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Community > Expert Q & A > Gout > What is Pseudogout?
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What is Pseudogout?

Q: I hear and read a lot about gout, but I have been diagnosed with pseudogout. What is pseudogout, and how it is treated?

A: Pseudogout often resembles gout and, like gout, is caused by the formation of crystals in the joints, thus the name. But instead of being composed of uric acid, as true gout crystals are, the crystals in pseudogout are composed of a salt called calcium pyrophosophate dihydrate (CPPD). The condition is also called CPPD disease. 

Pseudogout is the most frequent cause of acute arthritis in one joint among older people. Although any joint may be involved, the knee is most commonly affected. A typical attack begins rapidly with severe pain, redness and swelling of the affected joint or joints. The attacks often resolve within a few weeks whether treated or not.

To limit pain and swelling, your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) or remove fluid from the infected joint and inject it with a glucocorticoid compound.

Unfortunately, recurrent attacks of pseudogout are not uncommon. Chronic attacks are likely to affect several joints at once, most commonly the wrists, fingers and knees. Like gout, pseudogout primarily involves the body's metabolism (for instance, a problem with iron or calcium metabolism) rather than the immune system. However, there is no specific therapy for the underlying metabolic disorder.

Bernard Rubin, DO, Rheumatologist

Wendy
16 Oct 2009, 12:00
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Rita
This Arthritis clinic is in Virginia? I live in Boise Idaho. The rhumies here seem to think this is in my head and the pain couldn't be as bad as I say it is. The internet states this should come and go like regular gout. It is a constant for me. Like a gout attack that never goes away. It is painful and exhausting to say the least. I am willing to travel for treatment.Virginia is across the coutry. Is there someone a little closer that deals with this type of crystal? Please reply if you have a doctor that knows about this disease.
Rita
06 Oct 2009, 20:55
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This is for Wendy. Cortizone shots are heaven!!! I found a research doctor at the B&W Arthritis Center after seeing 3 other specialists and he has given me some relief although when the shot wears off the pain comes back and it is constant. I will be 47 next week and I have been diagnosed with RA, Osteo, Fibro...you name it. I think all in all it is just a big guessing game and $$$ for some of the docs. Anyway, I have been taking a water aerobic class at the Y and it has helped a great deal. I also take fish oil pills every morning and so far so good. Also stay away from carbs I get much achier when I eat crackers, chips etc. Give it a try and good luck to you.
mary oshiro
06 Oct 2009, 20:04
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MARY,i'm taking mexotrexate & alendronate, but lately my feet are burning actually my toes,is not to bad my feet i can manage but not my toes, i just start working , I'm on desability but unfortunatelly i have to work, i was on my feet for 6 hours but i can.t stand the burn that i feel on my toes,what should i do, i have only a primary doctor, i can't afort a specialist, should i suggest my doctor about prednosone?, i'm really scare about the side iffects, i used to take them for about 8 months, then i stop, because i mouve to another state and i couldn't affort insurance, now i have but it's very limited the cover., please do you have any suggestions regarding my desease
thank you for your interest in this matter
mary
Randy
06 Oct 2009, 16:26
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My doctor as digenosist with RA for the last three years. I have tried several RA meds and get limmited help. I will say that I got better but still have very painful days. It all actually started when my big toe swelled up and ny left knee started to hurt. The first doctor I saw thoght it was Gout. But the next one said it was RA. I went back to the first doctor because my wrist had swollen and he check my blood and told me I have gout, and that there was uric acid in my blood test. I wonder is it possible that I have both RA and Gout, or just Gout.
Wendy
03 Sep 2009, 09:55
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Pseudo gout…. I am now almost 54. I am female and was very active. When I was 50 my feet started to ache terribly. I went my rheumatologist and was tested for arthritis, MS, everything under the sun. The pain spread to my hands and to my back. The swelling was minimal but the pain was excruciating. I was put on many arthritis meds including Enbrel. My immune system went off the charts. I started having infections that they could not control. The meds were doing nothing to help the pain. I had 2 surgeries to stop a breast infection and part of my breast has now been removed.

Nothing showed up on labs, MRI’s, X-rays and after seeing 3 doctors, and running every test possible I am sure the doctors thought I was crazy.

After one year of trying different arthritis meds, I begged for relief and I insisted on a shot of cortisone directly in my foot. The shot had a global effect and I felt normal for the first time in 2 years. It lasted about 1 month and the intense pain returned. The doctor refused another shot stating it could cause cataracts and destroy my tendons.

I changed doctors because I had a feeling my original doctor thought I was making it all up. The second doctor started the testing all over from the beginning and prescribed the same arthritis meds. He did not have a sonogram machine and was not able to give cortisone shot in my foot. Another year and a half, I suffered in pain. I complained to everyone that would listen. The doctors found nothing. After all of this I feared he too was thinking it was in my head.

I decided to go back to the original doctor because he had a sonogram machine and he could give me another shot in my foot. I needed relief from this pain so I tucked my tail between my legs and crawled back to him.

I went in for the 3rd sonogram of my feet and lo and behold the girl that did the sonogram said “I think I know what you have! You have a thing called pseudo gout. It is rarely seen in someone your age. You are so young and healthy. She did a sonogram on my hands and after 3 years of testing, and excruciating pain, I finally have a diagnosis of chronic pseudo gout causing secondary fibromyalgia from the pain.

The doctor quickly pulled fluid from my joint for confirmation and gave me cortisone shot in my foot. This time, the shot felt like someone split my foot in half with a sledgehammer but in 3 days all the pain was gone.

That was a little over one month ago and the pain has returned. Cortisone shots can not be given often enough to relieve my pain but it is like having a remission that I can look forward to a couple times a year. I must pick my periods of relief sparingly.

I am now taking Darvocet 4x a day for pain (my stomach can not handle anything stronger) and he prescribed Celebrex which is not helping. The only constant med I had previously taken is Hydrochlorothiazide for 30 years. After searching the internet, I see that it might be the culprit.

It has been quite the 3 years. I am told that there is no cure and only treatment to make the reoccurrence less. Mine is different, it never goes away. It is always here. There is constant pain. The days of painless days are far and few between.

There must be some treatment out there.
Brenda Goodman, medical editor
31 Aug 2009, 11:34
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Hi Lucy,

I found some information on the University of Washingtons website about CPPD (Calcium Pyrophosphade Dehydrate), deposition disease, which is a kind of pseudogout.

In order to answer your question about medications and weight gain, I would need to know what you are taking. You can post that information here, or write to us privately by sending a question through the Ask an Expert a Question feature on our website.

Try pasting this link into your browser:

http://www.orthop.washington.edu/uw/cppddeposition/tabID__3370/
ItemID__29/PageID__1/Articles/Default.aspx#1417

Kind regards,

Brenda
Lucy Somsak
29 Aug 2009, 10:40
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I left two messages which I see here. But where are my answers.............? Lucy
Lucy Somsak
23 Aug 2009, 14:25
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I wonder if meds for my problem could cause weight gain. I have gained rapidly. I don't exercise because I feel very tired. I was also diagnosed with fibromyalga. Is there something to take that would not cause me to gain more weight? Thanks Lucy
Lucy Somsak
23 Aug 2009, 14:20
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I have been diagnosed with CPPD. I was told to take a med for the pain, that there is no research for this arthritis. I was told that my condition could get worse or remain as I am now. I first started with pain when I was 45 years old and I am now 67 years old. I was told that I do not have osteoarthritis nor rheuamtoid. I thought that maybe I could have both osteo and CPPD at the same time. But my doctor said no. I have had my tumb joints fused and a laminectomy w/fusion. That surgery involved, one rod one plate six screws one cage and fusion. All the while thinking that I had osteoarthritis. Couldn'/wouldn't a doctor tell that it was CPPD when he was in there doing these surgeries. I find no info regarding CPPD. Seems it is over looked..............Just wonder what info there is and where to find it. Thanks
denis
22 Jul 2009, 02:15
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I've had gout for perhaps 15 years. It started in the classical way - the big toe, and later gravitated to other places. As time when by the attacks become more frequent.

I finally (luckily) discovered the folks at www.goutcure.com. These people are nutritionists, and what they sell are "natural" products that treat gout. The most critical component helps keep uric acid soluble and you need to drink lots of (unadulterated) water to flush it out.

They not only tell you what not to eat, particularly during attacks, but recommend what you should eat.

You need to learn as much as you can, (because most docs just prescribe one of the standard prescription drugs - all of which may inflict you with bad side effects. These guys have good knowledge base because of all their clients. I'm told you can check out their references (by clients) on Yahoo
Daniel F. Maloney
13 Jun 2009, 16:34
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I thought I could tolerate any pain,but after 3 spine surgeries,ulnar nerve trans.achilles tendon tear,2 distant hernia operation and a neck srain as result of attempted mugging.....I am giving up...the pain is diffuse however my knees....pseudogout.......has put me under.
One becomes a joke among rude neuro/ortho geeks because I cannot take anti inflammatories due to the awful allergy causing VERTIGO.
Should I have knees replaced?
God bless you,
64 year old burned out bodybuilder,runner for 30years.Dan
Vern Niswander
25 May 2009, 02:14
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For years I have had pain in my ankels and have gone to doctors they have said that I have everything from bone spears to arthritis. I have worked const. all my life and they would hurt after I got off work and rested awhile and get up to walk. I'm not working any more just at home. My lower legs still swell making hard to walk. On 3/31/09 I went in for a back operation two days befor my ankel started swelling and hurt so bad that I could not even touch it they x-rayed it then a doctor said I had gout and he started me on colchicine this did little good. A week later I could put a little presure on it and some of the swelling went down, then my other ankel did the same thing that was for a week. Then it went back to the other one again. My pain doctor had two test done,no infection and uric acid are normal. I stop taking the colchicine. This has made my recovery on my back very slow. My ankel is still swelled and hurts to walk on. I'm going to my family doctor in two weeks and I want to have him try something diffrent or look at it in all ways.I want to tell him about this pseudogout since my tests did not show anything.I'm also on cymbalta,metformin,glimepiride,celebrex,metoprolol,diovan hct,caduet,flexeril,percocet,oxycontin,xanax, and methocarbamol. thank you
carole
17 May 2009, 16:03
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I have S L E and have recently suffered from painful swelling along with stiffness and heat in my lower right leg. After being backwards and forwards to my Doctor I went to the hospital were I have been told I have gout, which has been caused besause of the medication I take. They would not give me any medication to relieve the pain but told me to see my Dotcor. What will happen next, is there anything I can take to ease the swelling and pain

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