The following are the signs and symptoms of pseudogout:

• Affected joints are painful.
• There is fluid buildup in the joints.
• Affected area is warm to touch.
• Pseudogout may sometimes present with tophi [9].

• Asymptomatic

  Clinical syndromes associated with CPPD Asymptomatic CPPD – patients may have incidental x-ray findings consistent with CPPD (chondrocalcinosis) but have no apparent clinical consequence. [bpac.org.nz]

  Asymptomatic Asymptomatic (lanthanic) calcium pyrophosphate deposition disease does not present with any symptoms. [healthhype.com]

  Chondrocalcinosis is most common in older adults and can be asymptomatic, meaning that patients with this X-ray finding may have no joint symptoms at all. [brighamandwomens.org]

  In this instance, screening of family members did not uncover asymptomatic affected persons. [doi.org]

• Fever

  Ask patients about:6, 10 The number and site of affected joints The speed of onset and the severity of the pain The presence of systemic symptoms, e.g. fever – up to 50% of people with acute CPPD disease will have a fever, and rarely, older patients may [bpac.org.nz]

  […] usually a single joint disease It most often involves the knees but can involve the wrists, shoulders and ankles The patient presents much like gout with a hot red swollen and very painful joint Associated with the inflammation, there may be a low grade fever [myageingparent.com]

  Some individuals may experience a low-grade fever. Pseudogout is caused by the abnormal formation of calcium pyrophosphate dihydrate crystals in the joint fluid or cartilage, causing inflammation in the joint. [painscale.com]

  Rarely it affects the neck and causes neck, shoulder pains, headaches and in some cases fevers. This occurs when the calcium crystals deposit around the dens part of the second cervical vertebra. The condition is called crowned dens syndrome. [my.clevelandclinic.org]

  Fever may accompany an acute attack. Damage to the joint progresses after years of these attacks. [arthritis.org]

• Disability

  Untreated it will lead to sever joint degeneration and disability. Anyone can get it but the older you are, the greater the chances you will get it. [glutathionediseasecure.com]

  Proper diagnosis is important because untreated pseudogout may lead to a severe form of joint degeneration and ongoing inflammation, resulting in chronic disability. [the-rheumatologist.org]

  If not treated, gout episodes often become more severe, affecting more joints and occurring more frequently which may lead to severe joint damage and long-term disability. [uhbristol.nhs.uk]

  Crystal deposits can contribute to a severe form of joint degeneration resulting in chronic disability. [columbusarthritis.com]

• Congestive Heart Failure

  However, established risk factors for gout, such as obesity, alcohol consumption, thiazide use hypertension, diabetes and congestive heart failure, were not significantly associated with the risk of physician-recorded pseudogout. [academic.oup.com]

  N Engl J Med. 2016;374(26):2575-2584. doi: 10.1056/NEJMra1511117 Factors that Reduce Risk Alcohol and tobacco abuse disorders, coronary artery disease, congestive heart failure, diabetes, and hypertension seem to lower the risk of developing CPPD disease [arthritis-health.com]

  In general, great caution should be used when considering NSAIDs in persons who have impaired liver or kidney function, gastritis or peptic ulcer disease, or decompensated congestive heart failure or are taking anticoagulation medication. [rheumatologynetwork.com]

• Weight Loss

  Major illness or certain medical conditions, such as rapid weight loss or high blood pressure. Surgery. Having been born with a rare condition that causes high blood uric acid levels. [bcm.edu]

  Weight loss for those who are overweight or obese, reduction in alcohol intake (especially beer), and staying hydrated are other manuevers that can help avoid gout attacks. [hopkinsarthritis.org]

  Weight loss may also help, along with prescription medication. Pseudogout can’t be prevented or cured, but there are treatments that can relieve your symptoms. [arthritis-sa.com]

  loss, joint supports and mobility aids to maintain joint mobility and reduce pain and stiffness. [bpac.org.nz]

• Joint Swelling

  Permanent joint damage can occur without treatment. Call your health care provider if you have attacks of joint swelling and joint pain. There is no known way to prevent this disorder. [medlineplus.gov]

  Facts you should know about pseudogout Joint swelling and pain are signs and symptoms of pseudogout. Pseudogout is caused by crystals in a joint. Pseudogout causes arthritis (joint inflammation). Pseudogout can cause calcification of cartilage. [medicinenet.com]

  Possible Complications Permanent joint damage can occur without treatment. When to Contact a Medical Professional Call your health care provider if you have attacks of joint swelling and joint pain. [mountsinai.org]

• Knee Pain

  In patients with knee effusion, numbers of intertrochanteric fracture, radiographic knee OA, and postoperative knee pain were significantly large compared to those without effusion. [ncbi.nlm.nih.gov]

  (SBQ07SM.13) A 53-year-old male laborer presents to his primary care physician with complaints of acute onset of left knee pain. He has had mild episodes of knee pain in the past and is two years status post a left partial medial meniscectomy. [orthobullets.com]

  He describes acute-onset knee pain last evening that was accompanied by redness of the skin around the joint. He denies any precipitating injury or recent activity that could have caused this pain. [medbullets.com]

• Osteophyte

  Changes in the metacarpophalangeal joints, such as squaring of the bone ends, presence of subchondral cysts and hooklike osteophytes, are found in pseudogout. [medicaljoyworks.com]

  […] detected as incidental chondrocalcinosis on radiographs Identification of calcium pyrophosphate crystals in joint aspirates is diagnostic Radiographs demonstrate chondrocalcinosis and degenerative changes (such as asymmetric joint space narrowing and osteophyte [accessmedicine.mhmedical.com]

  Figure 1 (A) Hand radiograph showing pronounced eccentric loss of joint space at the MCP joints, with sclerosis, osteopenia, and radial ‘hook’ osteophytes. (B) Hip radiograph showing attrition of the femoral head with ring cysts. [doi.org]

  Note absence of osteophytes. [slideshare.net]

• Arthralgia

  In this case, a 56-year-old caucasian male presented with right sided preauricular swelling, temporomandibular joint arthralgia and restricted mouth opening; he developed identical symptoms on the left side two days later. [ncbi.nlm.nih.gov]

  These joint symptoms include : Pain in the joints (arthralgia) Swelling of the joints Warmth of the joint The symptoms may resolve and a person may be asymptomatic until another attack recurs. [healthhype.com]

  Pseudogout is one of the common entities causing arthralgia and arthritis in the elderly. Ramonda et al. reported the prevalence of chondrocalcinosis to be 10.4% in older Italians [13]. [hindawi.com]

  1 The H63D variant in the HFE gene predisposes to arthralgia, chondrocalcinosis and osteoarthritis. 54 61 17284543 2007 2 Investigation of the role of ENPP1 and TNAP genes in chondrocalcinosis. 54 61 Zhang Y...Wordsworth BP 17043047 2007 3 Inorganic pyrophosphate [malacards.org]

• Joint Effusion

  Aspiration of the left L4-L5 facet joint yielded 1.5 mL of pus-like synovial effusion. [ncbi.nlm.nih.gov]

  On physical examination, a mild varus deformity and anterior and medial joint tenderness were noted. There was no joint effusion. [amjmed.com]

  A simple X-ray of the left knee showed signs of advanced degenerative joint disease with marked tibiofemoral joint space narrowing and increased soft tissue density and joint effusion. [reumatologiaclinica.org]

Signs and symptoms of pseudogout are similar to those of gout. Therefore, it is necessary to carry out various tests to arrive at a definitive conclusion. The following methods are employed to diagnose pseudogout:

• Laboratory tests to detect the presence of crystals in the joints are done. In this, fluid is retrieved from the joints and is tested for the presence of crystals. In addition, blood tests may also be carried out to determine other underlying conditions such as thyroid disorders or mineral imbalances that can give rise to pseudogout.
• Imaging studies such as X-ray of the affected joint is done to determine the extent of damage to the joint. An X-ray examination of the joint would also reveal deposition of crystals.

Pseudogout cannot be cured, however various treatment methods can help in effective management of the condition. Treatment regime is geared towards relieving the symptoms and discomfort experienced due to the arthritic attack. The following methods are employed for management of pseudogout:

• Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids and colchicines are administered for relieving the inflammation and the associated pain in the affected joint. Individuals who are prone to suffer from recurrent attacks of pseudogout are advised to take colchicines as prophylactic measure.
• There is accumulation of fluid in the affected joint that leads to pain and inflammation. This fluid is drained with the help of a needle or scalpel (surgical decompression) which is inserted into the affected area to aid in fluid removal [10]. Such a kind of process also helps in removing significant amount of crystals from the joints.

Prognosis of the condition is usually favorable with timely initiation of treatment. Affected individuals are reported to do well with medications and other therapies. Acute attacks are known to resolve within 10 days of receiving treatment.

Complications

Complications occur when the individuals do not seek proper medical treatment. In such cases, the joint undergoes constant and permanent damage by the deposited crystals.

The deposition of calcium pyrophosphate crystals in the joints gives rise to development of pseudogout. What triggers the deposition of calcium salts is not known, but advancing age is thought to be the major factor. More than 50% of individuals aged 85 years and above have deposits of calcium salts in their joints. However, not all of them develop pseudogout. The reason behind this is still not understood. Genetic transmission has also been implicated in the expression of pseudogout [2].

Some of the risk factors contributing to development of deposition of calcium pyrophosphate crystals include the following:

• Hemochromatosis 
• Hypomagnesemia
• Hyperparathyroidism
• Hypercalcemia
• Hypothyroidism
• Acromegaly
• Wilson disease
• Intake of loop diuretics [3]
• Etidronate sodium therapy for osteoporosis [4]
• Dyes from diagnostic angiography [5]
• Spinal surgery [6]

Pseudogout is a common occurrence affecting about 1.3 per 1000 adult individuals. Incidence of pseudogout varies with age and older aged individuals, especially women, are known to be more affected by this condition.

It has also been estimated that about 30% of individuals above the age of 60 years and 50% individuals above 90 years were found to have deposits of calcium crystals in their joints. In addition, there is a considerable amount of risk associated with onset of pseudogout and development of heart diseases in the affected individuals.

Deposition of calcium pyrophosphate (CPP) crystals in the joints of individuals gives rise to pseudogout [7]. The exact factor that triggers such a kind of event is yet to be figured out. The deposition of the calcium pyrophosphate crystals in the joints causes the area to swell and be painful. The affected area also feels warm when touched.

The knee is the most common joint for development of pseudogout; however other areas such as ankle and wrist can also be affected. There are crystal arthropathies that involve both pseudogout and gout at the same time [8].

Pseudogout cannot be prevented. However, the various conditions that can give rise to development of such a condition should be treated to avoid the onset of pseudogout.

Pseudogout also known as calcium pyrophosphate deposition disease is caused due to deposition of calcium pyrophosphate crystals in the joints [1]. It is a type of arthritis significantly affecting the knee and other joints. Pseudogout is a serious condition causing pain and inflammation and the attacks can last for several days to weeks, severely affecting the patients life.

Pseudogout needs appropriate diagnosis and prompt treatment to avoid worsening of the condition. Women fall easy prey to this arthritic condition as compared to males. Pseudogout received its identity in the year 1962 when the condition was described to have independent characteristic features from gout.

Definition

Pseudogout is a type of arthritis that severely affects the joints causing inflammation and pain. In this condition, crystals of calcium pyrophosphate get deposited in the joint. Females are more prone to contract this condition than males.

Cause

Age is known to be the most common factor for pseudogout. As individual ages, the crystals get deposited into the joints giving rise to arthritic pain. Certain underlying conditions are also known to give rise to pseudogout. These are thyroid disorders, parathyroid diseases, Wilson disease, acromegaly and hemochromatosis.

Symptoms

Symptoms of pseudogout precipitate as pain and inflammation in the affected joints. The affected area is also warm to touch. An attack of pseudogout lasts for several days and should usually resolve with prompt initiation of treatment. 

Diagnosis

Diagnosis of pseudogout is carried out by an X-ray examination of the joints that reveal the presence of crystals and damage to the area. In addition, laboratory tests are also conducted to determine the presence of any underlying disease conditions. In many cases, the fluid from the joint is also tested for the presence of crystals.

Treatment

Pseudogout cannot be cured. With appropriate medications and therapies the condition can be effectively managed and symptoms kept under control. Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids are employed for relieving the pain and inflammation in the joint. Individuals prone to frequent attacks are given colchicines as a preventive regime. Fluid that gets accumulated in the joints can also be removed to reduce the associated pain and inflammation.

1. Currie WJ. The gout patient in general practice. Rheumatol Rehabil. Nov 1978; 17(4):205-17.
2. Ciancio G, Bortoluzzi A, Govoni M. Epidemiology of gout and chondrocalcinosis. Reumatismo. Jan 19 2012; 63(4):207-20.
3. Rho YH, Zhu Y, Zhang Y, Reginato AM, Choi HK. Risk factors for pseudogout in the general population.Rheumatology (Oxford). Nov 2012; 51(11):2070-4.
4. Watanabe H, Yamada S, Anayama S, Sato E, Maekawa S, Sugiyama H, et al. Pseudogout attack induced during etidronate disodium therapy. Mod Rheumatol. 2006; 16(2):117-9.
5. Taggarshe D, Ng CH, Molokwu C, Singh S. Acute pseudogout following contrast angiography. Clin Rheumatol. Feb 2006; 25(1):115-6.
6. Ogawa Y, Nagatsuma M, Kubota G, Inoue G. Acute lumbar spinal pseudogout attack after instrumented surgery. Spine (Phila Pa 1976). 2012; 37(24):E1529-33 (
7. Busso N, Ea HK. The mechanisms of inflammation in gout and pseudogout (CPP-induced arthritis). Reumatismo. 2011; 63(4):230-7 
8. Yoo Y, Seo YJ, Huh M. Gout and coexisting pseudogout in the knee joint. Knee Surg Sports Traumatol Arthrosc. 2011; 19(4):553-5
9. Srinivasan V, Kesler H, Johnson M. Tophaceous pseudogout of the thoracic spine. Acta Neurochir (Wien). 2012; 154(4):747-50; discussion 750
10. Lin SH, Hsieh ET, Wu TY, Chang CW. Cervical myelopathy induced by pseudogout in ligamentum flavum and retro-odontoid mass: a case report. Spinal Cord. Nov 2006; 44(11):692-4.a