Erase the Pain

WHAT IS PSEUDOGOUT?

Pseudogout results from a build up of calcium crystals (calcium pyrophosphate dihydrate) in a joint. The joint reacts to the calcium crystals by becoming inflamed. The calcium deposits and chronic inflammation can cause parts of the joint structure to weaken and break down. Cartilage, the tough elastic material that cushions the ends of the bones, can begin to crack and get holes in it. Bits of cartilage may break off into the joint space and irritate soft tissues, such as muscles, and cause problems with movement.

The word 'pseudogout' actually means 'fake' or 'imitation gout.' Like the disease gout, pseudogout can come on as sudden, recurrent attacks of pain and swelling in a single joint. Gout is also caused by the build-up of crystals within a joint. However, gout is caused by the build-up of uric acid crystals, rather than the calcium crystals. Gout usually attacks the big toe, while pseudogout most often attacks the knee.

Chances of getting gout increase with age. Pseudogout affects 3% of people in their 60s. 50% of people over age 90 will get gout.

The symptoms of pseudogout include sudden and repeated attacks of pain and swelling in one joint. There may be stiffness and increased heat at the affected joint. Pseudogout most commonly affects the knees, but it can also affect the wrists, elbows, shoulders and ankles.

Pseudogout usually comes on with no warning. The symptoms may last several days to a few weeks and then disappear. Recurrent episodes may occur, again without warning, and each time affect a completely different joint. The attacks will usually affect only one joint at a time.

Damage from pseudogout progresses over time and may result in several problems. You may have pain, especially when moving an affected joint. Sometimes, you may hear a grating sound when the roughened cartilage on the surface of the bones rubs together. Joints may feel sore and stiff, so that the joint will not move as easily or as far as it once did. All these changes can make it hard to move and do everyday tasks, such as walking up the stairs or opening a jar.

Calcium crystals (calcium pyrophosphate dihydrate) occur naturally within your body, and help with the absorption of calcium from food. If you have pseudogout, these crystals have deposited within the lining of your joints. Your body's natural reaction to this is to send in special fighter cells called neutrophils to destroy the calcium crystals. As these neutrophils try to attack the crystals they release certain enzymes. These enzymes cause local tissue damage, inflammation (swelling) and pain.

It is quite common for older people to have areas of calcification (hardening) in the cartilage. It is not clear why calcium deposits in the joints of some people and not others. However, in addition to aging, there are some factors that seem to increase a person's risk for pseudogout. 

Heredity seems to play a role. If you have pseudogout you might have other relatives who have had the same condition. If you have recently had an injury, major illness or surgery to a joint you could also be at greater risk of developing pseudogout. Pseudogout may be the first noted symptom in a few metabolic diseases such as disorders of the thyroid and parathyroid glands.

Establishing the correct diagnosis is very important because something can be done to manage most forms of arthritis, and most therapies work best when started early in the disease.

Your doctor may be able to diagnose that you have pseudogout based on a review of your medical history and a physical examination. Certain other tests may be ordered by your doctor to confirm the diagnosis, to determine if joint damage exists, or to distinguish between different types of arthritis. These tests may include x-rays, blood tests, or joint fluid tests.

There is no cure for pseudogout but there are steps you can take to reduce pain and stiffness and make movement easier. Active involvement in your prescribed treatment plan is essential.

Medicine

When the calcium crystals cause swelling and tissue damage within a joint, your doctor may prescribe non-steroidal anti-inflammatory drugs (NSAIDs), which can provide long-term relief from chronic pain and inflammation. NSAIDs reduce pain when taken at a low dose, and relieve inflammation when taken at a higher dose. NSAIDs such as ASA (Aspirin, Anacin, etc.) and ibuprofen (Motrin IB, Advil, etc.) can be purchased without a prescription. Examples of NSAIDs that require a prescription include Naprosyn, Relafen, Indocid, Voltaren, Feldene, and Clinoril. The various NSAIDs and Aspirin®, if taken in full doses, usually have the same levels of anti-inflammatory effect. However, different individuals may experience greater relief from one medication than another. Taking more than one NSAID at a time increases the possibility of side effects, particularly stomach problems such as heartburn, ulcers and bleeding. People taking these medications should consider taking something to protect the stomach, such as misoprostol (Cytotec).

By removing fluid from the affected joint your doctor can remove some of the crystals that cause the swelling. However, some crystals will still remain in the joint. Your doctor may also inject a powerful anti-inflammatory drug, called a corticosteroid, directly into the affected joint. Cortisone is a steroid that reduces inflammation and swelling. It is a hormone naturally produced by the body. Corticosteroids are man-made drugs that closely resemble cortisone. An injection can provide almost immediate relief for a tender, swollen and inflamed joint. However, this treatment can only be used rarely, since corticosteroids can weaken the cartilage and remove the minerals from (and therefore weaken) the bone, resulting in further joint weakness.

You may find general information in Arthritis Medications: A Consumer's Guide [PDF] even if your disease is not specifically addressed.

Exercise

Muscles and the other tissues that hold joints together weaken when they aren't moved enough, so the joint loses its shape and function. Moderate stretching exercises will help relieve pain and keep the muscles and tendons around the affected joint more flexible and strong. Low-impact exercises like swimming, walking, water aerobics and stationary bicycling can all reduce pain while maintaining your strength and flexibility. Always consult your doctor before beginning an exercise program.

Heat and Cold

Heat or cold application can provide temporary relief of pain. Heat helps to reduce pain and stiffness by relaxing aching muscles and increasing circulation to the area. There is some concern that heat may worsen the symptoms in an already inflamed joint. Cold helps numb the area by constricting the blood vessels and blocking nerve impulses in the joint. Applying ice or cold packs appears to decrease inflammation and therefore is the method of choice when joints are inflamed.

Protect Your Joints

Protecting your joints means using them in ways that avoid excess stress. Benefits include less pain and greater ease in doing tasks. Three main techniques to protect your joints are:

Pacing, by alternating heavy or repeated tasks with easier tasks or breaks, reduces the stress on painful joints and allows weakened muscles to rest.

Positioning joints wisely helps you use them in ways that avoid extra stress. Use larger, stronger joints to carry loads. For example, use a shoulder bag instead of a hand-held one. Also, avoid keeping the same position for a long period of time.

Using helpful devices, such as canes, luggage carts, grocery carts and reaching aids, can help make daily tasks easier. Small appliances such as microwaves, food processors and bread makers can be useful in the kitchen. Using grab bars and shower seats in the bathroom can help you to conserve energy and avoid falls.

Staying at your recommended weight or losing weight helps reduce the stress placed on weight-bearing joints that are sometimes affected by pseudogout, such as the knee and ankle. If you plan to lose a lot of weight, discuss the best program for you with your doctor and a dietician.

Relaxation

Developing good relaxation and coping skills can give you a greater feeling of control over your arthritis and a more positive outlook.

The Arthritis Society provides leadership and funding for research, advocacy and solutions to improve the quality of life for Canadians affected by arthritis.

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