Pseudo-gout: Understanding the Difference from Gout

Pseudo-gout, also known as calcium pyrophosphate deposition disease (CPPD), is a type of arthritis that causes joint pain, swelling, and inflammation. It is often confused with gout, but the two conditions have different causes and treatments.

Unlike gout, which is due to the buildup of uric acid crystals in the joints, pseudo-gout is due to the buildup of calcium pyrophosphate crystals. These crystals can form in the joints, causing sudden, severe pain, stiffness, and swelling. Pseudo-gout most commonly affects the knees, wrists, ankles, and shoulders.

Joint fluid analysis is the gold standard for verifying pseudo-gout.  A doctor performs joint aspiration (arthrocentesis) to extract synovial fluid from the affected joint, which is then examined under a polarized light microscope.  Calcium pyrophosphate dihydrate (CPP) crystals evaluated under a polarized light microscope are rhomboid-shaped and appear blue under polarized light, confirming the diagnosis. Pseudo-gout can coexist with gout or septic arthritis, so joint fluid analysis helps differentiate between these conditions.

Other tests may be done but are not diagnostic of the condition, such as X-rays to detect calcification in cartilage, a common occurrence in pseudo-gout; ultrasound to visualize CPP crystal deposits; or CT scans to identify calcifications, especially in the spine or complex joints. Blood tests may rule out underlying conditions (e.g., hypothyroidism, hemochromatosis, hypomagnesemia) that can trigger pseudo-gout.  Such tests may include serum calcium, phosphorus, magnesium, TSH, and ferritin.

There are several triggers that can lead to a flare-up of pseudo-gout. These include trauma to the joint, surgery, infection, or certain medical conditions such as hyperparathyroidism or hemochromatosis. Age is also a risk factor for developing pseudo-gout, with the condition most commonly affecting people over the age of 60. In several cases, treatment with bisphosphonate drugs, such as zoledronic acid (Aclasta® Zometa® ), has been associated with pseudo-gout. ¹

Managing pseudo-gout involves a combination of natural and medical approaches. To help reduce pain and inflammation, applying ice packs to the affected joints and resting the joint can be helpful. Over-the-counter pain relievers such as ibuprofen or naproxen can also provide relief.

Several natural supplements may help reduce inflammation and pain associated with pseudo-gout. It’s important to note that supplements, as well as medical treatment, should be under the guidance of a healthcare provider. Some natural supplements that may be beneficial for managing pseudogout include:

1. Turmeric: Turmeric contains a compound called curcumin, which has anti-inflammatory properties. It may help reduce joint inflammation and pain.

2. Ginger: Ginger also has anti-inflammatory properties and may help reduce pain and stiffness in the joints.

3. Boswellia: Boswellia, also known as Indian frankincense, has been used in traditional medicine for its anti-inflammatory properties. It may help reduce joint inflammation and pain.

4. Bromelain: Bromelain is an enzyme found in pineapple that may help reduce inflammation and pain. It may be particularly beneficial for reducing joint swelling.

5. Omega-3 fatty acids: Omega-3 fatty acids, found in fish oil and some plant-based sources like flaxseed, are known for their anti-inflammatory properties. They may help reduce joint inflammation and improve symptoms of pseudo-gout.

6. Vitamin D: Vitamin D plays a role in regulating the immune system and may help reduce inflammation in the body. Some studies have suggested that vitamin D deficiency is associated with inflammatory joint diseases, such as pseudo-gout.

It’s important to talk to a healthcare provider before starting any new supplement regimen, as some supplements may interact with medications or have side effects. Additionally, it’s essential to follow a healthy diet and lifestyle to manage pseudo-gout effectively. Regular exercise, maintaining a healthy weight, and staying hydrated can all help reduce inflammation and improve joint health.

In more severe cases, a doctor may prescribe corticosteroids to help manage pain and inflammation. In some cases, a doctor may also recommend draining the joint to remove excess fluid and crystals.

In addition to medication, making lifestyle changes can help manage pseudo-gout. An anti-inflammatory diet, rich in antioxidants, is key. Avoiding a diet high in sugar, refined carbohydrates, alcohol, and processed foods can help reduce intake of inflammatory foods, potentially contributing to pseudo-gout flare-ups.

Maintaining a healthy weight, eating a balanced diet low in purines (which can contribute to crystal formation, although this is more likely in gout than pseudo gout), and staying hydrated can all help reduce the frequency and severity of flare-ups. Magnesium-rich diets are also helpful, as a deficiency can contribute to pseudo gout. Foods high in magnesium include spinach, almonds, black beans, and pumpkin seeds.

While pseudo-gout can be a painful and debilitating condition, with the proper treatment and lifestyle changes, it is possible to manage symptoms and improve quality of life. If you suspect you may have pseudo-gout, it’s important to see a doctor for an accurate diagnosis and an appropriate treatment plan.

References:

1.         F. R, T. T, M.J. JP. Pseudo-gout induced by zoledronic acid: A case report, review of the literature and French pharmacovigilance database. Fundam Clin Pharmacol. 2014;28.