Difference between gout and pseudogout

Joint pain can be a debilitating condition that affects day-to-day life. Among the many causes of joint inflammation, gout and pseudogout (also called Calcium Pyrophosphate Deposition Disease or CPPD) are two common culprits that are often mistaken for each other. Although they share similar symptoms such as sudden and intense joint pain, they differ significantly in their underlying causes, risk factors, diagnosis, and treatment.

In this blog, we will explore gout and pseudogout in detail—breaking down their similarities and differences—to help you better understand these conditions and how to manage them.

What is Gout?

Gout is a type of inflammatory arthritis that occurs due to the deposition of uric acid crystals in the joints. It is often characterized by sudden attacks of pain, redness, and swelling, most commonly in the big toe.

Cause:

Gout occurs when there is an excess of uric acid (hyperuricemia) in the bloodstream, leading to crystal formation in the joints.

What is Pseudogout?

Pseudogout, also known as CPPD (Calcium Pyrophosphate Deposition Disease), mimics the symptoms of gout but is caused by the accumulation of calcium pyrophosphate crystals instead of uric acid.

Cause:

In pseudogout, calcium pyrophosphate dihydrate crystals form in the cartilage and cause inflammation when they are released into the joint space.

Key Differences Between Gout and Pseudogout

Risk Factors: Who’s at Risk?

Gout Risk Factors:

• Gender: More common in males

• Obesity: Higher body mass can increase uric acid levels

• Medical conditions: Diabetes, hypertension, dyslipidemia

• Alcohol consumption: Particularly beer and spirits

• Diet: High purine intake (red meat, seafood)

• Genetics: Family history of gout

• Kidney disease: Impaired uric acid excretion

Pseudogout Risk Factors:

• Age: More common in people over 60

• Joint trauma: Previous injury or surgery increases risk

• Endocrine disorders: Hypothyroidism, hyperparathyroidism

• Electrolyte imbalance: Hypomagnesemia, hypercalcemia

• Hemochromatosis: Iron overload disorder

• Genetics: In rare cases, familial predisposition

Triggers That Can Set Off an Attack

Gout Triggers:

• High-purine meals (organ meats, shellfish)

• Alcohol intake, especially binge drinking

• Fasting or crash diets

• Dehydration

• Surgery or trauma

Pseudogout Triggers:

• Trauma or joint injury

• Infection or severe illness

• Surgery

• Electrolyte disturbances

Symptoms: How Do They Present?

Both gout and pseudogout present similarly but can vary in severity and joint involvement.

Common Symptoms of Gout:

• Sudden, severe joint pain (commonly at night)

• Swelling, redness, and warmth at the joint

• Tenderness, often in the big toe

• Limited joint movement during flare-ups

• Tophi (chronic deposits of urate crystals under the skin) in long-term cases

Common Symptoms of Pseudogout:

• Sudden joint pain, often in the knee

• Swelling, redness, and tenderness

• Pain in the wrist, ankle, shoulder, or elbow

• Less intense than gout but longer-lasting

• Stiffness in the affected joint

Diagnosis: How Are They Identified?

Correct diagnosis is essential as treatments vary between the two.

Diagnostic Steps for Gout:

• Physical examination: Signs of joint inflammation

• Blood tests: Elevated uric acid levels

• Joint fluid analysis: Needle aspiration shows needle-shaped, negatively birefringent urate crystals

• Ultrasound/X-ray: Shows urate deposits in chronic cases

Diagnostic Steps for Pseudogout:

• Physical examination

• Joint fluid analysis: Shows rhomboid-shaped, positively birefringent calcium pyrophosphate crystals

• X-ray imaging: Calcifications in cartilage (chondrocalcinosis)

• Blood tests: Evaluate for underlying metabolic disorders

Treatment Options

Treatment aims to reduce pain, inflammation, and prevent future attacks.

Gout Treatment:

Acute Attack:

• NSAIDs: Naproxen, indomethacin

• Colchicine: Effective if given early

• Corticosteroids: Oral or intra-articular for those who can’t tolerate NSAIDs

Long-Term Management:

• Allopurinol or Febuxostat: Reduce uric acid levels

• Lifestyle changes: Weight loss, hydration, low-purine diet

• Avoid alcohol and sugary drinks

• Regular monitoring of uric acid levels

Pseudogout Treatment:

Acute Attack:

• NSAIDs: First-line treatment

• Colchicine: Sometimes used for prevention and treatment

• Corticosteroids: Oral or injected

Long-Term Management:

• Manage underlying conditions: Thyroid issues, calcium/magnesium levels

• Colchicine: May be used prophylactically in recurrent cases

• Joint aspiration: Sometimes used for symptom relief

Lifestyle and Dietary Modifications

For Gout:

• Hydration: Drink plenty of water

• Low-purine diet: Limit red meat, shellfish, organ meats

• Limit alcohol: Especially beer and spirits

• Weight management

• Regular exercise

• Avoid sugary beverages: Especially fructose-rich drinks

For Pseudogout:

• There is no specific diet, but managing underlying conditions like thyroid or parathyroid dysfunction is important.

• Ensure adequate magnesium and vitamin D intake

• Avoid joint injuries and manage chronic conditions

Complications if Left Untreated

Gout:

• Chronic arthritis

• Tophi formation

• Kidney stones

• Joint deformities

• Increased risk of cardiovascular disease

Pseudogout:

• Chronic joint damage

• Recurrent arthritis

• Functional disability

• Association with other metabolic diseases

When to See a Doctor

Seek medical attention if:

• You experience sudden, intense joint pain

• Swelling and redness occur in one or more joints

• You have recurring flare-ups

• You notice lumps or nodules near joints

• There is decreased joint movement or chronic stiffness

Prompt diagnosis and treatment can significantly reduce the impact of these conditions.

While gout and pseudogout may appear similar at first glance, understanding their differences is crucial for effective management. Gout is driven by uric acid buildup, while pseudogout results from calcium pyrophosphate crystals. Proper diagnosis—through joint fluid analysis—is essential to differentiate between the two.

Management strategies also differ. Gout benefits from long-term uric acid control and lifestyle changes, while pseudogout requires treating underlying metabolic conditions and using anti-inflammatory medications.

By working closely with your healthcare provider, you can develop a comprehensive plan to manage either condition and reduce the frequency and severity of painful joint attacks.

To consult a Doctor at Sparsh Diagnostic Centre, call our helpline number 9830117733.

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Disclaimer:

No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.