Pseudogout (CPPDD)

By Harvard Health Publications
Content provided by the Faculty of the Harvard Medical School

What Is It?

Pseudogout is a form of arthritis triggered by deposits of calcium crystals (calcium pyrophosphate dehydrate) in the joints. This disease can cause short-term or long-term swelling in joints, most often the knee, wrist, shoulder, ankle, elbow or hand. As the name suggests, this condition can appear similar to gout, which is caused by another type of crystal – uric acid crystals – and commonly causes sudden pain and swelling in a single joint, usually in the foot. Pseudogout also can resemble osteoarthritis or rheumatoid arthritis. It is also called calcium pyrophosphate deposition disease (CPPDD).

Pseudogout is most common in the elderly. It affects about 3% of people in their 60s and as many as half of people in their 90s. No one knows what causes it. Many people who get pseudogout already have joint damage from other conditions or they may have age-related degenerative joint disease. One theory is that an injury to cartilage allows calcium crystals to be released into the joint space, and these crystals cause inflammation.

In some cases, other medical conditions can make people more likely to develop pseudogout. These include an underactive thyroid (hypothyroidism), a genetic disorder of iron overload (hemochromatosis) or too much calcium in the blood (hypercalcemia). Pseudogout also can be triggered by joint injury, such as joint surgery or a sprain, or the stress of a medical illness. Frequently, however, nothing can be identified that might have triggered the disease. Although age-related joint degeneration, prior joint damage or trauma, and these other medical conditions increase the likelihood of an attack of pseudogout, the reason some people develop this condition while others do not is unknown.

Symptoms

Symptoms include:

  • Pain, swelling and stiffness around a single joint, especially the knee or wrist. Occasionally, more then one joint is affected at the same time.

  • Fever, usually low-grade

Diagnosis

Diagnosing pseudogout can be tricky because it can resemble gout, an infection or other causes of joint inflammation. Also, pseudogout commonly is associated with other joint problems.

X-rays may reveal calcium deposits along the affected joints, although X-rays of many healthy elderly people often show such deposits even when the person has no symptoms of pseudogout. Your doctor may recommend that joint fluid be removed from an inflamed joint and analyzed for calcium pyrophosphate crystals and for evidence of other diseases that can have similar symptoms. Your doctor may want to do tests for conditions that can trigger pseudogout. These may include tests of iron, calcium and thyroid function.

Expected Duration

Attacks of pseudogout can last for days or weeks. If the condition is not diagnosed, it can cause the joint to degenerate (break down).

Prevention

There is no way to prevent pseudogout. If your pseudogout is triggered by a medical condition, treating that condition may prevent future attacks of pseudogout. For people with frequent attacks, medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or colchicine, may prevent future attacks.

Treatment

Fluid can be removed from the joint to ease the pressure. In this procedure, called joint aspiration, a needle is inserted into the joint after the area is numbed, to withdraw fluid. Treatment usually also includes NSAIDs or injections of a medication called a glucocorticoid to keep the swelling down. These two treatments usually eliminate symptoms within hours to a few days.

You may also need to take oral corticosteroids for a short time. Your doctor may prescribe a medicine called colchicine to prevent attacks. Occasionally, people with recurrent or chronic pseudogout may develop degenerative joint disease. In this case, surgery (such as joint replacement) may become the only effective treatment.

When To Call a Professional

If you experience significant joint pain, especially if the joint is swollen, contact your doctor.

Prognosis

With treatment, the outlook for pseudogout is usually good. Joint pain and swelling usually go away promptly. It's common for attacks to return, but usually they can be controlled with repeated treatment.

Additional Info

American College of Rheumatology 1800 Century Place Suite 250 Atlanta, GA 30345-4300 Phone: 404-633-3777 Fax: 404-633-1870 http://www.rheumatology.org/

Arthritis Foundation P.O. Box 7669 Atlanta, GA 30357-0669 Toll-Free: 1-800-283-7800 http://www.arthritis.org/

National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse National Insitutes of Health 1 AMS Circle Bethesda, MD 20892-3675 Phone: 301-495-4484 Toll-Free: 1-877-226-4267 TTY: 301-565-2966 http://www.niams.nih.gov/

Last Annual Review Date: 2008-06-19T00:00:00-06:00 Copyright: Medical content reviewed by the Faculty of the Harvard Medical School. Copyright © 2010 by Harvard University. All rights reserved. Used with permission of StayWell.

Reference: Gout section on Better Medicine



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