Everything You Need to Know About Pseudogout

Medically Reviewed By Nancy Carteron, M.D., FACR

Pseudogout is a type of arthritis that causes swelling, pain, warmth, and redness around your joints. As its name implies, pseudogout — often called “false gout” — has many symptoms that are similar to those of gout. According to the Arthritis Foundation, pseudogout is most likely to affect the joints of the knees, wrists, or large knuckles. It may also affect the hips, shoulders, and spine. Pseudogout often does not affect big toes, which are the main target areas for gout.

This article explains what pseudogout is and discusses how it differs from gout. It also explores the signs, symptoms, causes, and treatment options associated with the condition.

What is pseudogout?

man with gout hands
Branislava Živić/Stocksy United

Pseudogout belongs to a family of conditions called calcium pyrophosphate deposition (CPPD) diseases Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source . It develops when microscopic calcium pyrophosphate (CPP) crystals gather in the joint cartilage. When they are released from the cartilage, they enter the joint fluid, lodge in the soft tissue, and trigger an immune system response.

CPP crystal deposits associated with CPPD diseases occur in about 3% of people in their 60s and up to 50% of people in their 90s. Researchers are not sure whether underlying disorders or genes lead to the deposits of these crystals.

The following list is a breakdown of the different types of CPPD diseases:

  • Pseudogout, or acute CPP crystal inflammatory arthritis: This causes a sudden onset of swelling, pain, warmth, and redness in your joints. Pseudogout is more likely to develop as you age. People over the age of 60 years are more commonly affected.
  • Chronic CPP crystal inflammatory arthritis: This causes mild, chronic pain with some swelling and redness.
  • Nonsymptomatic CPPD disease: In this condition, the CPP crystals present in your joints do not cause pain. In fact, you may not even be aware that you have a CPPD disease.

Symptoms of pseudogout

Symptoms of pseudogout may include the following:

  • sudden, intense pain in the joints of the knees, wrists, or large knuckles
  • pain in your hips, shoulders, or spine
  • swelling and stiffness of the joint due to the buildup of fluid
  • an increase in the pain when you touch the joint  
  • warmth in the joint
  • redness or other discoloration of the skin around the joint

A flare-up of pseudogout can last between days and weeks.

When to contact a doctor

If you experience a sudden flare-up of symptoms, talk with your doctor. They may recommend that you speak with a rheumatologist. Research suggests Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source that getting an early and accurate diagnosis provides the best chance to prevent severe joint damage.

Pseudogout vs. gout

Understanding the differences between pseudogout and gout can help you manage your condition. Below are some of the differences between the two.

Affected joints

  • Pseudogout is most likely to affect the knees, wrists, or large knuckles. It may also involve the hips, shoulders, or spine. Pseudogout may affect multiple joints at the same time.
  • Gout most commonly Trusted Source Centers for Disease Control and Prevention (CDC) Governmental authority Go to source affects one joint at a time. The affected joints can include the big toe, instep, heel, ankle, or knee.

Types of crystals

  • Pseudogout is due to CPP crystals. When these build up in your cartilage, they can lead to inflammation and pain.
  • Gout happens as a result of Trusted Source Centers for Disease Control and Prevention (CDC) Governmental authority Go to source high levels of uric acid in the blood. When the uric acid builds up, it leads to the formation of monosodium urate crystals or uric acid crystals in the joint. This leads to swelling and pain.

Type of pain

  • Pseudogout may flare up at any time of day. Although the pain is severe, it is not usually as acute as the pain from gout.
  • Gout pain often starts in the middle of the night. The pain is acute.

Triggers

  • Pseudogout does not usually have a clear trigger.
  • An episode of gout is usually traceable Trusted Source Centers for Disease Control and Prevention (CDC) Governmental authority Go to source to triggers such as eating certain foods, drinking alcohol, or changing medication.

Causes and risk factors for pseudogout

The buildup of CPP crystals causes pseudogout in the joint cartilage and fluid. The following is a list of causes and risk factors for this:

  • Metabolic conditions: Metabolic conditions such as hypophosphatasia and hyperparathyroidism are well-established risk factors for pseudogout.  
  • Kidney failure: Older research Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source suggests that chronic kidney failure is associated with pseudogout.
  • Arthritis: If you have gout, rheumatoid arthritis, or osteoarthritis, you are at higher risk of developing pseudogout.
  • Trauma and surgery: Previous trauma to the joint is also a strong risk factor for CPPD diseases. Acute episodes of pseudogout often occur after acute illness. One study suggests that decades after knee surgery, pseudogout developed in 20% Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source of the knees. This is compared with only 4% of knees not treated with knee surgery. Similarly, pseudogout can occur after procedures such as hip fracture repairs.
  • Age: A person’s risk of developing pseudogout increases with age. Most people who develop pseudogout are ages 60 years or older. In fact, after age 60 years, the likelihood of developing pseudogout doubles with each decade of life.
  • Genetics: It appears that certain mutations in the ANKH gene, which helps regulate metabolism, increase the risk of developing pseudogout. For this reason, if you are younger than 60 years of age and have pseudogout, your family members should talk with their doctors about testing for this mutation.

Repeated episodes of pseudogout can lead to permanent joint damage and a loss of regular motion in the affected joints.

Diagnosis

Getting a diagnosis of pseudogout can help Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source you prevent permanent joint damage.

When you speak with your doctor, they will begin by asking you for your medical history and doing a physical exam. They will examine the affected joints, the swelling, your pain points, and your range of motion.

The following is a list of tests that your doctor may recommend to help them reach a diagnosis.

Joint fluid examination

The most significant test for diagnosing pseudogout is a joint fluid examination. Your doctor will use a needle to extract a small amount of synovial fluid from the affected joint. They will then send it to a laboratory for analysis.

If rod or rhomboid shaped crystals of calcium pyrophosphate are present, your doctor will give you a diagnosis of a CPPD disease and possible pseudogout.

Blood and urine tests

Blood and urine tests cannot confirm the presence of pseudogout. However, your doctor may recommend these tests in order to help rule out other conditions.

X-rays

X-rays can help detect the calcification that can occur due to the buildup of CPP crystals. X-rays can also help your doctor see your overall joint damage.

CT scan

If you have pain and swelling in your spine, your doctor may recommend a CT scan. A CT scan can help make calcifications in the spine visible.

Treatments for pseudogout

Although pseudogout is not currently curable, treatment can be successful. With the correct treatment, you can prevent swelling and pain. The following is a list of drugs that doctors may use in your treatment:

  • Colchicine: Doctors usually prescribe this for CPPD disease flares.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): These include aspirin, ibuprofen, and naproxen, and they can ease the pain of pseudogout.  
  • Steroids such as prednisone: These can help people who cannot take colchicine or NSAIDs. They are injectable into inflamed joints.

Prevention

In some cases, you can reduce recurrent episodes of CPPD diseases by taking a low dose of colchicine.

How to manage pseudogout

If you are experiencing a sudden episode of pseudogout, the following tips can help you manage your condition:

  • Place a cool compress against the affected joint to help relieve the discomfort and decrease swelling.
  • Try to rest the affected joint by using it as little as possible.
  • Try to elevate your knee, foot, or leg by lying down and placing a pillow underneath your foot.

Summary

Pseudogout is a type of arthritis that causes swelling, pain, warmth, and redness in your joints. It happens when CPP crystals accumulate in the cartilage of a joint.

Although the condition is not currently curable, it is manageable. You can often relieve the symptoms within 24 hours of beginning treatment with anti-inflammatory medications.

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Medical Reviewer: Nancy Carteron, M.D., FACR
Last Review Date: 2022 Mar 3
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