by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Pseudogout is a type of arthritis.
Pseudogout can cause symptoms similar to gout, but is caused by a different type of crystal deposit (pseudogout is also sometimes referred to as calcium pyrophosphate deposition disease). Severe attacks of pseudogout often occur in the knees and can be incapacitating for days or weeks. The wrists, shoulders, ankles, elbows or hands may also be affected.
Pseudogout develops when deposits of calcium pyrophosphate crystals accumulate in a joint. The crystals lead to pain and swelling in the joints. The swelling and inflammation can cause damage to the cartilage in the joint. It is not known why the crystals form, although crystal deposits clearly increase with age.
Incidence increases with age, with crystals present in as many as 50 percent of people in their nineties, although not all will experience symptoms. Because the condition sometimes runs in families, genetic factors are suspected of contributing to the disorder. A severely underactive thyroid (hypothyroidism), excess iron storage (hemochromatosis), an overactive parathyroid gland, and other causes of excessive calcium in the blood (hypercalcemia) may contribute to the development of pseudogout.
In some people, attacks of pseudogout may develop following joint surgery or other surgery. Because many older people have calcium crystal deposits in their joints, any kind of injury to the joint can trigger the release of the calcium crystals, which then induce a painful inflammatory response.
Diagnosis is made on the basis of symptoms and medical tests. The physician will aspirate fluid from a swollen or painful joint to determine whether calcium pyrophosphate crystals are present. An X-ray of the joint may be taken to determine whether calcium-containing deposits are causing chondrocalcinosis. Other potential causes of symptoms, such as gout, rheumatoid arthritis, or infection, must be ruled out. Pseudogout is often present in people who have osteoarthritis.
To treat pain and disability during severe episodes of pseudogout, the doctor may prescribe non-steroidal anti-inflammatory drugs (NSAIDS). People with reduced kidney function, a history of stomach ulcers, and those who are on blood thinners should avoid NSAIDs.
Another option is a cortisone shot into the affected joint. To prevent further attacks, low doses of colchicine or NSAIDs may be effective. There is no cure for the disease.
Treatments that decrease inflammation may help slow the progression of joint degeneration that often accompanies pseudogout. Surgery to repair and replace damaged joints is an option.
If the condition has developed because of some other medical conditions, such as hemochromatosis (too much iron stored in the body), or parathyroid problems, treatment of that condition may slow the development of pseudogout.
Diagnosis is confirmed by microscopic identification of calcium pyrophosphate crystals. While anti-inflammatory agents can help lessen symptoms, there is currently no way to eliminate the crystals themselves.
In refractory cases, disease-modifying therapies such as Plaquenil and methotrexate have been used with mixed success.
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