Pseudogout
Also known as: Calcium pyrophosphate deposition disease, CPPD, Chondrocalcinosis
Pseudogout is a form of arthritis caused by calcium pyrophosphate crystals depositing in the cartilage and fluid of a joint. When those crystals shed into the joint they trigger sudden, painful swelling that looks very much like gout, hence the name, but gout is caused by a different crystal (uric acid) and is treated differently. Pseudogout most often strikes the knee, followed by the wrist, shoulder, ankle and hip, and it is mainly a condition of older adults. Attacks can last days to weeks and may be triggered by illness, surgery or injury. Some people have chronic joint inflammation rather than discrete attacks. The crystal deposits cannot be removed, but attacks can be treated effectively and their frequency reduced.
At a Glance
- Common symptoms
- Sudden onset of severe pain, swelling and warmth in one joint, most often the knee, Redness over the joint, Stiffness and difficulty moving the joint
- Main treatments
- Nonsteroidal anti-inflammatory drugs to reduce pain and inflammation during an attack, Draining the joint and injecting a corticosteroid, which brings rapid relief, Colchicine for acute attacks and, in low doses, to prevent frequent recurrences
- Category
- Musculoskeletal · Common in older adults; cartilage calcification is found in a large proportion of people over 80, though many never have symptoms
- See a doctor if
- A hot, swollen, painful joint that developed suddenly, as joint infection must be ruled out
Symptoms
Causes
- Deposition of calcium pyrophosphate dihydrate crystals in joint cartilage, which increases with age
- Release of crystals into the joint space, triggering an inflammatory response
- Genetic factors in some families that cause early-onset disease
- Metabolic conditions that promote crystal formation, including hyperparathyroidism, hemochromatosis, low magnesium and hypothyroidism
- Joint trauma, surgery or a serious illness, which can precipitate an attack
Risk Factors
- Age over 60; risk rises steeply with each decade
- Previous joint injury or surgery
- Hyperparathyroidism
- Hemochromatosis (iron overload)
- Low magnesium levels, including from certain diuretics or gut absorption problems
- A family history of pseudogout
Diagnosis
- Drawing fluid from the swollen joint and examining it under a polarizing microscope for calcium pyrophosphate crystals
- Joint fluid analysis to exclude infection, which can look identical
- X-rays showing calcium deposits in cartilage (chondrocalcinosis)
- Ultrasound, which can detect cartilage crystal deposits
- Blood tests for calcium, parathyroid hormone, iron, magnesium and thyroid function to look for an underlying cause
Treatment
- Nonsteroidal anti-inflammatory drugs to reduce pain and inflammation during an attack
- Draining the joint and injecting a corticosteroid, which brings rapid relief
- Colchicine for acute attacks and, in low doses, to prevent frequent recurrences
- Oral corticosteroids when NSAIDs and injections are unsuitable
- Treating any underlying metabolic condition such as hyperparathyroidism or low magnesium
- Supportive: resting and icing the joint during an attack, then gentle exercise to restore movement
- Supportive: physiotherapy and weight management to protect joints with chronic involvement
Prevention
- There is no proven way to prevent crystal deposits, but treating underlying conditions such as hyperparathyroidism or low magnesium may help
- Take low-dose colchicine as prescribed if you have frequent attacks
- Protect joints from injury and keep muscles around the joint strong
- Maintain a healthy weight to reduce stress on weight-bearing joints
- Stay active between attacks to preserve joint mobility
When to See a Doctor
- A hot, swollen, painful joint that developed suddenly, as joint infection must be ruled out
- A swollen joint with fever or feeling generally unwell (seek urgent care)
- Repeated attacks of joint pain and swelling
- Joint pain that does not improve with over-the-counter measures within a few days
- Joint symptoms in someone known to have hyperparathyroidism or hemochromatosis
Frequently Asked Questions
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