Pseudogout
Posted by GoutPal in Gout Related, tags: pseudogout, sudo gout, _pseudo-gout, _sudogout
A question from a reader today prompted me to take another look at my pseudogout page.
Everything was OK – just a bit missing about causes and potential treatments.
Pseudogout Causes
Though we know that pseudogout is caused by a buildup of calcium joints, we do not know all the reasons for this buildup.
Risks increase with age. 3% of people in their 60s get it, rising to 50% in their 90s. Pseudogout affects men and women equally. In general, their may be a hereditary risk factor. Dietary calcium does not appear to affect calcium deposits.
Specific factors that can trigger pseudogout are:
- Excessive calcium in the blood (hypercalcemia)
- Excess iron storage (hemochromatosis)
- low magnesium levels in blood
- overactive parathyroid gland
- severely underactive thyroid (hypothyroidism)
Pseudogout Treatments
I have said that there are no known treatments for pseudogout, other than pain relief. The pain relief options are similar to those listed on my gout pain relief page. However, if pseudogout is caused by one of the underlying conditions I listed above, then treating that can slow down the development of pseudogout.
As with gout, it is important to consult a rheumatologist if you have, or suspect pseudogout. You can find a local rheumatologist on the College of Rheumatology website. Their listing of rheumatologists covers the USA and most other countries.
If you have experience of pseudogout, please tell me in the comment box below, or on my Contact Form.
Entries (RSS)
I am 49 year young female with pseudogout. First diagnosis in 1991 in my right knee.
In 2004 them scoped and removed both lateral and medial meniscus after a severe attack. Only bits remained. 2 plus years later and I am not back to normal and unable to manage with out some pain meds.
Deb,
That’s terrible. I used to think nothing could be worse than gout, but it sounds like pseudogout is.
My sympathies lie with you.
I’m a 61 year old male in excellent physical condition. Diagnosed with pseudogout after flareups in both knees recently. Knees feel normal after treatment with cortisone and several months of recuperation. Can’t take the recommended drug, colchicine without stomach and lower GI upsets. I face a dilemma: strenuous physical activity brought on the original attacks, and I cannot risk a reoccurance. My work and recreational activities involve lots of physical activity. I’m too young and healthy to give these up. Can I manage the disease the same way diabetics do, by injecting this stuff before I engage in physical activity? I gather that no one has either thought of this or tried it, and I admit it seems pretty extreme, but I’m willing to try anything within reason. Thanks
(Addition to my comments) My understanding from doctors I have seen is that colchicine dissolves the crystals involved in pseudo gout and prevents flareups
Hi Steve,
Cortisone is an anti-inflammatory drug, similar to the same substance that is produced naturally in the body, but more powerful.
There is some concern that over-use can impair tendons and cartilage, though there does not appear to be any definitive scientific view on this. Any injection carries a slight risk of causing nerve or blood vessel damage.
I think there may have been some thought of using cortisone for sports injuries, but I have no real knowledge of this.
Any sports injury specialists out there care to comment?
Your second point about colchicine is incorrect. Colchicine is an anti-inflammatory drug. It has no effect on dissolving pseudo gout crystals. As far as I am aware, there is no medication available for dissolving the calcium crystals that cause pseudogout. If the cause of pseudo gout can be determined, then tackling that can have a beneficial effect on pseudogout.
Please remember that I have no medical qualifications. You should consult a rheumatologist to discuss treatment options.
My 28 yr old daughter has just been diagnoised with sudo gout. After orthoscopic surgery 3 weeks ago on her right knee she returned to the ER in EXTREME pain, leg was swollen and hard, Dr.drained of 100 cm of yellow junk and it was sent to pathology, it showed crystals which they believe is sudo gout, also it showed strep, have you ever heard of such? we have been told she will need a knee replacement
I remember one of my clients suffered from gout. He couldn’t work and had to rest for 3 days. This client of mine is only in his early 40’s. Thanks for the relevant links you have provided. I will share those information with him.
Hi, you mentioned that pseudogout typically affects larger joints but is it possible that it could affect the big toe?
My mom has been experiencing spouts of pain in her right big toe. She had a blood test done, and the doctor said that she didn’t have gout because she had normal levels of uric acid.
Unfortunately a huge number of doctors in general practice simply do not understand gout, which is why I almost always recommend seeing a rheumatologist.
When gout crystals form, they remove uric acid from the blood, so uric acid levels are frequently within the normal range during a gout attack.
Pseudo gout can affect the toe joints, so it cannot be ruled out, but the only way to be certain is to have an arthrocentesis test.
Try my find a rheumatologist page.
I remember my rheumy saying PG is often overlooked even by rhumys
I just posted elsewhere on this site and just now came across the above message. I am confused now about my gout. Is it possible it’s pseudogout? I had hypercalcemia as a result of an overactive parathyroid gland until December 2009 when the surgeon removed the gland. Although it’s impossible to know when this condition began, hyperparathyroidism commonly goes undetected for many years. I probably had it when I had my first two “gout” attacks seven and two years ago. Now I’ve just had a third attack, three months after the removal of the gland. Is it possible that you can have a pseudogout attack that long after the hypercalcemia had been normalized? Could there have been a build-up of calcium in the toe but trigged by something three months after the calcium levels returned to normal? Of course it’s not ruled out that there is not another affected parathyroid gland. Also, all attacks have been in the big toe joints. I just find it curious that with two of the five above-listed triggers, my system was well set up for pseudogout, but it appears that I had gout instead?
I have recently been diagnosed with pseudo gout(Knee). Has anybody any experience with alternative Treatment (herbs, supplements, etc.).
Has your doctor indicated any underlying cause for pseudogout? There is not much that you can do for sudo gout directly, other than anti-inflammatory preparations. Something like flax seed oil may be helpful.
I have recently been diagnosed with psuedogout. I am a very active 51 year female. I currently take calcium and vitamin c supplements and am wondering if it would be advisable to stop taking them.
Pseudo gout is extremely hard to treat. However, it is often the result of underlying conditions. If these conditions can be treated, then pseudogout usually clears-up, or at least does not get worse.
So you need to get tests and advice from a rheumatologist to seek out the cause, and try to fix it.
A common cause is excess iron, and vitamin C will make this problem worse. Another cause is problems with the parathyroid gland. Some of these problems are helped with calcium, but it really needs expert examination and analysis to make sure you are not making the situation worse.
This site has a lot of general purpose info on Psuedogout
http://www.arc.org.uk/arthinfo/patpubs/6051/6051.asp
While not there to help people ’self treat’ – a lot of questions get answered and illustrated ,particularly on shoulders and knees -where uric acid is far less likely to cause problems, by all I’ve read on the topic.
Last year I was chatting to a young woman in my local surgery waiting room and she said she’s had terrible problems with knee inflammation and it wasn’t gout.
I asked if Psuedogout had been investigated and she said No! – but would definitely bring the issue up with the Dr.
Nothing changes, does it? – but I hope it did the trick , if on the mark for her.
I am a 48 yr old, diagnosed with pseudo-gout 5 years ago. HORRIBLE, HORRIBLE, HORRIBLE pain. I have no thyroid problems but I do have significant spinal issues. There is nothing to dissolve the crystals and nothing to “cure” it. Anti-inflammatories and cholchicine are the best there is at this time. Cortisone injections help some too. I have it in both knees and in my right ankle. I feel that pseudo-gout attacks are equal in pain to childbirth – HORRIBLE!
That is terrible. My sympathies to you.
Have you had blood tests for excess iron or low magnesium?
Yes, I have. however, most recently I have had labs done to check thyroid. haven’t heard anything yet.
For the last 2 years I have been dxed and treated for Rheumatoid Arthritis. About 6 weeks ago, after seeing a new rheumy, the dx has been changed to Psuedo Gout. It appears that Psuedo Gout can produce RA symptoms.
Has this happened to anyon els?
Joint inflammation can take many forms. Rheumatoid arthritis, osteoarthritis, pseudogout, gout, septic arthritis and bursitis are all examples of swollen joint conditions that can be misdiagnosed. The risks of mis-diagnosis are greatly reduced if the rheumatologist analyzes fluid drawn from the affected joint.
There is some evidence to suggest that methotrexate can relieve the symptoms of pseudo gout.
My husband is in the process of being diagnosed with peudogout. It sounds like this isn’t going to be fun for him. Any suggestions on a diet that works well for this?
As far as I am aware, diet has no effect on pseudogout. Your rheumatologist will normally try to find the underlying cause of pseudo-gout and there may be dietary factors that affect whatever that condition might be.
My rheumy found the calcium crystals on x-rays.
Has anyone lese found them on x-rays?
I did see them.
I had a pseudogout attack in my right knee in April of 2007 shortly after I began to exercise by walking outdoors after a long winter break from daily walks. I went to the emergency room 4 days later. I could barely walk because my right knee was swollen to twice normal size. They took xrays, said nothing was broken, tentatively diagnosis was gout, and referred me to my orthopedic doctor. He relieved the fluid on my knee and sent it to the lab Because my orthopedic doctor is very knowledgeable, he knew immediately there were no uric acid crystals in the fluid and tentatively diagnosed pseudogout, but sent it to the lab anyway for confirmation. He also gave me a cortisone injection and a prescription for indocin. He warned that indocin cannot be taken by everyone because it causes stress on the digestive tract. The relief of having the fluid removed and the cortisone shot were basically all I needed. I took indocin for a few days but believed my doctor’s warning and so I did not continue to take it when my symptoms were relieved. I have not had an attack since.
I’m glad the symptoms have gone. It’s never a good idea to take indocin for long periods.
It is good to hear that the pain has gone. Did the fluid reveal any calcium crystals? I.e, did your doctor ever confirm what the real problem is (or was)
Keith, I know the problem is hypothyroidism because I was diagnosed with it 17 years ago. But it is the first and only time it had ever caused a problem like this and No calcium cyrstals in the fluid….Fran
And let us hope it is the last. :-D
Keith (AKA GoutPal)
After being dxed with Psuedogout, RA was ruled out. However, it is back in the equation.
It seems the PG causes the most pain in my left (outside) ankle.
Unbelievable pain.
Feels like something is gnawing and crunching on the bone.
I can not take NSAIDs so am in pain much of the time.
Hopefully, I will start Orencia soon.
Where is your most painful area from pG?
I was first diagnosed with ‘arthritis’ 15 years ago. Negative test for Rheumatoid A so my GP settled on Osteo A (orthodox medicine cause == cartilage wear and tear). The pain started in my fingers and later escalated and spread.
Over the years two different General Practitioners (family doctors) both showed little interest in further assessment.
I couldn’t accept cartilage wear as the cause (how did I wear out the joint in my little finger I asked?)
Subsequently decided to become my own doctor and I am now starting to get some answers.
Just some opinions:
- don’t accept there is no cure
- imaging tests and testers have variable competence so scans etc may not show deposition
- AFAIK uric acid chrystals will not show on XRay (anyone agree or disagree with that?)
- I believe it is possible to have systemic or widespread gout (urate depositions) without the obvious symptoms (toe lumps etc)
- calcium depositions do show up on XRay (in my case I have confirmed minor chrystals in my shoulder – haven’t XRayed all joints)
- I haven’t ruled out the possibility that I could have uric acid depostion and calcium deposition at the same time (maybe in different places)
- since I have XRay confirmed CPPD lets go with that … my GP missed it even though OA does not usually appear in the elbows and shoulders == typical of CPPD …. yes, it gets in the toes, especially the big toe, just like gout … yes, it gets in the neck and spine where orthodox medicine calls it something else … I have had a stiff neck for 15 years and XRays showed nothing unusual
- IMO CPPD is very common and is usually misdiagnosed as RA
- the things that the docs have done to some of you guys is horrendous
At my worst I could not turn my head 180 degrees, could not swim overarm == free style and had to dog paddle in the pool, could not run.
I am wary of using strong pharma medicataion (NSAIDS etc) and so turned to ‘natural healing’ because I was predisposed to that anyway.
Tried ginger, homespun remedys, mild diet improvement, Glucosamine etc and certainly did not get any worse and possible had some minor improvement.
Recently started using Magnesium Oil (I don’t sell it or benefit in anyway from its sale).
After 3 months I have had some improvement …. I have had few short runs down the beach .. did 3 kilometers in the sand one day .. also swim a kilometer once a week and paddle a canoe up to 20 klms, once a day.
I haven’t found the cure but I believe I will.
In the meantime … read and research voraciously.
You might need to adjust your attitude … if very few people are cured or stabilized by Rheumatologists why keep having faith in them?
Don’t take risky medications or natural supplements but be prepared to try anything reasonable.
Try to get some excercise and gradually build up.
(The rational for the Mag Oil is that it supplements Magnesium directly via skin absortion and this can balance out excessive Calcium OR alkalize the blood enough to inhibit uric acid depostion).
I believe massage, to break up the chrystals, is important (excercise helps with this also).
Also look to your diets (read about alkalizing the body).
To find out about Magnesium Oil google for Dr Mark Sircus OR Dr Seelig OR Carolyn Dean (find their books at Amazon) OR check out MagnesiumForLife.com website
Good luck to you all.
Brian
Thank you for your input, Brian.
The magnesium oil angle is interesting. In my article on pseudogout, I list low magnesium as one of the potential causes:
I think the very least that doctors can do where calcium deposits are suspected is to check for any of these underlying conditions.
Did you get tested for low magnesium, or did you just fall lucky on the magnesium oil?
I will do a little updating to my pseudo gout page as I transfer it to the new format. I believe that the new anti-inflammatory drugs currently being tested for gout, will also be beneficial to pseudogout sufferers, Though, as always, it is better to try and fix the cause rather than merely mask the pain.
Gidday Goutpal,
Yes, indeed, a cascade of fortuitous events lead to me hearing about Mag Oil.
No, I haven’t been tested for Magnesium levels.
Mg deficiency can’t be accurately diagnosed from standard blood serum tests because the serum level is auto regulated so that, if the intake is inadequate Mg will be moved from the bodies store houses to the blood.
Testing is actually quite difficult and/or expensive and/or not readily available e.g. Dr Altura (USA) has developed an accurate blood serum analysis but this is only available, if at all, in the one lab.
Other methods, like Hair analysis are controversial or not readilyu available e.g. Mg load testing (the subject takes a controlled amount of Mg supplements and the retention rate is measured as the difference between ingested amoun the amount excreted in the urine).
The list of possible causes of Calcium deposits is a very interesting list.
I will have to do some homework in Hemochromatosis (what has it got to do with iron?)
My understanding is that Mg will keep Ca in solution in the blood if it is present in the required amounts hence my experimentation with Mg Oil.
I just started taking Nascent Iodine to assist my thyroid since I read that many of us are deficient in Iodine and the role it plays in the overall hormonal system (so far so good).
I am a little unsure about my Ca status …. I haven’t drunk milk for over a decade and only eat cheese sparingly so in the past I assumed I would be at danger of being low on Ca if anything.
As a precaution I took Calcium Citrate, as a supplement, for over a year, just in case but really my CPPD/arthritis/gout/whatever it is developed over a decade when I didn’t supplement Ca and didn’t consume much dairy.
I also have it on my short list to find out a bit more about how an overactive PT gland gets into the act.
No arthritis in my parents or grandparents AFAIK.
The local Dr’s are pretty hard pressed.
IMO it is up to us to be proactive, ask informed questions and press for referrals to specilists and/or perform further diagnosis (scans, tests etc). From my experience many of the first line medics know very little about it.
I also have to agree with the comments of another blogger that ‘we’ seem to have to go to the teaching hospitals to find those who are well informed. I guess the better Rheumatologists would also be up to speed with it.
I have heard about the new gout drugs also helping with psuedogout.
I am interested to see how a drug designed to target the pain/inflammation caused by uric acid chrystals can also be effective with Calcium Pyrophosphate DecaHydrate Deposits.
BTW I don’t have the classic profile of a gout sufferrer … I am a non-drinker, non-smoker, non-drug user and not on any medication at all. I don’t each a lot of meat (or other prurine rich foods).
The reason I opened my mind to the possibilty that ‘gout’ sufferers could be diagnosed as arthritics is because I have the classic big toe pain plus I have heard of many ‘arthritics’ who don’t have XRay confirmation
(as per my neck i.e., I have the neck pain but nothing on the scan.)
I think it is always better to exhaust every avenue before turning to medication and other interventionist strategies. As always though .. it depends on the individual and their particular circumstances.
I am not against medication if all else has failed and medication makes the persons life better.
If I get to the point where my quality of life is severely diminished and I can’t relieve the pain any other way then of course I will consider what medication is available.
So far, luckily I am heading in the other direction.
Good luck to all of the other gout/pseudogout/arthritic sufferers out there (the worst partof it is that often we appear normal when we are not and people don’t know otherwise … not much sympathy for people without visible handicaps out there).
Brian.