Gout vs pseudogout crystals: What is the Difference Between Gout and Pseudogout?
What is the Difference Between Gout and Pseudogout?
Gout and pseudogout sound very similar. What do they have in common?
Gout and pseudogout are both conditions in which substances that should be dissolved in the blood or body fluids becomes a solid chalky white material in tissues. Both of these conditions have the crystals that can build up in joints resulting in pain, swelling and possibly even joint damage. White blood cells called macrophages try to digest the crystals which causes them to release toxic chemicals causing inflammation. Conditions like these are called crystalline arthropathies, because they are joint problems (arthropathies) caused by crystals (crystalline). Normal joints do not have crystals in them.
Does having pseudogout mean “kind of” having gout?
Gout and pseudogout, while both joint problems caused by crystals, are caused by different kinds of crystals. Gout is caused by sodium urate crystals and pseudogout is caused by calcium pyrophosphate crystals.
Who gets gout and pseudogout? What are the causes? Are the same joints affected?
Gout is most common in middle-aged men and usually starts in the large toe. This is called podagra. The knee is the most common place for pseudogout to start. Pseudogout tends to occur more evenly in men and women and usually occurs in older people. Gout attacks can sometimes be caused by eating lots of red meat, particularly organ meats that are high in purines. Drinking certain types of alcohol, such as beer and distilled liquor may increase attacks. Wine does not seem to cause gout. Pseudogout is not related to diet. In both conditions, joints in the hand and wrist can be involved.
How are gout and pseudogout diagnosed?
The best way for your doctor to make the diagnosis is to draw fluid from an affected joint and look at it under a special microscope. Gout and pseudogout crystals can be seen with the microscope and they look different when viewed in a special polarized light under a microscope.
Gout crystals are shaped like a needle and are negatively birefringent. Pseudogout crystals are rhomboid shaped and positively birefingent. X-rays can also be helpful as they show different changes. Gout eats away at the bones and joints of the hand and wrist. There may be many small cystic erosions in the bones at the joint surfaces. Pseudogout may be seen on x-ray due to the calcium crystals depositing in the soft tissues around the joints. Blood levels of urate are often elevated in gout but are normal in pseudogout.
What else can be confused with gout and pseudogout?
Fractures, infection, osteoarthritis and other inflammatory problems such as rheumatoid arthritis can be confused with gout and pseudogout. Your hand surgeon can help tell these conditions apart and ensure you get the right treatment.
How are gout and pseudogout treated? Are they treated the same?
Treatment differs and that is why getting the right diagnosis is important.
In both cases, steroid injections (cortisone shots), anti-inflammatory medications and colchicine may be useful. For gout, your medical doctor may prescribe a mediation that decreases urate and may also recommend diet changes to keep gout from coming back.
I think I have one of these problems! How can I find a hand surgeon to help me?
Please check out the Find a Hand Surgeon tool from the American Society for Surgery of the Hand to find a hand surgeon near you.
Ryan Zimmerman, M.D. is a Hand, Shoulder and Elbow Surgeon in Baltimore, Maryland. He is a member of Greater Chesapeake Hand to Shoulder and an Attending Surgeon at the Curtis National Hand Center.
4 Ways Gout and Pseudogout Are Different
Both gout and pseudogout cause sudden joint pain, swelling, and redness, making the two diseases difficult to tell apart. Understanding what makes each condition unique can help when diagnosing, treating, and preventing flare-ups, ultimately minimizing permanent joint damage.
Pseudogout is also known as acute calcium pyrophosphate crystal arthritis (acute CPP crystal arthritis). This page describes four ways gout and pseudogout are different.
Half of all gout attacks affect the joint in the big toe. Learn more: Gout Symptoms
1. Joints affected
Gout attacks typically affect only one joint.
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Ragab G, Elshahaly M, Bardin T. Gout: An old disease in new perspective–A review. J Adv Res. 2017. Sep 1;8(5):495-511. PMCID: PMC5512152 DOI: 10.1016/j.jare.2017.04.008
In contrast, pseudogout attacks commonly affect between 1 and 4 joints.
2
Slobodonick A, Toprover M, Pillinger M. Crystal Arthritis. In: Efthimiou P, ed. Absolute Rheumatology Review. Springer Nature Switzerland AG; 2020; chap 15. Accessed September 15, 2020. https://doi.org/10.1007/978-3-030-23022-7_15
In addition, the locations of the flare-ups tend to differ:
- Gout most commonly affects the big toe, instep, heel, ankle, and/or knee.
3
Sidari A, Hill E. Diagnosis and Treatment of Gout and Pseudogout for Everyday Practice. Prim Care. 2018;45(2):213-236. doi:10.1016/j.pop.2018.02.004
About 50% of first-time gout attacks in men involve a big toe joint.2
Slobodonick A, Toprover M, Pillinger M. Crystal Arthritis. In: Efthimiou P, ed. Absolute Rheumatology Review. Springer Nature Switzerland AG; 2020; chap 15. Accessed September 15, 2020. https://doi.org/10.1007/978-3-030-23022-7_15
In women, who are significantly less likely to develop gout, an attack is most likely to involve a knee.2
Slobodonick A, Toprover M, Pillinger M. Crystal Arthritis. In: Efthimiou P, ed. Absolute Rheumatology Review. Springer Nature Switzerland AG; 2020; chap 15. Accessed September 15, 2020. https://doi.org/10.1007/978-3-030-23022-7_15 - Pseudogout is most likely to affect the knee, wrist, and/or large knuckles of the hand (metacarpophalangeal joints). It may also involve the hip, shoulder, and/or spine.
2
Slobodonick A, Toprover M, Pillinger M. Crystal Arthritis. In: Efthimiou P, ed. Absolute Rheumatology Review. Springer Nature Switzerland AG; 2020; chap 15. Accessed September 15, 2020. https://doi.org/10.1007/978-3-030-23022-7_15
,
4
Genetic and Rare Diseases Information Center, National Institute for Advancing Translational Sciences. Chondrocalcinosis 2. Last updated January 12, 2018. Accessed August 4, 2020. https://rarediseases.info.nih.gov/diseases/1292/chondrocalcinosis-2
Unlike gout, pseudogout rarely affects the big toe.2
Slobodonick A, Toprover M, Pillinger M. Crystal Arthritis. In: Efthimiou P, ed. Absolute Rheumatology Review. Springer Nature Switzerland AG; 2020; chap 15. Accessed September 15, 2020. https://doi.org/10.1007/978-3-030-23022-7_15
It may also involve the hip, shoulder, and/or spine.While certain joints are more likely to be affected, both gout and pseudogout can affect any joint in the body.
See Gout Symptoms and Pseudogout Symptoms
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2. Causes
Gout and pseudogout are both caused by microscopic crystals that collect in a joint and trigger inflammation, which causes pain. The types of crystals are different:
- Gout is caused by monosodium urate crystals, often referred to as uric acid crystals.
- Pseudogout is caused by calcium pyrophosphate dihydrate crystals, often referred to as calcium pyrophosphate crystals (CPP crystals).
Not everyone who has urate crystals or CPP crystals in a joint will experience inflammation and pain. Researchers do not fully understand why these microscopic crystals lead to painful flare-ups in some people but not others.
See Gout Causes and Risk Factors and Pseudogout Causes
3. Severity, timing, and duration of pain
While gout and pseudogout can cause notable joint pain without warning, the severity of pain, when it appears, and how long it lasts may differ:
Even though gout and pseudogout flare-ups will go away on their own, treatment is encouraged.
Joint damage is more likely to occur without treatment.
See Pseudogout Treatment and Gout Treatment
4. Tendon involvement
People with pseudogout are more likely to have a build-up of calcium deposits in the tendons of the affected joint.
5
Miksanek J, Rosenthal AK. Imaging of calcium pyrophosphate deposition disease. Curr Rheumatol Rep. 2015;17(3):20. PMID: 25761927 doi: 10.1007/s11926-015-0496-1
These deposits are called calcifications. Tendon calcifications can occur because the crystals that cause pseudogout—calcium pyrophosphate dihydrate crystals—contain calcium.
Calcifications can be seen on x-rays as thin lines that run in the same direction as the tendon. Tendons that have undergone calcification may be inflamed and painful.
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People with gout can have deposits of uric acid crystals in tendons. These deposits can be detected by certain types of imaging tests, such as musculoskeletal ultrasound.
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Pascart T, Lioté F.
Gout: state of the art after a decade of developments. Rheumatology. 2019; Jan 1;58(1):27-44. PMID: 29547895 DOI: 10.1093/rheumatology/key002
Uric acid crystal deposits or too much uric acid in a tendon may lead to inflammation and/or damage to the tendon (tendinopathy),
7
Andia I, Abate M. Hyperuricemia in Tendons. Adv Exp Med Biol. 2016;920:123-32. doi: 10.1007/978-3-319-33943-6_11. PMID: 27535254 DOI: 10.1007/978-3-319-33943-6_11
,
8
Ray K. Crystal arthritis: Tendon damage in gout–a role for MSU crystals? Nat Rev Rheumatol. 2014 Jun;10(6):321. doi: 10.1038/nrrheum.2014.65. Epub 2014 Apr 22. PMID: 24752181 DOI: 10.1038/nrrheum.2014.65
which can be painful.
Both gout and pseudogout are treatable conditions. People who suspect they have gout or pseudogout are advised to seek a definitive diagnosis confirmed by medical imaging and lab tests.
Learn more
How to Prevent the Next Gout Attack
Being Overweight Linked to Gout Risk
Dr.
Nadine Mbuyi is a board-certified rheumatologist and internal medicine physician. She is also an assistant professor at the George Washington University School of Medicine. She specializes in diagnosing and treating rheumatic diseases, with a particular interest in gout, CPPD disease (pseudogout), lupus, rheumatoid arthritis, osteoarthritis, and seronegative spondyloarthropathies.
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How not to confuse real gout with another disease
Pseudogout
is a disease that mimics the symptoms of gout, but they are caused by a different cause.
Pseudogout is characterized by rare but rather acute attacks of rheumatoid arthritis and is characterized by severe pain.
Causes of pseudogout
There are several reasons for the development of pseudogout, but it is not always possible to determine the exact etiological factor. The main risk factors for the development of the disease are advanced age and joint injuries.
The most common causes of pseudogout are:
— hereditary predisposition. Patients found with pseudogout often have a mutation in the ANKH gene (locus 5p15.2), which encodes a protein that transports intracellular inorganic pyrophosphate;
– an excessive increase in the level of calcium in the blood, which is the result of too high levels of parathyroid hormone in the blood.
– elevated levels of iron in tissues.
– low levels of magnesium in the blood.
Any joint dysfunction is a reason to seek medical help.
– attacks of severe joint pain;
– swelling or redness of individual joints;
– chronic pain in the joints.
– lack of mobility in the joints.
A rheumatologist deals with the treatment of joint diseases. Only a doctor can make the correct diagnosis and choose the appropriate treatment.
Symptoms
Pseudogout manifests itself with symptoms that are very similar to those of classic gout:
– the appearance of swelling in the affected joints. Sometimes visually noticeable edematous bumps form on the joint.
– fever in the affected area of the body. The skin over the joint becomes red and hot to the touch.
– severe pain. The pain can be sharp and sharp, or sometimes dull and constant.
In some cases, pseudogout may present with only slight soreness for a long time.
For a correct diagnosis, it is necessary to contact a rheumatologist who will conduct a detailed analysis of the patient’s condition and prescribe the appropriate treatment.
Gout attack
Gout attack is a disease that causes severe pain and swelling of the joints, usually the big toe.
It is caused by high levels of uric acid in the blood, which forms crystals in the joints.
A rheumatologist also treats a gout attack. Using a well-chosen treatment regimen, which includes the use of anti-inflammatory and pain medications, as well as a special diet that excludes foods containing a large amount of uric acid, good positive results can be achieved.
Pseudogout and a gout attack without observation and proper treatment can lead to destruction of the joints, so it is necessary to contact a rheumatologist in a timely manner and follow the recommendations for treatment and prevention. Trying to deal with the problem on your own can lead to serious consequences.
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The cost of analyzes is indicated without taking biomaterial
Description
Method of determination
polarizing microscopy.
Test material
Articular (synovial) fluid
Violation of the exchange of purine bases in the body with gout leads to an increase in the content of uric acid in the blood and synovial fluid. An acute attack of gouty arthritis is accompanied by crystallization of salts with the formation of sodium monourate crystals. Direct detection of crystals is possible when examining the joint fluid. Thin needle-shaped crystals of sodium monourate can be located intra- and extracellularly.
When examined in polarized light, they can be identified due to their characteristic negative birefringence.
Another form of microcrystalline arthritis is pseudogout, which is accompanied by the formation of calcium pyrophosphate crystals, which are thought to result from changes in pyrophosphate metabolism in the articular cartilage. Unlike sodium monourate, calcium pyrophosphate crystals in pyrophosphate arthropathy are thicker and shorter, and also have positive birefringence.
Preparation
No special preparation required. Biomaterial for research is obtained by puncture of the joint or arthroscopy.
Indications for prescription
Interpretation of results
Interpretation of test results contains information for the attending physician and is not a diagnosis./data/photo/2021/08/18/611cda33ce7f1.jpg)