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Wrists that's inflamed.

What is Pseudogout? Understanding Causes, Symptoms, and Treatment

Pseudogout, or calcium pyrophosphate deposition disease (CPPD), is a painful form of arthritis caused by the buildup of calcium pyrophosphate crystals in the joints. This condition commonly affects larger joints like the knees, wrists, and ankles, leading to intense joint pain, swelling, and stiffness.


Understanding pseudogout is essential for managing symptoms, preventing joint damage, and improving joint function through effective treatment options. Recognizing the causes, symptoms, and available treatments is also important for managing the condition and reducing pain and inflammation.

Illustration of calcium pyrophosphate crystals.

What is Pseudogout?

Pseudogout, or calcium pyrophosphate deposition disease (CPPD), occurs when calcium pyrophosphate crystals form in the joint cartilage, leading to joint inflammation, intense pain, and swelling.


This condition is often mistaken for gout because both involve crystal deposits and painful joint attacks. However, the types of crystals differ, as pseudogout involves calcium pyrophosphate crystals, while gout is caused by uric acid crystals.


Feature

Pseudogout

Gout

Cause

Calcium pyrophosphate crystals

Uric acid crystals

Commonly Affects

Knees, wrists, ankles, hips

Toes, ankles, knees

Onset

Gradual

Sudden

Diagnosis

Joint aspiration shows calcium pyrophosphate

Joint aspiration shows uric acid

Treatment

Focus on reducing inflammation

Lowering uric acid level

Illustration of uric acid crystals.

What Causes Pseudogout?

Pseudogout is caused by the deposition of calcium pyrophosphate crystals in the joints. This condition, also called calcium pyrophosphate deposition (CPPD), triggers joint pain and inflammation when the crystals irritate the surrounding tissue.


Although the exact reason crystals form remains unclear, it is linked to changes in joint cartilage and biochemical imbalances. Over time, chronic inflammation from CPPD can lead to joint damage and decreased joint function.

Risk Factors

Several factors increase the likelihood of developing pseudogout:


  • Age and gender: The risk rises with age, particularly in people over 60, affecting both men and women.

  • Genetic factors: A family history of pseudogout or related conditions can increase the risk.

  • Other medical conditions: Disorders like osteoarthritis, hyperparathyroidism, and kidney function issues are associated with pseudogout.

Illustration of crystals forming in joint cartilage.

What Are the Symptoms of Pseudogout?

Pseudogout symptoms can vary but often involve joint pain, swelling, and other signs of inflammation. These symptoms typically appear in acute attacks and may affect joint function over time.

Joint Pain and Swelling

Pseudogout commonly affects larger joints, such as the knees, wrists, and ankles. These affected joints often experience intense pain and painful swelling, making movement difficult. Swelling is accompanied by stiffness and tenderness, limiting joint function and causing discomfort during daily activities.


If untreated, inflammation from calcium pyrophosphate crystals can become chronic and worsen over time. Repeated attacks may contribute to joint damage over time, emphasizing the need for prompt treatment.

Redness and Warmth

Inflammation from pseudogout can cause the affected joint to become red, warm, and tender to the touch. These symptoms are part of the body’s response to crystal deposits in the joint. The redness and warmth are particularly noticeable during acute attacks and can help differentiate pseudogout from other forms of arthritis.

Acute Attacks

Pseudogout attacks often occur suddenly and can last for days or weeks. These severe attacks are intense joint pain, swelling, and stiffness. The frequency of pseudogout attacks varies, with some individuals experiencing repeated episodes and others developing chronic joint inflammation. Without treatment, future attacks can lead to joint damage and reduced mobility.

Wrists that

How is Pseudogout Diagnosed?

Doctors diagnose pseudogout by evaluating symptoms, examining affected joints, and performing specific tests. A combination of medical history, imaging, and joint fluid analysis is used to confirm the condition.

Medical History and Physical Examination

During a doctor’s visit, the physician will ask about joint pain, swelling, and previous episodes of joint inflammation. A physical examination will focus on the affected joint to identify signs of redness, warmth, and painful swelling.


The doctor may also check for stiffness and reduced joint function. Detailing family history and other medical conditions, such as osteoarthritis or rheumatoid arthritis, can help with diagnosis.

Imaging Tests

Imaging tests such as X-rays, ultrasounds, or CT scans help detect calcium pyrophosphate crystal deposits and joint damage. X-rays often reveal calcification in the joint cartilage, while ultrasounds can highlight inflammation around the affected joints. These imaging tools are essential for differentiating pseudogout from other forms of arthritis, including gout.

Joint Fluid Analysis

Joint fluid analysis is the most definitive way to diagnose pseudogout. The procedure, called joint aspiration, involves removing a small amount of joint fluid using a needle.


The fluid is then analyzed under a microscope to confirm the presence of calcium pyrophosphate crystals, ruling out other causes, such as uric acid crystals seen in gout.

Visualization of joint aspiration.

What Are the Treatment Options for Pseudogout?

Treatment for pseudogout focuses on relieving pain, reducing inflammation, and improving joint function. Medications, procedures, and lifestyle changes can help manage symptoms and prevent future attacks.

Medications

Medications are often the first line of treatment for pseudogout:


  • Anti-inflammatory drugs (NSAIDs): Help reduce pain and inflammation during attacks in many cases.

  • Colchicine: Used to relieve pain and prevent future attacks.

  • Corticosteroids: Injected or taken orally to quickly decrease inflammation in severe cases.

Joint Aspiration

Joint aspiration is a common procedure for treating pseudogout. During the process, a doctor removes excess joint fluid to relieve pain and reduce swelling. Numbing medication may be used to minimize discomfort. Removing fluid can alleviate symptoms and reduce pressure on the joint.

Lifestyle and Home Remedies

Using ice packs and resting the affected joint can help relieve pain and reduce swelling during a pseudogout attack. Resting the joint prevents additional strain while inflammation subsides.


Physical therapy and gentle exercises may help improve joint function and maintain mobility. Regular movement reduces the risk of chronic joint inflammation and damage.

Ice packs on affected knee.

How Can Pseudogout Be Managed and Prevented?

Long-term management of pseudogout involves reducing risk factors, maintaining a healthy lifestyle, and preventing severe attacks. Regular care and preventive steps can improve joint health and reduce the frequency of pseudogout attacks.

Regular Medical Check-Ups

Frequent doctor visits are essential for managing pseudogout. Monitoring calcium levels, kidney function, and other medical conditions like hyperparathyroidism may help reduce the risk of crystal formation. Treating these underlying issues minimizes the risk of pseudogout symptoms worsening over time.

Diet and Hydration

Including anti-inflammatory foods like fruits, vegetables, and omega-3-rich fish in your diet may support joint health. Avoiding foods high in purines, which can contribute to joint inflammation, may also be beneficial.


Staying hydrated is crucial for joint health. Drinking enough water helps maintain joint fluid balance and supports overall joint health.

Managing Risk Factors

Reducing the risk of pseudogout involves several proactive steps:


  • Maintain a healthy weight to reduce stress on joints.

  • Stay active with low-impact exercises to improve joint strength and flexibility.

  • Address other medical conditions like rheumatoid arthritis or osteoarthritis.

  • Avoid excessive alcohol and ensure proper hydration daily.

  • Follow your doctor’s advice on medications or supplements that may prevent pseudogout attacks.

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Managing Pseudogout for Better Joint Health

Pseudogout, caused by calcium pyrophosphate crystal deposits in the joints, can lead to painful swelling, joint damage, and chronic inflammation. Early diagnosis through medical history, imaging, and joint fluid analysis is critical for effective treatment.


Managing pseudogout with medications, procedures like joint aspiration, and lifestyle changes can relieve pain, reduce inflammation, and prevent future attacks. Consulting a healthcare provider ensures personalized care and helps address underlying risk factors, improving joint health over time.

Frequently Asked Questions

How does pseudogout differ from gout?

Pseudogout is caused by calcium pyrophosphate crystals, while gout involves uric acid crystals; both have similar symptoms but require different treatments.

Can pseudogout be cured?

Pseudogout cannot be cured, but its symptoms can be managed with medications, lifestyle changes, and medical care to reduce inflammation and prevent attacks.

What triggers a pseudogout attack?

Dehydration, joint injuries, or other medical conditions like osteoarthritis or kidney function issues can trigger pseudogout attacks.

Which joints are commonly affected by pseudogout?

Pseudogout commonly affects larger joints, including the knees, wrists, shoulders, and sometimes the ankles, causing intense joint pain and swelling.

How is pseudogout diagnosed?

Doctors diagnose pseudogout by confirming calcium pyrophosphate crystals through imaging tests, medical history, physical examination, and joint fluid analysis.

Medical Disclaimer:

The information provided in this article is for educational and informational purposes only and should not be considered a substitute for professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider before starting any new dietary supplement, especially if you are pregnant, nursing, have a medical condition, or are taking other medications. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.

References

  1. Abhishek, A., & Doherty, M. (2011). Pathophysiology of articular chondrocalcinosis--role of ANKH. Nature reviews. Rheumatology, 7(2), 96–104. https://doi.org/10.1038/nrrheum.2010.182

  2. Dieppe, P., & Swan, A. (1999). Identification of crystals in synovial fluid. Annals of the rheumatic diseases, 58(5), 261–263. https://doi.org/10.1136/ard.58.5.261

  3. Pascual, E., & Jovaní, V. (2005). Synovial fluid analysis. Best practice & research. Clinical rheumatology, 19(3), 371–386. https://doi.org/10.1016/j.berh.2005.01.004

  4. Richette, P., & Bardin, T. (2010). Colchicine for the treatment of gout. Expert opinion on pharmacotherapy, 11(17), 2933–2938. https://doi.org/10.1517/14656566.2010.529432

  5. Rosenthal, A. K., & Ryan, L. M. (2016). Calcium Pyrophosphate Deposition Disease. The New England journal of medicine, 374(26), 2575–2584. https://doi.org/10.1056/NEJMra1511117

  6. Zhang, W., Doherty, M., Bardin, T., Barskova, V., Guerne, P. A., Jansen, T. L., Leeb, B. F., Perez-Ruiz, F., Pimentao, J., Punzi, L., Richette, P., Sivera, F., Uhlig, T., Watt, I., & Pascual, E. (2011). European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Annals of the rheumatic diseases, 70(4), 563–570. https://doi.org/10.1136/ard.2010.139105 

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