A little while ago on this blog, we looked at gout and its impact on knee joints.
Gout is one of those medical conditions that’s well known to the general public, partly due to its associations (rightly or wrongly) with famous historical victims like Henry VIII.
Less famous – but equally important from a joint perspective – is a condition called pseudogout. Although the name makes it sound a lot like classic gout (it’s sometimes actually known as “false gout”), there are some significant differences. Here’s what you need to know.
What is pseudogout?
Pseudogout is a type of inflammatory arthritis where microscopic crystals build up in the soft tissues of joints. It can happen to any joint in the body, but most commonly affects the knees, hands and ankles. The crystals can cause a number of unpleasant symptoms, including swelling and pain.
Doesn’t gout also involve microscopic crystals?
Yes, but a different type. Gout is caused by excess production of urate, an acid that our body produces when it breaks down purine molecules (after we’ve eaten, for example). Pseudogout is caused by deposits of calcium pyrophosphate, a chemical compound that’s produced within our joint cartilage. For this reason, you’ll also see pseudogout referred to as Calcium Pyrophosphate Deposition (CPPD).
What problems do these crystals cause?
One common symptom is swelling. This is often accompanied by hot, red skin – and sometimes quite severe pain. In time, CPP crystals can also damage the joints themselves. Confusingly, however, the presence of deposits in your knee doesn’t necessarily mean you have pseudogout proper. About half of people over the age of 85 have CPP deposits in their joints, but only a minority will go on to develop pseudogout and its unpleasant symptoms.
How do the symptoms differ from gout?
They’re often very similar, which is another reason why the two conditions are easily confused. One difference is that gout often starts in the big toe, whereas pseudogout is usually seen in the knees first, then the wrists and ankles. It’s also pretty rare in the under-60s, whereas gout can affect young people too (and indeed seems to be increasing in younger age groups).
So how would you know if I have one or the other?
The only way to be sure is to do a proper diagnosis. This will involve your medical history, an examination, imaging (such as x-rays) and some tests on your joint fluid and / or blood. Because redness and heat can be signs of infection, we will also want to rule this out. If you do have these symptoms, you should see a doctor immediately.
What actually causes pseudogout?
Scientists aren’t sure why some people go on to develop pseudogout when others don’t. A hormone imbalance or metabolic disorder may be involved at first, followed by an immune system response when the crystals enter the joint fluid (triggering swelling, redness, and so on). But we do know that certain risk factors make people more likely to develop it. These include:
Genes – if you have family members who have suffered from pseudogout
Injury – if you damage your knee joint in an accident
Age – because CPP production seems to increase as we get older
Existing arthritis – studies suggest people who already have osteoarthritis are up to three times more likely to have CPPD
Thyroid problems – issues with the parathyroid glands can raise the risk of pseudogout
How do you treat pseudogout?
There’s no specific cure for pseudogout, so treatment focuses on managing your symptoms when they arise. There are a number of practical things you can do to ease the pain and inflammation. Rest and using ice packs to reduce the swelling can be helpful. Painkillers and anti-inflammatory medicines can also help. If we aspirate your knee (remove some fluid from the joint), we may also recommend a steroid injection at the same time. A knee support can sometimes be useful if the joint gets very swollen. As with many other knee issues, we also want to keep a close eye on any underlying conditions that may be contributing to the problem – such as osteoarthritis. The good news about pseudogout, however, is that it tends to settle down after the initial flare-up. These flare-ups tend to last for two weeks or so before subsiding. So the main thing we want to do is reduce those symptoms, alleviate pain and swelling, and give you the right support when pseudogout strikes.
If you’re worried about your knees – or experiencing pain, swelling or other problems in your joints – it’s always a good idea to get them properly looked at. You can book an appointment with Mr Bailey here, or call us direct on 01962 826107. We’ll be really pleased to get you the help you need.