By: Adrienne R. Hollander, M.D.

Gout or pseudo-gout? Your Rheumatologist Knows The Difference.

It takes a specialist physician, such as a rheumatologist, to make this tricky diagnosis.  This is because gout and its pretender, pseudogout, both cause painful, inflamed, stiff joints in the fingers, knees, and wrists. And in gout, a throbbing big toe is a hallmark symptom. Sometimes symptoms can become so severe that they disturb sleep.

Although gout and pseudogout are types of inflammatory arthritis, that is where the similarity ends. Gout affects millions of people and occurs when the body produces too much uric acid, or it can’t handle the uric acid produced. This results in uric acid crystals forming in the joints or the kidneys.

Pseudogout is a rare condition where, for unknown reasons, calcium pyrophosphate crystals form in the joints and surrounding tissues.

What triggers a gout attack? How about pseudogout?

Everyday triggers for a gout attack include a joint injury, obesity, an infection, drinking too much alcohol (especially wine), or even eating meat/shellfish.  These specific foods are naturally high in compounds called purines.  These purines break down into uric acid.

Individuals with a family history of gout, kidney disease, or an organ transplant are also at higher risk of developing this ongoing disease.

Pseudogout is a condition that primarily affects older individuals. It’s not understood what actually triggers an attack, but factors such as a family history, excess iron or low magnesium blood levels, and an under-active thyroid are some predisposing factors for developing pseudogout.

How to get an accurate diagnosis?

Your rheumatologist has the experience to differentiate between gout and pseudogout. Diagnosis starts with a medical history & physical examination.  A usual work-up involves some imaging tests (like an X-Ray or Ultrasound) as well as blood tests.  Testing usually reveals high levels of uric acid in your body and in the fluid of the affected joint.

If pseudogout is suspected, fluid from an affected joint can be examined to determine if calcium pyrophosphate crystals are present and confirm a diagnosis.

How are gout and pseudogout treated?

Treatment for both gout and pseudogout focus on reducing inflammation and pain and preventing joint damage. The American College of Rheumatology has developed a list of dietary changes as well as exercise guidelines which help increase your likelihood of success.  Your rheumatologist may prescribe anti-inflammatory drugs and steroids, along with other medications based on your specific clinical needs and the severity of symptoms.

If you have battled gout for awhile without success – consultation with a Rheumatologist is usually the first step in turning that around.  In moderate-severe cases of gout, maintenance medications can help to prevent sudden “attacks” of gout symptoms.

*Calcium Pyrophosphate Deposition Disease (CPPD)