Pseudogout: Causes, Symptoms, Treatment and Cost

Pseudogout is a kind of arthritis that arises when calcium pyrophosphate crystals grow and collect in the joints, producing pain and inflammation.

It is similar to gout, which is caused by uric acid crystals. Larger joints, such as the knees, wrists, and shoulders, are often affected by pseudogout.

• Monosodium urate (MSU) pseudogout: This type is caused by accumulation of MSU crystals in the joints, often resulting in inflammation and pain.
• Calcium pyrophosphate dihydrate (CPPD) pseudogout: This type is caused by deposition of CPPD crystals in the joints, which can lead to inflammation and pain.
• Mixed crystal pseudogout: This type results from the presence of both MSU and CPPD crystals in the joints, causing inflammation and pain.

Common causes may include:

• Metabolic disorders (such as hypomagnesemia, hyperparathyroidism, hemochromatosis).
• Genetic disorders (such as Wilson's disease or familial idiopathic arthritis).
• Chronic renal failure
• Inflammatory conditions (such as rheumatoid arthritis).
• Other causes may include:
• Certain medications
• Infection

Symptoms may include stiffness, warmth, redness, and tenderness within the affected joint, as well as decreased range of motion due to the swelling.

Other associated signs and symptoms may include fever, fatigue and an overall feeling of malaise.

• Maintain a proper diet: Eat foods with low levels of purines, such as fruits, vegetables, beans and fish.
• Take medications to help control calcium and uric acid levels: These may include diuretics, allopurinol and probenecid.
• Participate in regular exercise: Participating in moderate physical activity can help lower levels of uric acid in the body.
• Avoid excessive alcohol consumption & high intensity exercising: Alcohol is a risk factor for developing pseudogout since it increases the risk of developing hyperuricemia (high serum uric acid). High intensity exercises increase the risk of spontaneous calcium deposits that contribute to joint inflammation and pain.
• Monitor & adjust your medical conditions: Make sure that any underlying medical conditions are managed properly as this may reduce their risk for developing pseudogout.

• Joint Fluid Analysis: This test involves removing a sample of joint fluid and analyzing it for the presence of calcium pyrophosphate crystals, which can indicate pseudogout.
• X-ray: An x-ray can show the presence of joint damage, which can help to diagnose pseudogout.
• Ultrasound: Ultrasound imaging may be used to determine the existence of calcium pyrophosphate crystals in the joints and soft tissues around them.
• Blood Tests: Blood tests may be performed to rule out other disorders that produce symptoms similar to gout or rheumatoid arthritis.
• CT Scan: A CT scan is an imaging technique that can produce detailed images of both the bones and soft tissues around them and may help diagnose pseudogout if calcifications are seen in the joints or surrounding tissues.

• Inflammation and subsequent stiffness in the affected joint(s).
• In rare circumstances, joint deformities and limited range of motion.
• Risk of developing arthritis, which can lead to permanent damage of the joint.
• Osteoporosis, a weakening of bones due to lack of calcium or vitamin D, is a potential complication if pseudogout is left untreated for long periods of time.
• Infections in the affected joints are possible if an excess amount of uric acid crystallizes around them.

• Turmeric: It is well-known that turmeric has anti-inflammatory and pain-relieving effects. Consume 1/2 teaspoon of turmeric powder mixed with warm milk or water twice daily to reduce inflammation and pain caused by pseudogout.
• Ginger: Ginger has anti-inflammatory properties that help reduce pseudogout symptoms like swelling and pain. Consume 1 teaspoon of ginger juice mixed with 1 teaspoon of honey twice daily to get relief from the symptoms of pseudogout.
• Castor Oil: Castor oil can be applied topically to reduce swelling and inflammation associated with pseudogout. Massage the affected area with castor oil 2-3 times a day for best results.
• Epsom Salt Baths: Epsom salt baths are known to provide relief from joint pain and stiffness caused by pseudogout. To relieve the symptoms of pseudogout, add 2 cups of Epsom salt to a warm bath and soak for 15 to 20 minutes.

• Maintain a healthy and balanced diet with foods rich in calcium, magnesium, and potassium like dark leafy greens, fruits, and dairy products.
• Choose anti-inflammatory foods such as salmon, tuna, cauliflower, broccoli, walnuts, almonds and flax seeds to reduce inflammation associated with Psueudogout.
• Incorporate whole grains such as quinoa, brown rice and oats into your diet for added fiber content that may help to lower uric acid levels.
• Enjoy plenty of fluids including water to keep the body hydrated throughout the day and help flush toxins from the body.

• Stay away from high-purine foods, such as seafood, organ meats, and red meat.
• Avoid alcohol, which increases the risk of developing pseudogout and can cause a flare-up.
• Limit dairy products, as they may increase the levels of calcium in your blood which can worsen the symptoms of pseudogout.
• Avoid high-sodium and high-sugar processed meals like fried chicken and refined grains.
• Limit refined carbohydrates like white bread, pasta and pastries which can increase inflammation in the body and aggravate symptoms of pseudogout.

• Joint debridement: In severe cases, a surgical procedure known as joint debridement may be used to remove inflamed tissue from the affected area and restore range of motion in the joint.
• Joint replacement: In some cases, a total joint replacement may be necessary for total restoration of movement and resolution of symptoms such as pain and stiffness associated with pseudogout.
• Joint aspiration: Joint aspiration is a procedure in which a doctor inserts a needle into the affected joint to remove excess fluid, thereby relieving pressure on the joint and providing some relief from pain and swelling associated with pseudogout.
• Physical therapy: Physical therapy can be used to help strengthen the muscles around the affected joint, improve range of motion, and reduce pain associated with pseudogout.
• Intra-articular injections: Injections of corticosteroids into specific joints can effectively treat pain and swelling associated with pseudogout flare ups.
• Draining of joint fluid: A joint aspiration or arthrocentesis may be performed to drain away any joint fluid buildup, which can reduce swelling and pain in the affected area.

Physicians who specialize in Joints, Connective tissue and bone diseases such as Orthopedists, Rheumatologists or General practice / Primary care doctors can be consulted for a diagnosis regarding Pseudogout.

• Nonsteroidal anti-inflammatory drugs (NSAIDs): These can help reduce symptoms of pseudogout; however, they should be used with caution due to potential side effects.
• Corticosteroids: These are administered for brief durations and may help minimise the related pain and swelling.
• Colchicine: A medication commonly used for gout, colchicine may also be effective in treating pseudogout by reducing inflammation and easing pain.

The length of time needed to recover from Pseudogout is highly dependent on the condition's nature and severity.

In most cases, Pseudogout is a self-limiting condition which resolves itself after a few days, however the pain and swelling may take several weeks to subside.

The results of treatment for pseudogout can be improved and have a positive effect on symptoms but it is not guaranteed to be a permanent cure.

Treatment for pseudogout commonly focuses on decreasing inflammation, reducing pain, and improving joint function.

• After a successful treatment for pseudogout, some general post-treatment guidelines should be followed in order to minimize the recurrence of symptoms and reduce the risk of flare-ups.
• If a medication is prescribed to treat the condition, it should be taken according to the doctor's instructions; this generally means taking the drug exactly as prescribed and not missing doses.
• Any dietary changes recommended by a physician should be followed closely and any supplements taken as directed in order to improve overall health and joint flexibility.
• Regular exercise can help to improve mobility and strengthen joints; this should include low impact exercises such as walking, swimming, or yoga/stretching exercises that could help increase flexibility and reduce strain on joints.
• Maintaining a healthy weight can also help lessen symptoms; it is important to continue monitoring body mass index (BMI) after treatment for pseudogout has begun in order to keep it within a healthy range.
• Self-care measures should be implemented such as elevating the affected joint during times of pain or stiffness, applying cold or hot compresses intermittently throughout the day, and avoiding activities that could further injure weakened joints such as running or contact sports.

Generally, a doctor's consultation fee can range from Rs 500 to Rs 2,000.

The cost of medication may range from Rs 500 to Rs 2,000 for a single course.

In certain instances, surgery may be required to treat Pseudogout, which may cost up to Rs 20,000.

Common side effects of pseudogout treatments include:

• Joint pain
• Headache
• Nausea
• Dizziness
• Fatigue.
• Musculoskeletal effects may include weakening of muscles around the affected joint and stiffness of nearby tissue.
• Other possible side effects include skin rash or itching, upset stomach, abnormal liver or kidney function tests.
• Serious side effects are rare but may include severe allergic reactions such as hives and swelling of the face or tongue, changes in vision or hearing, shortness of breath, blood clots in the legs or lungs.

If you are suffering from any symptoms relating to Pseudogout then you should visit a doctor nearby as they can cause complications like 'joint deformity, osteoporosis etc.' in which treatment courses can range from a few months to years depending on the severity of the condition.