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Despite its name, pseudogout is real. It’s not gout, but there’s good reason it’s called “false gout.” Like gout, pseudogout is inflammatory arthritis caused by an excess of crystals in the joint fluid. And, like gout, it hurts, leaving your joint swollen and red. While gout is often triggered by diet, pseudogout is believed to get its start when the body is dehydrated (yet another reason to drink plenty of water), such as might occur after surgery or in an older adult who simply doesn’t consume enough liquid. And, yes, you can have both gout and pseudogout at the same time.
Pseudogout is in over 20 percent of the population over the age of 80, reports Anne C. Brower MD, Donald J. Flemming MD, in Arthritis in Black and White (Third Edition). They list its likely onset between the ages of 60 and 70.
It’s in the Crystals
Gout is caused by uric acid buildup in the blood. If your kidney function is impaired or your body produces too much uric acid for the kidneys to process, uric acid builds up, forming hard crystals that attach to joints and tendons, setting the stage for inflammation and painful gout. These crystals are monosodium urate.
With pseudogout, the crystals are calcium pyrophosphate, and pseudogout is sometimes called calcium pyrophosphate deposition disease or CPPD (there is some movement to change the name of the ailment from pseudogout to CPPD). Unlike gout, it’s not established why these crystals form. And, unlike gout, these crystals form in the joint fluid rather than the blood. While gout is seen in men as early as 30 years old, pseudogout seems to be related to aging and age-related osteoarthritis.
“Almost half of people over 85 have the crystals, but many of them do not have symptoms. Because CPPD tends to run in families, genes may play a role. Other possible factors in its development include hemochromatosis, a condition when the body stores excess iron; low blood magnesium levels; and an overactive parathyroid or severely underactive thyroid,” says arthritis.org.
There does seem to be agreement that aging and other conditions are behind pseudogout, unlike gout, which is its own illness. “Pseudogout can be associated with other diseases that need to be investigated,” says Kevin Deane, MD, an assistant professor of medicine in the division of rheumatology at the University of Colorado Health Sciences Center in Denver, on Everydayhealth.com. “With pseudogout you usually try and identify if there is a long-term disease that might be driving it. If that’s not driving it, you basically have to put them on long term anti-inflammatory medications.”
Medicinenet.net explains further: “Pseudogout may be associated with other conditions, including hemophilia, hemochromatosis, ochronosis, amyloidosis, or hormonal disorders (such as hyperparathyroidism and hypothyroidism).”
As stated, pseudogout occurs most often in older adults, although it’s possible in younger people, too, and there may be a hereditary link. Both men and women are considered equally susceptible. Those batting a chronic condition involving the thyroid or kidney may be more likely to have an attack, as is any older adult in a state of dehydration.
For most patients, a pseudogout attack comes on suddenly and may leave just as abruptly, or it may linger for weeks.
- Inflammation in the joint (red and hot)
- Joint pain
- Loss of motion/function in the joint
- Stiffness in joint
- Swelling in the joint
While gout occurs most frequently in the big toe, pseudogout usually happens in the knee. It has also been noted in wrists, hands, shoulders, hips, and the ankles.
Your physician will likely x-ray your joint, looking for abnormal calcifications. In addition, he or she may draw out some joint fluid to be sent to a lab for examination under a polarizing microscope. That will determine if there are calcium pyrophosphate crystals present in the joint fluid.
Treatment involves reducing pain and joint damage. Apply cold therapy to reduce inflammation (ice packs) and force rest, so the joint isn’t further damaged. Non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed. Clearly, increasing fluid intake is recommended.
Other treatment is dependent upon the cause or related conditions.
For most people, pseudogout will resolve. Immediate treatment can help reduce the chance of joint-function damage. Repeated attacks increase the risk of cartilage and bone damage, furthering osteoarthritis.
The Arthritis Foundation says that, “About 5 percent of people with CPPD deposition will have a chronic rheumatoid arthritis-like condition involving several joints in a symmetric pattern (affecting the same joint on each side of the body, such as both wrists or both knees). Inflammation is low-grade as opposed to the intense swelling and pain of pseudogout. Similar to rheumatoid arthritis, this condition is characterized by morning stiffness and fatigue and can lead to joint deformities.”