Sending Away Pseudogout
You have a swollen, painful knee. It has been bothering you for a week. You don’t know what to do about it. You could have pseudogout.
Unlike gout which fills joints with uric acid crystals, pseudogout fills joints with calcium pyrophosphate crystals, a different substance but equally as painful.
A first attack of gout commonly strikes the joint at the base of the big toe. Pseudogout usually picks on the knee.
Anti-inflammatory drugs like Naprelan often soothe inflamed pseudogout joints. Simply draining a swollen joint can bring prompt relief. If attacks become frequent, daily colchicine, the medicine used for gout, can control pseudogout. Another alternative is to instill cortisone into the drained joint.
Pseudogout most often occurs in people over the age of 60 and tends to run in families. Pseudogout is first suspected when X-rays demonstrate calcification in cartilage (chondrocalcinosis) of the affected joint. The disease brings attacks of acute arthritis, generally involving large joints like the knees and wrists. Pseudogout affects only joints, whereas gout may be complicated by uric acid kidney stones and chronic kidney failure. Pseudogout is frequently associated with some underlying metabolic abnormality such as diabetes mellitus, hypothyroidism, hyperparathyroidism, excessive tissue deposits of iron (hemochromatosis) or copper (Wilson’s disease) and even true gout.
For years, pseudogout had all the earmarks of gout and people were mistakenly diagnosed with gout. An attack of the disorder reaches peak intensity in 12 to 36 hours. Lesser pain could linger for weeks. Pseudogout also can resemble osteoarthritis or rheumatoid arthritis, in making joints ache simultaneously. It occurs not only in the knee but also wrist, shoulder, ankle or elbow. It happens without explanation. Frequently, however, doctors cannot identify anything that might have triggered the disease.
To diagnose pseudogout, your healthcare provider may remove a sample of fluid from the inflamed joint. He or she will test it for calcium crystals and uric acid crystals as well (to check for gout). The fluid also will be tested for an infection or other cause of joint inflammation. Your provider may test for conditions that trigger pseudogout, too.
Removing the fluid from an inflamed joint to make a diagnosis, a procedure called joint aspiration, can also help relieve the symptoms. It eases the pressure and discomfort. After the area is numbed, your provider inserts a needle to withdraw fluid.
Many gout medicines also work for pseudogout. Indomethacin is an example. Other treatment methods include pain- and inflammation-relieving NSAIDs or injections of a glucocorticoid to keep the swelling down. These two treatments usually eliminate symptoms within hours to a few days. If your provider determines you cannot take these medicines, you may instead be prescribed corticosteroid pills for a short time.
Preventing future attacks is possible. If another condition is triggering attacks of pseudogout, such as an underactive thyroid, treatment of that condition may prevent future attacks. In addition, your provider may prescribe colchicine or an NSAID to take regularly. Both types of treatment help to prevent the inflammation in the joint.
Over time, pseudogout can cause a joint to degenerate in people with recurrent or ongoing symptoms. In this case, surgery (such as joint replacement) may become the only effective treatment.
Pseudogout is a chronic, annoying problem that usually responds to prompt treatment. Fortunately, serious consequences are rare.
