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].

• Hemophilia A

  […] several organs and tissues gout, which causes painful inflammation of the toes and feet commonly but can affect other joints Pseudogout can sometimes be associated with other illnesses, such as: the thyroid disorders hypothyroidism and hyperparathyroidism hemophilia [healthline.com]

  Pseudogout can occur along with aging, be inherited, or be associated with hemophilia, hemochromatosis, ochronosis, amyloidosis, or hormonal disorders (such as hyperparathyroidism and hypothyroidism ). [medicinenet.com]

  Localized chondrocalcinosis has been reported in a number of entities including systemic lupus erythematosus, ochronosis, acromegaly, Wilson’s disease, hemophilia, following trauma and infection, and in asymptomatic elderly persons. [ajronline.org]

  Accumulation of iron in the joints has also been identified as a possible contributor to pseudogout development from reports of the condition in patients with iron overload from transfusion hemosiderosis and hemophilia. [news-medical.net]

• 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]

• Amyloidosis

  Pseudogout can occur along with aging, be inherited, or be associated with hemophilia, hemochromatosis, ochronosis, amyloidosis, or hormonal disorders (such as hyperparathyroidism and hypothyroidism ). [medicinenet.com]

  Abstract Articular involvement such as osteodystrophy, osteonecrosis, dialysis-related amyloidosis, septic arthritis, malignancy and various crystal-induced arthropathies among patients with chronic renal failure is common. [ncbi.nlm.nih.gov]

  […] thyroid disorders hypothyroidism and hyperparathyroidism hemophilia, a hereditary bleeding disorder that prevents the blood from clotting normally ochronosis, a condition that causes a dark pigment to deposit in the cartilage and other connective tissues amyloidosis [healthline.com]

• Surgical Procedure

  If pseudogout attacks are misdiagnosed as periprosthetic sepsis, patients may undergo unnecessary surgical procedures. We report a case of pseudogout in the early postoperative period. [ncbi.nlm.nih.gov]

  Some theories are : • a person may have a high level of calcium in their body • high levels of iron levels in their tissues • low magnesium levels in the blood • hereditary • dehydration • following surgical procedures Yet again to completely get the [gout-aware.com]

  Surgery There is no specific surgical procedures for pseudogout. Therapeutic arthrocentesis is a procedure where fluid is removed from the joint in order to relive pain and swelling in very acute cases of pseudogout. [healthhype.com]

• Swollen Knee

  Some of the most common signs include: A swollen knee joint that feels warm when touched and extremely tender Episodes of intense and sudden joint pain Chronic arthritic pain Fluid accumulating around the joint. [hrosm.com]

  Wondering about that suddenly painful and swollen knee, elbow, or wrist? The cause of your troubles may be pseudogout, or calcium pyrophosphate dihydrate (CPPD) deposition disease. [everydayhealth.com]

  Signs of haemarthrosis are: swelling of the knee warmth stiffness and bruising, which occur soon after the injury Go to A&E immediately for treatment if you have a very swollen knee following an injury. [nhs.uk]

• Constitutional Symptom

  Systemic symptoms including fevers, and chills, and constitutional symptoms often occur. Acute attacks of CPPD disease may last for weeks or months. [patient.info]

  Fever and other constitutional symptoms may also be possible. Given these misleading findings, this particular variant of pseudogout is often misdiagnosed as rheumatoid arthritis. [accessmedicine.mhmedical.com]

  The patient was treated with a 3-day course of anakinra (an interleukin-1 inhibitor), and all of her symptoms resolved. [thejns.org]

  Chondrocalcinosis: Asymptomatic incidental finding in articular tissues Commonly involves knee menisci and intervertebral discs Often detected on radiology Acute CPP deposition (acute pseudogout): Symptomatic, painful swollen joints with warmth and erythema Constitutional [pathologyoutlines.com]

• Aspiration

  If the joint is septic (often the other main differentials – and the reason for joint aspiration) – then there are usually no crystals, but the aspirate may appear purulent, will contain raised white cells on microscopy and a culture will be positive. [almostadoctor.co.uk]

  If the joint is able to be aspirated, synovial fluid should be obtained and sent for microscopy and culture. [bpac.org.nz]

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

  Joint fluid aspiration is performed as a diagnostic procedure to aspirate the excess fluid accumulated in the elbow joint. [epainassist.com]

• Ulcer

  […] specific drugs, such as allopurinol, which are useful in treatment In Pseudo Gout, it is important to tailor the treatment according to the individual patient Ibuprofen or naproxen can be very useful, but in the elderly can also cause toxicity due to ulcers [myageingparent.com]

  Two weeks after completing the third cycle, severe pain and swelling occurred in the DIP joints of the right middle, ring, and left ring finger; and skin ulcer formation was observed on the dorsal side of the DIP joints of the right middle and ring fingers [ncbi.nlm.nih.gov]

  You may not be able to take NSAIDs if: you’re taking blood-thinning medication, such as warfarin (Coumadin) you have poor kidney function you have a history of stomach ulcers To help reduce the risk of additional flare-ups, your doctor may prescribe low [healthline.com]

  However, no treatment is available to dissolve the crystal deposits, and those with poor kidney function, a history of stomach ulcers, or on blood thinners often cannot take NSAIDs. [the-rheumatologist.org]

• 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]

• Suggestibility

  Basic home remedies are also suggested, including rest and icing the swollen joints. [treatingpain.com]

  Pseudogout is suggested when abnormal calcifications are seen in the cartilage of joints on X-rays. [medicinenet.com]

  As the name suggests, this condition can appear similar to gout, which is caused by another type of crystal – uric acid crystals – and commonly causes sudden pain and swelling in a single joint, usually in the foot. [health.harvard.edu]

  […] calcification include osteoarthritis, under-active thyroid, haemochromatosis (iron overload) and kidney failure, especially in patients on dialysis Presentation The most common presentation is, in fact, non-symptomatic, i.e. there are simply x-ray changes suggestive [myageingparent.com]

  Your doctor may suggest these treatments: Medications – the very first thing your doctor will recommend is to use over-the-counter medications to relieve the pain. [jointhealthmagazine.com]

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.

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