Gout and pseudogout are types of arthritis. They cause pain and swelling in the joints. Both of these conditions are caused by sharp crystals that collect in the joints. This is why they’re also called crystal arthritis and crystalline arthropathy.
Gout and pseudogout are sometimes mistaken for other joint conditions, such as:
The differences between gout and pseudogout include where the pain happens and the kinds of crystals that cause it. Treatment also differs.
Gout most commonly happens in the big toe. It can also affect joints such as:
- finger joint
Pseudogout is also called calcium pyrophosphate deposition disease (CPPD). As its name suggests, pseudogout is often mistaken for gout. CPPD typically happens in the knee and other larger joints, including:
Gout and pseudogout cause very similar symptoms in the joints. Both can cause sudden symptoms. Or, they can be set off by a minor injury, such as hitting your knee or elbow against something.
Gout and pseudogout can both cause:
- sudden, severe pain
- warmth at the site of pain
A gout attack causes sudden, sharp pain that get worse for up to 12 hours. The symptoms then reduce for several days. The pain goes away after a week to 10 days. About 60 percent of people with gout will have another attack within a year. If you have chronic gout, you may have attacks or pain more often.
Pseudogout attacks are also sudden. However, the pain usually stays the same and can last for days or weeks. Some people may have constant pain or discomfort that doesn’t go away. Pseudogout pain is more like pain caused by osteoarthritis or rheumatoid arthritis.
You can get gout if you have too much uric acid in your blood. This causes sodium urate crystals to build up in the joints. High levels of uric acid may be caused when:
- the body makes too much uric acid
- the kidneys aren’t getting rid or uric acid fast enough
- you eat too many foods that make uric acid, such as meats, dried beans, seafood, and alcohol
Other health conditions may raise your risk of gout. These include:
- high blood pressure
- high cholesterol
- heart disease
Pseudogout is caused by calcium pyrophosphate dihydrate crystals in the joints. The crystals cause pain when they get into the fluid in the joint. The cause of these crystals isn’t yet known.
Pseudogout is sometimes thought to be caused by another health condition, such as thyroid problems.
Gout is more common in men than women until about the age of 60 years. Men who are 40 to 50 years old are more likely to have gout. Women typically get gout after menopause.
Pseudogout normally happens in adults who are 50 years or older. Older adults are at higher risk of this joint condition. In the United States, almost 50 percent of people over the age of 85 have pseudogout. It’s slightly more common in women than in men.
You’ll need a physical exam to help diagnose gout and pseudogout. Your doctor will also look at your medical history. Tell your doctor about any symptoms you have and when you have them.
A blood test can show if you have high levels of uric acid in your body. This may mean that you have gout.
You may also have other blood tests to diagnose pseudogout or gout. Blood tests also help to rule out other conditions that cause joint pain. Your doctor might check:
- blood mineral levels, such as calcium, phosphorus, magnesium, phosphatase
- blood iron levels
- thyroid hormone levels
If you have any type of joint pain, your doctor will likely send you for an X-ray. You may also have an ultrasound or CT scan. Scans may show damage in the joints and help to find out the cause.
An X-ray may also show crystals in the joint, but not what kind of crystals. Sometimes, pseudogout crystals may be mistaken for gout crystals.
Joint fluid may be taken from an affected joint. This involves using a long needle. Your doctor may numb the area with a cream or injection first. The fluid is sent to a lab to check for any sign of an infection.
One way doctors can tell if you have gout or pseudogout is to look at the crystals. Crystals are removed from the joint fluid. Then, crystals are examined with a polarized microscope.
Gout crystals are needle-shaped. Pseudogout crystals are rectangular and look like tiny bricks.
Gout and pseudogout can happen together in rare cases. A medical study reported the case of a 63-year old man with knee pain. Fluid was removed from the joint and examined. He was found to have crystals for both conditions in the knee. More research is needed on how often this can happen.
You can have pseudogout and other joint conditions, such as osteoarthritis. You can also have pseudogout and an infection in the joint.
Both gout and pseudogout can damage your joints. Treating these conditions is important to help prevent flare-ups and protect your body. Treatment for gout and pseudogout is different for several reasons.
Gout can be treated by lowering high levels of uric acid in your blood. This helps to get rid of the needlelike crystals in the joints. Medications that treat gout by reducing uric acid include:
- xanthine oxidase inhibitors (Aloprim, Lopurin, Uloric, Zyloprim)
- uricosurics (Probalan, Zurampic)
There’s no drug treatment for too many pseudogout crystals in the body. Your doctor may recommend draining excess fluid from the joint. This may help remove some of the crystal. This involves numbing the area and using a long needle to aspirate or take fluid from the joint.
Pseudogout is mainly treated by drugs that help control pain and swelling. These drugs are also used to treat gout symptoms. They include medications that are taken by mouth or injected into the joint:
- nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil), naproxen (Aleve), and celecoxib (Celebrex)
- colchicine pain reliever drugs (Colcrys, Mitigare)
- corticosteroid anti-inflammatory drugs, such as prednisone
- anakinra (Kineret)
In serious cases, you may need surgery to help repair damaged joints. It’s possible you’ll still need some pain relief and anti-inflammatory medications after the surgery.
Afterwards, physical therapy and at-home exercises are very important to keep your joints flexible and healthy. Your doctor will advise you when it’s safe to exercise after you heal from surgery.
Diet and lifestyle changes can lower uric acid in the body. This may help prevent gout. The Arthritis Foundation recommends making these changes to your daily diet:
- stop eating or limit red meat and shellfish
- reduce drinking alcohol, especially beer
- stop drinking soda and other beverages that contain fructose sugar
It’s also important to maintain a healthy weight. Obesity increases your risk for gout.
Some medications can raise uric acid levels. Your doctor may stop or replace drugs such as:
- diuretics for high blood pressure
- immune-suppressing drugs
Pseudogout is more difficult to prevent. This is because the exact causes of the crystals aren’t yet known. You can help prevent pseudogout attacks and joint damage with treatment.
Gout and pseudogout have very similar joint symptoms. However, the causes, treatment, and prevention for these arthritis conditions are different.
You may need several tests to find out what’s causing your joint pain. Both of these conditions are treatable.
See your doctor immediately if you have any joint symptoms. Early treatment is important to help prevent damage to your joints and other health conditions, such as kidney problems.
If you have gout or pseudogout, you’ll need medical treatment and lifestyle changes to help keep your joints healthy. Talk to your doctor, nutritionist, and physical therapist about the best medication, diet, and exercise plan for you.