Pseudogout

(Also known as Calcium pyrophosphate dihydrate deposition disease or CPPD)

What Is Pseudogout and How Is It Different from Gout?

Both pseudogout and gout are inflammatory arthritides caused by crystal deposition in joints. They differ however in the types of crystals deposited and the typical joints affected.

The following are several differences between pseudogout and gout:

  • The first attack typically affects the knee rather than the joint of the big toe.
  • At least two-thirds of cases affect more than one joint during a first attack.
  • The symptoms of pseudogout develop more slowly than those of gout, taking days rather than hours to develop.
  • Pseudogout is more likely to first develop in elderly people, particularly those with osteoarthritis. (It affects between 10% and 15% of people over 65.)
  • Pseudogout is more likely to occur in the autumn while gout attacks are most common in the spring

Prognosis

There is no cure for pseudogout. There are however medications and therapies to prevent attacks and abort active pseudogout attacks.

Treatment

Treatments for pseudogout are similar to those for gout and are aimed at relieving the pain, joint inflammation, and reducing the frequency of attacks.

  • With the onset of an attack, treatment should be initiated as quickly as possible to avoid disabling joint symptoms
  • In younger, healthy patients without serious medication conditions, nonsteroidal anti-inflammatory drugs (NSAIDs) or COX2 inhibitors are the drugs of choice. (ie. ibuprofen, naproxen, indomethacin, etc…)
  • Corticosteroids may be given both orally or as an injection into the affected joint. Oral corticosteroids (ie. Medrol or Prednisone) can be beneficial in patients who cannot tolerate NSAIDs and may be particularly beneficial for elderly patients or those with kidney problems. Injections into the affected joints provide effective relief for many patients.
  • Colchicine is used in healthy adults only and with caution. It should not be used in patients with severe kidney or liver problems.
  • In severe cases surgery to remove the calcifications or joint replacement is necessary.
  • Rest, applying cold, and protecting the affected joint with a splint can also promote recovery. After the first attack, some physicians advise their patients to keep a supply of medications on hand so that self-medication can begin at the first sign of symptoms of a second acute attack

* Adopted from MD Consult Patient Handouts