogout can also lead to joint damage. Bones in the affected joint or joints can develop cysts, bone spurs and cartilage loss. Further damage can lead to fractures.

Joint damage associated with CPPD crystals sometimes mimics the signs and symptoms of osteoarthritis or rheumatoid arthritis.

Preparing for your appointment

Make an appointment with your doctor if you have symptoms that are common to pseudogout. After an initial examination, your doctor may refer you to a specialist in the diagnosis and treatment of arthritis and other inflammatory joint conditions (rheumatologist).

Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Write down your symptoms, including when they started and how often they occur.
• Note any possible sources of trauma to your affected joint or joints, including accidents, injuries or surgery.
• Make a list of your key medical information, including any other conditions for which you're being treated and the names of any medications, vitamins or supplements you're taking.
• Take a family member or friend along, if possible. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.

Questions to ask the doctor at the initial appointment include:

• What are the possible causes of my symptoms or condition?
• What tests do you recommend?
• If these tests don't pinpoint the cause of my symptoms, what additional tests might I need?
• Are there any treatments or lifestyle changes that might help my symptoms now?
• Do I need to follow any restrictions while we're seeking a diagnosis?
• Should I see a specialist?

Questions to ask if you are referred to a rheumatologist include:

• What is my diagnosis?
• What treatments are most likely to help me feel better?
• What are the possible side effects of the drugs you're prescribing?
• If these drugs don't work or cause serious side effects, what will we try next?
• How soon after beginning treatment should my symptoms start to improve?
• Will I need to take medications long term?
• I have these other health conditions. How can I best manage them together?
• Do you recommend any changes to my diet or exercise routines?
• What handouts or Web sites do you recommend for learning more about pseudogout?

If any additional questions occur to you during your medical appointments, don't hesitate to ask.

What to expect from your doctor
A doctor who sees you for symptoms common to pseudogout may ask a number of questions, such as:

• What are your symptoms?
• When did you first notice these symptoms?
• What part or parts of your body are affected?
• Do your symptoms come and go? How often?
• When symptoms occur, how long do they last?
• Have your symptoms gotten worse over time?
• Does anything in particular seem to trigger your symptoms, such as certain foods or stress?
• Have you tried any treatments so far? Has anything helped?
• Are you being treated for any other medical conditions?
• What medications are you currently taking, including over-the-counter and prescription drugs as well as vitamins and supplements?
• Have any of your first-degree relatives — such as a parent or sibling — been diagnosed with an arthritic condition?

Tests and diagnosis

Pseudogout signs and symptoms mimic those of gout, so your doctor may first suspect gout. Tests can rule out gout as a cause of your signs and symptoms.

To determine whether pseudogout is causing your pain, your doctor may have you undergo these tests:

• Analysis of joint fluid. Your doctor inserts a needle into your joint to extract a small sample of joint fluid for analysis with a microscope. He or she looks for CPPD crystals in the fluid.
• X-rays. X-rays of your knee can reveal other conditions caused by CPPD crystals, such as crystal deposits in the joint cartilage (chondrocalcinosis) and joint damage.

Your doctor may want to rule out other causes of joint pain and inflammation, such as infection, gout, injury and rheumatoid arthritis.

Treatments and drugs

Pseudogout treatment aims to reduce your pain and swelling. No treatments can rid your joints of the CPPD crystals that lead to pseudogout.

Treatments to relieve the pain and inflammation of pseudogout include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others), naproxen (Aleve) and indomethacin (Indocin). NSAIDs can cause stomach bleeding and decreased kidney function, especially in older adults, so discuss these risks with your doctor.
• Colchicine. This medication reduces inflammation in people with gout, but it may also be useful in people with pseudogout who can't take NSAIDs. Side effects include stomach pain, nausea, diarrhea and vomiting. Rare side effects include bone marrow suppression and intestinal bleeding. To minimize these risks, your doctor will prescribe the lowest dose possible to manage flare-ups — typically not more than two tablets daily.
• Joint aspiration and injection. To relieve pain and pressure in an affected joint, your doctor inserts a needle and removes some of the joint fluid. Then he or she injects a corticosteroid to decrease inflammation and an anesthetic to temporarily numb your joint.
• Rest. Keeping your affected joints still in addition to taking medications may relieve pain and swelling. Your doctor may recommend limiting your activity for a short time.

If your pseudogout is caused by joint trauma or a disease, such as hemochromatosis, your doctor also will treat the underlying condition.

Lifestyle and home remedies

Home treatment measures that commonly help with joint pain may ease the symptoms of pseudogout. During flare-ups, you may find relief by:

• Resting and elevating the affected joint
• Applying heat to the affected area
• Taking over-the-counter NSAIDs, such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve)

Regular exercise, especially activities that strengthen the muscles around your affected joints, may help you keep those joints mobile. Ask your doctor to recommend a safe and effective exercise program for you.

Prevention

If you experience repeated pseudogout attacks, you and your doctor may consider medication that may prevent attacks from occurring. Low doses of colchicine, a drug commonly used to prevent and treat gout, may reduce the number of pseudogout attacks you experience. Side effects, such as stomach problems, can occur in people taking colchicine. Discuss the benefits and risks of colchicine with your doctor.