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Looks like gout, sounds like gout, but it's....Pseudogout

Looks like gout, sounds like gout, but it's....Pseudogout

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By Dr Irwin Lim, Rheumatologist

A really painful swollen left big toe. So painful he needed to use a crutch to avoid standing on it.

Not surprisingly, the doctor told him it was gout. 5 days of anti-inflammatory medication and the problem was fixed. He remembered some advice about reducing the amount of beers he'd drink at the end of the day, but this didn't really lead to any change.

Fast forward 3 years.

This time, he woke up with a swollen right knee. Painful and warm to touch. He didn't see the doctor this time and hobbled around for about a week. He also used some over-the-counter anti-inflammatory tablets his wife bought from the local pharmacy. Probably gout.

Another few years before the really painful attack.

A bit of hammering and sawing in the shed, and the next day, a really painful, hot, puffy left wrist. He couldn't grip and the inflammatory medication was not touching the pain.

This time, he went to the doctor. X-rays were performed and the diagnosis was made.

The arrows highlight a white line sitting in the joint space between bones. This represents calcification within the cartilage. What we term Chondrocalcinosis.

It's a big clue that the underlying problem may be Calcium Pyrophosphate Deposition Disease (CPPD), a disorder where crystals of calcium pyrophosphate dihydrate deposit in joints. This can then lead to intermittent attacks of inflammatory arthritis, Pseudogout (read patient information).

The attacks can look like gout, the history can sound just like gout, the symptomatic treatment is the same as gout (note: longer term treatment for gout is very different & is dependent on medications to lower the level of uric acid).

But, the offending crystal is different. In gout, the offender is monosodium urate crystals. In pseudogout, it's calcium pyrophosphate dihydrate. This can be confirmed by aspirating some joint fluid from the inflamed joint and identifying these crystals within the fluid.

Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here.
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