Pseudogout is often misdiagnosed as gout because they share many of the same symptoms. The causes of these two conditions are however very different.
While treatment to relieve the pain and inflammation during an acute attack is the same, the long-term measures to prevent gout will not avoid future attacks if you actually suffer from pseudogout.
You can use the comparisons of pseudogout vs gout below to see if you don’t possibly suffer from pseudogout, how to confirm the diagnosis and what the possible long-term options are for the treatment of pseudo-gout.
Causes and Risk Factors
Both gout and pseudogout result from crystal deposits in the joints which lead to the severe pain and inflammation experienced by the sufferers.
However, whereas gout is caused by uric acid crystals, the crystals in the case of pseudogout are calcium based.
In medical terms pseudogout is referred to as CPPD arthropathy, after the salt known as calcium pyrophosphate dehydrate.
Those with gout usually experience the first episode when they are between 30 and 50 years old, while pseudogout more often starts when people are in their 60’s.
Both conditions also appear to be linked to a genetic predisposition and/or previous injury or surgery to the affected joint. Men are more likely to suffer from gout than women, whereas pseudogout affects both men and women equally.
Those with gout have high levels of uric acid in their blood while pseudogout is associated with high levels of calcium and low levels of magnesium, a mineral with an important role in balancing calcium levels in the body.
Pseudogout is often also associated with other diseases that affect calcium metabolism such as an underactive thyroid gland or overactive parathyroid gland, medical conditions related to too much iron in the body, or long-term use of steroid drugs.
Episodes of both these conditions usually develop spontaneously but they can be triggered by physical stress on the body for example dehydration (such as if you don’t drink enough fluids on a very hot day or when travelling), severe illness, surgery or injury.
Symptoms and Diagnosis
The acute attack of both gout and pseudogout are characterised by sudden, severe joint pain accompanied by stiffness, redness, heat and swelling.
With either of the conditions you may not experience any further symptoms for months or even years, until the next episode.
In pseudogout it may take longer for the pain to reach its peak and it could also take longer to resolve, possibly up to three months.
The joints affected during an acute episode are the key distinguishing characteristic between true gout vs. pseudogout.
Gout most often affects one of the big toes, especially when the first attack occurs, and an acute episode typically involves a single joint only.
Pseudogout affects mostly the knees, but can also develop in the wrists, hands, elbows, shoulders, hips and toes. Sometimes it affects only one joint but it can also appear in multiple joints at the same time.
If your attacks of joint pain and inflammation occur mainly in your knees, or in the other joints mentioned above, you should consult a medical practitioner to establish whether you possibly have pseudogout rather than gout.
The diagnosis of either of the conditions can be confirmed by drawing some fluid out of the affected joint and studying the crystals under a microscope.
Treatment and Prevention of Future Episodes
The treatment for acute episodes of gout or pseudogout is the same, aimed at reducing pain and inflammation.
Home treatment which you can start immediately is rest, ice and over-the-counter medication for pain and inflammation.
If the condition is very severe and is not relieved by the above measures you should consult a medical practitioner for a prescription of stronger medication and possibly cortisone injections or surgery.
Supervision by a medical practitioner is also necessary if you have frequent episodes as this can lead to permanent damage of the joints.
There are various medications which reduce the build-up of uric acid and crystal formation in gout. Recurrent attacks of gout can also be reduced or prevented with diet and other lifestyle changes.
Foods with high levels of purines should be limited and you must prevent dehydration by drinking sufficient fluids and avoiding excessive use of alcohol.
Some blood-pressure medications that contain a diuretic may also contribute to excessive fluid loss, dehydration and build-up of uric acid.
When you are first diagnosed with pseudogout your medical practitioner will conduct tests and examinations to make sure that it is not caused by another underlying condition such as an under-active thyroid gland or excessive deposits of iron in the body.
If an underlying condition is found and treated it will then also prevent recurrence of pseudogout.
In most cases of the metabolic cause of pseudogout is not known and at this stage there is no specific medication that can prevent the development of the calcium crystals.
Current long-term treatment is based on the use anti-inflammatory medications and there has been some success with low doses of Colchicine as a preventive measure.
Recent studies have found a strong association between CPPD crystal deposits and low levels of magnesium, a mineral which is essential in metabolising and using calcium.
Magnesium supplements are suggested as preventive treatment of pseudogout and calcium supplements should be avoided.
As in gout, dehydration can contribute to attacks of pseudogout as the salts that form the crystals are not properly excreted in the urine.
Diuretics, medicines which increase urinary output and are often part of treatment for high blood pressure and other heart conditions, have been shown to lead to reduced levels of magnesium and increased calcium crystal deposits.
As both gout and pseudogout are inflammatory conditions foods that are known to contribute to inflammation should be avoided.
This includes polyunsaturated fats, found in vegetable oils, and the trans-fatty acids present in many processed foods like margarine and most factory produced baked goods.
On the other hand omega-3 fatty acids, found in oily fish and flaxseed and the antioxidants available in fruit and vegetables reduce inflammation.
Adopting a healthy lifestyle can make a difference in the recurrence of both gout and pseudogout, as with most other chronic conditions.
A healthy diet of natural foods and plenty of fruits and vegetables is very important. Exercise strengthens and helps to maintain full movement and use of joints.
Gentle range of motion exercises are recommended after the worst pain and inflammation of an acute episode are over. When the condition has subsided strength exercises, including walking or cycling, can be introduced.
Enough sleep and activities to promote relaxation are also essential as the hormones released during high levels of stress also contribute to inflammation.
If you’re looking for natural supplements for gout, read our review of Nutri Gout.
References:
1. MacMullan, P & McCarthy, G. Treatment and management of pseudogout: insights for the clinician.
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383522/Rothschild, BM. Gout and Pseudogout.
3. http://emedicine.medscape.com/article/329958-overview UW Medicine. Basics of CPPD deposition disease.
4. http://www.orthop.washington.edu/?q=patient-care/articles/arthritis/cppd-deposition-disease.html
5. Whelan, B.R.; F. O’Shea, F &McCarthy, G. Pseudoneuropathic CPPD arthropathy: magnesium matters.
6. https://academic.oup.com/rheumatology/article/47/4/551/1790360/Pseudoneuropathic-CPPD-arthropathy-magnesium.
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