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Unraveling Pseudogout: Understanding CPPD

Let’s talk about pseudogout, a condition often overshadowed by its more renowned counterpart, gout. In this blog, we embark on a journey to unravel the mysteries of pseudogout, also known as CPPD (calcium pyrophosphate deposition disease).

What is Pseudogout?

Pseudogout mirrors the symptoms of gout, presenting as an inflammatory arthritis characterized by crystal deposition in the joints. Unlike gout, which is caused by uric acid crystals, pseudogout manifests with calcium pyrophosphate dihydrate (CPPD) crystals. These crystals, when examined under a microscope, differentiate pseudogout from its namesake.

Recognizing Pseudogout

Pseudogout manifests as an inflammatory arthritis with notable joint swelling, warmth, redness, and severe pain, often accompanied by morning stiffness. The knees, hands (specifically the MCP joints), and feet are common sites of inflammation, although involvement can extend to other joints, including the spine.

One hallmark of pseudogout is its sporadic nature, characterized by episodes of intense pain followed by periods of remission, akin to crystal arthropathy. Furthermore, unlike gout, pseudogout doesn't correlate with dietary factors.

Distinguishing Pseudogout from Gout

While both conditions share similarities, pseudogout tends to exhibit a more chronic course compared to the fluctuating nature of gout. Additionally, pseudogout often presents with asymmetrical joint involvement.

Investigating Pseudogout: Secondary Causes

Pseudogout can arise secondary to various underlying conditions, necessitating thorough investigation. Secondary pseudogout may be linked to hyperparathyroidism, renal failure, or hemochromatosis. Testing for PTH, calcium levels, TSH, iron, and ferritin levels helps elucidate potential secondary causes.

Consider a patient initially diagnosed with seronegative rheumatoid arthritis. Despite treatment, including biologic agents, symptom relief remained elusive. Further investigation, including synovial fluid analysis, revealed CPPD crystals, leading to a revised diagnosis of pseudogout. Treatment adjustment to include prednisone resulted in significant improvement.


Pseudogout, often overshadowed by gout, merits recognition for its distinct clinical presentation and management considerations. By understanding its unique features and potential secondary causes, clinicians can navigate diagnosis and treatment more effectively, ensuring optimal patient care.

Join us in our next blog, as we delve deeper into diagnosing and managing pseudogout. 

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