Pseudogout

Pseudogout is actually a type of arthritis, in which one or several joints in the body suffer from an acute and painful inflammatory process. Each episode of pseudogout has a different duration, ranging from a couple of days to several weeks. From all the joints in the body, the knee joint presents the highest risk of suffering from a pseudogout attack.

Pseudogout Picture (1) - Image labels : Bone erosions, Urate crystals in a tophus and Synovium

In the medical world, this condition is also known as pyrophosphate deposition disease (CPPD). However, the term “pseudogout” is more commonly used, due to the similarities this condition has with gout. Both conditions are caused by the excess deposits of crystals in various joints; however, not the same crystals are deposited in pseudogout as in gout. Even though the cause of pseudogout has not yet been identified, it seems that aging is a risk factor for its appearance. As you will have the opportunity to read below, the treatment is looking to improve the symptomatology experienced by the patient, relieving the pain and associated inflammation.

Pseudogout Symptoms

These are the most common symptoms of pseudogout:

• Joint inflammation
• Most commonly affected – knee joint
• Rare cases – wrist and ankle joint involvement
• Warmth at the level of the affected joint
• Intense pain (characteristic of pseudogout attack).

It should be mentioned that it is possible that no symptoms are obvious for this condition.

Pseudogout Picture (2) - Shedding of crystals from cartilage into the joint capsule.

Causes of Pseudogout

The main problem that causes the pseudogout attacks is related to the deposits of calcium pyrophosphate dihydrate crystals in different joints of the body. Aging increases the percentage of crystal deposits; however, it should be mentioned that not everyone who presents these deposits, also develops pseudogout. Further research is necessary in order to establish why pseudogout does not affect all people, despite the crystal deposits being present in similar quantities.There are a number of risk factors that can increase the chances for pseudogout attacks. From what has been said so far, you have probably understood that old age is a definite risk factor for pseudogout. Joint trauma, occurring because of an injury or as post-operative complication, increases the risk for pseudogout attacks. It is possible that pseudogout appears as an inherited disorder, the attacks becoming frequent at a younger age.Other risk factors include mineral imbalances and different medical conditions. In regard to the mineral imbalances, it has been discovered that increased quantities of iron or calcium in the blood can favor the pseudogout attacks. On the other hand, not having enough magnesium in the blood can trigger similar problems. As for the different medical conditions that can trigger pseudogout attacks, these include hypothyroidism and hyperparathyroidism.

Pseudogout Complications

In the situation that no treatment measures are taken, the excessive deposition of crystals can cause permanent damage to the respective joint. Because of this joint damage, the pseudogout might be mistaken for other rheumatologic conditions, such as osteoarthritis or rheumatoid arthritis. On the long run, the joint damage can reduce the functionality of the patient, with a negative effect on the overall quality of life.

When should you go to the doctor?

In the situation that you experience severe pain at the level of a joint, you should consider going to the doctor. This becomes even more urgent, if the symptoms appear all of a sudden, with the joint inflammation restricting your mobility and reducing your overall functionality.

Diagnosis of Pseudogout

These are the most common methods used for the diagnosis of pseudogout:

• Medical history
• When did the symptoms appear for the first time
• Similar problems in the past
• Current and past treatments (including surgical interventions)
• Physical movement aggravates the symptoms or makes them better
• Other medical conditions
• Family medical history (inherited conditions)
• Physical examination
• Palpation of the affected joint (identification of warmth and inflammation)
• Assessment of range of motion in the respective joint
• Laboratory testing
• Hormone levels (thyroid, parathyroid)
• Mineral imbalance (calcium, iron and magnesium levels)
• Joint fluid analysis
• With the help of a special needle, the doctor will take a small sample of joint fluid
• The analysis of the joint fluid can reveal the excess deposits of crystals in the respective joints, thus confirming the diagnosis
• Imaging studies
• X-ray – joint damage + crystal deposits
• CT scan or MRI – recommended for confirmation of diagnosis.

Pseudogout Treatment

These are the treatment measures recommended for pseudogout:

• Non-steroidal anti-inflammatory drugs
• Topical or oral administration (depending on the severity of the pain and inflammation)
• Pain relief and reduction of inflammation
• Recommended choices – acetaminophen, ibuprofen, naproxen
• This medication has to be administered with caution in those who suffer from chronic liver or kidney disease
• Colchicine
• Medication commonly administered in patients who suffer from gout
• Recommended in patients who experience frequent pseudogout attacks
• May also be administered for prophylactic purposes
• Corticosteroids
• Recommended in more severe cases, characterized by severe pain and inflammation
• Administered as pills
• Commonly prescribed – prednisolone
• Cannot be administered for prolonged periods of time, due to the negative side-effects (weight gain, diabetes, cataract, weakened bone structure)
• Joint drainage
• Removal of joint fluid → pain relief and reduction of pressure experienced in the affected joint
• The symptoms improve, as the number of crystals deposited in the respective joint is reduced
• Numbing medication and corticosteroids are injected into the respective joint, once the fluid has been drained.

Self-care measures

In the situation that you are experiencing a pseudogout attack, it is recommended to avoid movement. The affected joint needs rest in order to recover from the attack. The less you use the respective joint, the higher the chances for recovery are going to be. A good home remedy against the pain and inflammation caused by the pseudogout attack is the application of ice packs on the affected joint. The one thing that you have to be careful of is not apply the ice pack directly on the skin, as you can actually burn it. Always wrap the ice pack in a towel before applying it on the skin.

Physical therapy

As pseudogout attacks can damage the joints, physical therapy becomes an essential measure of prevention. The physical therapist can work with you, so as to maintain the normal range of motion in the affected joint. At the same time, he/she will teach you a number of exercises that are meant to strengthen the muscles surrounding the affected joint. In the situation that you suffer from repeated pseudogout attacks, the physical therapist can help you recovery in a faster and more efficient manner. This specialist will often collaborate with the occupational therapist, so as to provide the best possible care and help you deal with the activities of daily living at the same time.

Pseudogout Pictures