Pseudogout: Causes, Symptoms, Treatment, Ayurveda Understanding

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S

Pseudogout is a form of arthritis. It presents with painful swelling in one or more of the bony joints which occurs suddenly. There are sudden flare ups of symptoms including pain, swelling and stiffness of the affected joints. The symptoms which occur in episodes can last for many days or weeks.

Other names –

–        CPPD – Previously pseudogout was known by yet another name i.e. CPPD – Calcium Pyrophosphate Deposition Disease. Since it is similar to gout in its presentation, it is commonly called Pseudogout.

–        Calcium Pyrophosphate Arthritis and

–        Chondrocalcinosis

Both gout and pseudogout are crystal arthritis. In both these conditions, crystals get deposited within a joint. But the type of crystal deposited in the joint in both these conditions differs.

It is called pseudogout because the symptoms of this disease are similar to those of gout. In spite of that, it is a different condition from gout. While too much of uric acid in the blood causes gout, excessive buildup of CPP i.e. calcium pyrophosphate dihydrate causes pseudogout.

Nothing has been proved so as to why crystals form within the joints and cause pseudogout. It is seen that the risk of pseudogout increases with age. Pain and inflammation can be relieved by timely interventions.

To sum up – A condition of the joints presenting with inflammation of the joint, pain, stiffness and swelling caused by severe buildup of calcium pyrophosphate crystals in the joint is called pseudogout.

Symptoms of Pseudogout

Pseudogout is seen to commonly affect the knee joints. It can also occur in hands, wrists, shoulders, hips, pelvis, elbows or ankles.

Symptoms of Pseudogout / Pseudogout attack

–        Sudden and intense pain in the joint / joints

–        Discolouration / redness of the skin

–        Swelling of the joint

–        Stiffness of the joint

–        Increased heat / warmth in and around the joint

Flares or attacks – The symptoms of pseudogout have tendency to recur i.e. they keep coming and going often. This is called flares or attacks of pseudogout. The attacks of the disease and appearance of symptoms may take place suddenly. Many times, the symptoms may not be experienced developing slowly but in fact all symptoms are noticed at a time. Flares of pseudogout can last from a few days to a few weeks or even longer.

Sudden manifestation of severe joint pain and swelling should alert one to immediately seek a medical opinion with his or her doctor.

Causes of Pseudogout

Pseudogout is mainly caused by buildup of CPP – calcium pyrophosphate in the affected joints. This leads to formation of small crystals that build up in the cartilage and synovial membranes. These CPP crystals eventually clump up inside the joints and cause flare ups of symptoms of pseudogout.

Thus, pseudogout is marked by the formation and presence of calcium pyrophosphate dihydrate crystals within the affected joint.

With ageing these crystals become more numerous. On the contrary, all people who have deposition of these crystals in their joints do not end up developing pseudogout.

Therefore, there is no evidence or studies to substantiate why some people with these crystals in their joints develop pain and other symptoms relative to pseudogout and why the others would not develop the symptoms.

Many factors have been contributed to the formation of excessive CPP in the joints but experts are not sure about none of them. They are –

–        Hereditary factors

–        Trauma / injury which damages the joint

–        Metabolic conditions

–        Endocrine conditions

Risk Factors for Pseudogout

Below mentioned are the risk factors for pseudogout.

Ageing – Though anyone can develop pseudogout, it is found to commonly affect people older than 65 years of age. The chances of developing pseudogout increases with age. It is common in ageing individuals.

Trauma to the joint – the risk of one developing pseudogout increases following a serious injury to the joint. The same is the case after surgery.

Genetic – hereditary tendency to develop pseudogout among the family members is found among some families. In these cases, the disease develops at a younger age itself.

Medical conditions – underactive thyroid gland or overactive parathyroid gland are linked to development of pseudogout.

Imbalances in minerals – having too much calcium or iron in blood is a risk factor for development of pseudogout. Same is the case in those having too little of magnesium in the blood.

In short, below mentioned health conditions can increase the risk of developing pseudogout –

–        Thyroid disease

–        Hyperparathyroidism

–        CKD – chronic kidney disease

–        Hemochromatosis

–        Osteopenia

–        Low magnesium levels in the blood – Hypomagnesemia

–        Low levels of phosphates – Hypophosphatasia

–        Gout

–        Osteoarthritis

–        Rheumatoid Arthritis

–        Post-traumatic arthritis

Complications of pseudogout

Joint damage due to crystal deposits in the joints is a common complication of pseudogout. Post damage, pseudogout may present with symptoms and signs of rheumatoid arthritis or osteoarthritis.

Other complications

–        Frequent and severe flares of pseudogout – are evidenced in untreated or improperly treated pseudogout.

–        Headaches

–        Neck pain

Time to see the doctor

One needs to immediately consult a doctor in the below mentioned conditions –

–        Experiencing sudden and intense pain in the joints

–        Intense joint pain along with swelling and discoloration / redness of the skin

–        Pseudogout like flare ups in those already having other types of arthritis, gout, infections

Diagnosis of Pseudogout

Signs and symptoms of pseudogout mimic those of gout, rheumatoid arthritis, osteoarthritis and other types of arthritis. Therefore, to confirm the diagnosis of pseudogout and to differentiate it from other conditions the doctor may run some lab and imaging tests as and when needed.

Blood tests – to find our problems with thyroid and parathyroid glands and also for mineral imbalances which are often linked to pseudogout.

Arthrocentesis / aspiration of joints – is done to test the fluid in the affected joint for presence of crystals.

X-ray – of the affected joint will be needed for knowing the extent of joint damage and crystal deposition.

Other tests

–        CT scan

–        MRI

–        Ultrasound

The above tests may be preferred to find chondrocalcinosis – signs of CPP buildup.

Differences between pseudogout and gout

 Prevention

There is no proven way to prevent pseudogout. One way is to manage the other health conditions to reduce flares of the disease. Pseudogout attack does not usually have direct causes i.e. triggers that you can modify or avoid.

Treatment of Pseudogout

As such there is no particular proven treatment for pseudogout. But pain can be relieved and the functions of the joint improved by effectively combining some treatments.

One or more of the below mentioned medications are useful in treatment of Pseudogout.

–        NSAID – Non-steroidal Anti-inflammatory Drugs – like Naproxen, Indomethacin etc

–        Colchicine

–        Corticosteroids – prednisolone – to reduce inflammation and to end attacks and prescribed for those who cannot take NSAIDs or Colchicine

Joint Drainage – Pain and pressure in the affected joint can be relieved to an extent by removing some of the fluid which has accumulated in the joint causing the mentioned symptoms. This fluid is removed using a needle. Some crystals formed in the joint can also be removed with this procedure.

Biological injections – anakinra / canakinumab injections may be suggested to manage pseudogout attacks.

Home remedies and lifestyle changes

Home remedies will help in flare-ups of pseudogout but they do not constitute proven remedies and should not be resorted for without medical opinion. Using NSAIDs, resting the affected joint, applying cold packs to the affected joints are included in home remedies for pseudogout.

Outlook / Prognosis of Pseudogout

Flares of symptoms are common if you have pseudogout. If pseudogout is not diagnosed and treated promptly on time, the flares are likely to happen more frequently. Flares occur often with ageing in spite of the person being treated for pseudogout.

Related Studies and Researches

A Study – ‘Chondrocalcinosis – Pseudogout Syndrome – A family study’ – The findings noted in this study support the concept that this syndrome may be hereditary.

In yet another study – Analysis of 24 cases of articular chondrocalcinosis showed that in 5 cases there was association with other rheumatic diseases, but of the other 19 cases there was otherwise unexplained acute or subacute arthritis in 12 cases i.e. 63% cases at some time during illness and chronic symptoms of joint involvement characterized by low grade arthralgias in 10 cases i.e. about 53% cases. Hyperuricemia with or without gout was found in six of 19 cases in which uric acid studies were conducted. This suggested a possible relationship between hyperuricemia and chondrocalcinosis.

Ayurveda Understanding of Pseudogout

Pseudogout can occur in many joints but knee joints are mainly affected. ‘Janu Madhye Maja Rujah’ i.e. severe pain in the centre of the knee joint is the hallmark symptom of a condition mentioned in ‘Vata Vyadhi’ i.e. ‘Kroshtuka Sirsa’.

Kroshtuka Sirsa is a swelling of the knee joint caused by aggravated vata in association with rakta – aggravated blood, presenting with severe pain in the knee joint.

Pseudogout can be correlated with Kroshtuka Sirsa.

This condition has not been explained in detail in Ayurveda, except a two-line verse.

Since it is a vata vyadhi, it shall be treated on the lines of ‘vata vyadhi chikitsa’ – treatment of vata vyadhi. Pseudogout can also be treated on the lines of Vatarakta – popularly correlated with gouty arthritis. Vatarakta, according to Master Sushruta, is also a kind of Vata Vyadhi.

Related Reading – ‘Kroshtuka Sirsa’