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The Pseudogout Story, or how every single inflamed joint isn’t only rheumatoid arthritis.

Updated: May 30, 2023

The truth is, rheumatoid arthritis (RA) is such a common diagnosis that often physicians may consider any swollen and painful joints due to this condition. But if it was this easy we wouldn’t have to go through medical school (4 years), residency (3 years) and fellowship (2 to 3 years). And most importantly, all patients with swollen joints would be in a much better state since RA has so many treatments option.

While in some cases RA is very easy to diagnose (there are hallmark of the disease via blood work (ie CCP) or via Xrays (with specific erosion), there are many cases where the diagnosis is left to the clinical skills of the physician that examines the patient.

I have found in my 20+ years of clinical career that many patients with “seronegative” (when both CCP and rheumatoid factor antibodies are negative) RA may continue to have pain and swelling despite different medication courses because they have not been properly diagnosed.

Take the case of a recent patient of mine. She had had intermittent joint pain and swelling in her hands for many years. At first, she had responded to the treatments that her physician had given her, but as her disease progressed, she had found herself requiring more and more steroids (a medication that decreases the immune system and can cause diabetes, obesity, osteoporosis and so many other unwanted side effects) as none of the other drugs would even touch her symptoms. There was jn fact no reasons to go with different treatments for her so-called RA as It was in fact a different diagnosis altogether! In this blog post, id like to discuss what pseudogout is so that if you ever find yourself in this situation you may discuss this possibility with your physician.

What is Pseudogout?

Pseudogout is also known as calcium pyrophosphate deposition disease (CPPD). It is a form of arthritis caused by deposits of calcium pyrophosphate crystals in the joints. These deposits can then cause inflammation, resulting in symptoms such as joint pain, stiffness, redness, warmth, and swelling. While these symptoms might be similar to those of other forms of arthritis such as RA or gout, the underlying cause for CPPD is unique to pseudogout.

How do we make a diagnosis of pseudogout?

The gold standard to make the diagnosis is obtaining some of the synovial fluid (the fluid that is contained between your bones, in your joints) by performing an arthrocentesis (also called joint tap). If we can see under the microscope the CPPD crystals, then we can make a diagnosis of Pseudogout.

Blood tests may also be used to check for elevated levels of calcium and phosphorus in the body since these are often associated with pseudogout.

Sometimes we can also suspect the diagnosis when we find chondrocalcinosis (a calcified line deposition over the joints) on Xrays, most often the knees, wrists, or pelvic bones. This chondrocalcinosis is sometimes even more visible when we perform a joint ultrasound to look for a “double contour sign” which represent this deposition of calcium pyrophosphate over the joint.

How Is It Treated?

Treatment for pseudogout usually involves medications such as non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids or colchicine to reduce inflammation and relieve pain. Joint injections may also be used to provide short-term relief from inflammation. Physical therapy can help strengthen weakened muscles around affected joints while lifestyle changes such as exercise can help improve overall health and reduce symptoms over time. Treatment for pseudogout differs from other types of arthritis such as RA because it does not involve immunosuppressive drugs or biologic agents like those used to treat RA. It should also be noted that treatments for gout are different than those for pseudogout since they involve controlling uric acid levels rather than addressing crystal deposits in the joints directly. Finally, there are secondary causes of pseudogout that should always be evaluated when making such a diagnosis. In the case of our patient for example, we found that she was suffering from hyperparathyroidism. which was leading to overproduction of calcium and deposit of calcium in her joint. The treatment of her hyperparathyroidism led to complete resolution of her symptoms!

Conclusion: There are some key differences between treating pseudogout versus other forms of arthritis such as RA or gout. To make such diagnosis, we need to take the time. At UnabridgedMD in rheumatology we understand how important it is for people suffering from any form of arthritis to have access to accurate diagnosis and effective treatment options tailored specifically for their needs – something that traditional medical practices don’t always offer due to time constraints. That’s why we created UnabridgedMD in rheumatology_we believe everyone deserves personalized access to quality health care without having to worry about time constraints or cost barriers getting in their way! Contact us today if you have questions about our services or would like more information about diagnosing and treating conditions like pseudogout! we are currently accepting new patients:

Keywords: `gout, pseudogout, colchicine, Autoinflammatory syndrome, fever of unknown origin, elevated ESR, elevated CRP, arthritis, inflammatory arthritis, joint pain, joint swelling, best rheumatologist in Denver, Colorado

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