Pseudogout, Causes, Symptoms, Treatment

Pseudogout is another type of inflammatory arthritis marked by abrupt pain and swelling in the joints. These painful events can last for days or weeks. Pseudogout commonly presents in older adults and most usually affects the knees.

Like acute gouty arthritis, pseudogout has a rapid onset of pain, caused by crystal deposits in the joint usually affecting the large joints of the arms and legs. Pseudogout is caused by calcium pyrophosphate crystals. It is unlike gout, which is caused by monosodium urate crystals.

Symptoms:

Pseudogout usually attacks the knee joints, as well as the ankles, hands, wrists, elbows and shoulders. Symptoms of pseudogout include:

• Edema (swelling) of the joints


• Inflammation


• Warmth


• Severe joint pain

Causes of Pseudogout:

Calcium pyrophosphate dihydrate (CPPD) forms in the joint's cartilage, then crystalizes and accumulates in the lining, or synovium of the joint, resulting in the pain, swelling, and inflammation.

Approximately one half of elderly people 90 and over have CPPD crystals present in their joints, but remain asymptomatic.

Pseudogout is also known as calcium pyrophosphate deposition disease, which can lead to calcification and destruction of joint cartilage.

Risks include:

• Family members with pseudogout


• Hypothyroidism—an underactive thyroid


• Hemochromatosis—excess iron storage


• Overactive parathyroid gland


• Hypercalcemia (elevated calcium in the blood)


• Kidney failure


• Diabetes


• Recent surgery


• Joint injury

Diagnostic testing:

Pseudogout can often be misdiagnosed as gout, as well as osteoarthritis or rheumatoid arthritis. That is why testing is important to distinguish between gout, pseudigout, and other arthritic conditions.

Tests for pseudogout include:

Aspiration of synovial fluid looking for the presence of 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 will determine the cause of joint pain and inflammation, such as infection, gout, injury, and rheumatoid arthritis.

Complications:

The CPPD crystal deposits can result in damage to the joint structure. Damage can be caused by:

• Cysts,


• Bone spurs and


• Cartilage loss


• Fractures

Treatment:

Treatment focuses on reduction of pain and swelling. However, treatment does not eliminate the CPPD crystals from the joints. Treatment includes:

Anti-inflammatory medications, such as aspirin are administered to decrease inflammation.

Nonsteroidal anti-inflammatory drugs (NSAIDs): Such as ibuprofen (Advil, Motrin, others), naproxen (Aleve) and indomethacin (Indocin). Side effects can include stomach bleeding and kidney damage.
Colchicine: Decreases inflammation in people with gout, but can be used in the management of pseudogout when NSAIDs is contraindicated. Side effects include stomach pain, nausea, diarrhea and vomiting, and bleeding.

Joint aspiration and injection: For relief of pain and pressure in the joint, by removing some of the fluid present in the affected joint. An injection of corticosteroids reduces inflammation and an anesthetic to temporarily numb your joint.

As with gout, there is a chance of future attacks of pseudogout. Your doctor can prescribe medications to prevent future events of this condition, such as low doses of colchicine.

by Barb Hicks, RN