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Gout and a pseudogout are similar conditions caused by different crystal deposits in joints.

Gout is a disorder that results from deposits of sodium urate crystals generating in the joints which leads to attacks of painful joint inflammation. These depostits come from the elevated blood levels of uric acid, a condition called hyperuricemia. Pseudogout can cause symptoms similar to gout, but is caused by a different type of crystal deposits -calcium Pyrophosphate!

Incidence of the gout  

Gout is more common in men than in women. Usually, gout develops in middle-aged men and after the menopause in women. It is very rare in younger people but is often more severe in people who develop the disorder before the age 30. It is also important to know that gout often runs in families.

Normal cycle of uric acid

What exactly is a uric acid? Normally, uric acid is nothing more then a by-product of cell nucleic acid breakdown. It is present in very small amounts in the blood because the body continually breaks down cells and forms the new ones. Another source of uric acid are the substances called purines which can normally be found in food.

Foods high in purines include:

  • anchovies,
  • asparagus,
  • consommé,
  • herring,
  • meat gravies and broths,
  • mushrooms,
  • mussels,
  • all organ meats,
  • sardines,
  • sweetbreads

Possible causes of gout

In most cases, the elevated uric-acid levels are caused by the improper functioning of the kidneys. If for some reason the kidneys cannot eliminate enough uric acid in the urine, too much uric acid in the blood results in urate crystals being formed and deposited in the joints.

There are several other conditions that can cause hyperuricemia. Large amounts of uric acid may be produced because of an inherited enzyme abnormality or a disease such as leukemia, in which cells multiply and break down rapidly.

Sometimes however, the exact cause of gout cannot be determined. Doctors refer to this as secondary gout. 

Risk factors for developing gout

There are several possible risk factors that could be linked to developing gout:

  • Certain cancers and blood disorders
  • Certain drugs - thiazide diuretics, Cyclosporine, nicotinic acid, warfarin, salicylates…
  • Certain foods, especially those rich in purines
  • Hypothyroidism
  • Lifestyle factors - consumption of alcohol is a common lifestyle factor that increases the risk of gout.  
  • Genetics.
  • Age and sex.
  • Lead poisoning  
  • Obesity
  • Radiation treatment
  • Renal failure
  • Starvation

Symptoms of gout

Joint pain

The most common symptom of gout is a sudden joint pain attack. The problem is these attacks can occur without warning. They may be triggered by an:

  • injury,
  • surgery,
  • consumption of large quantities of alcohol or
  • consumption of large quantities food rich in purines,
  • fatigue,
  • emotional stress,
  • illness

The pain usually isn’t located in one joint only. Typically, it occurs suddenly and it often happens at night. When you look at the joint that is causing you pain, you should be able to see that it’s becoming inflamed, swells, feels warm, and the skin over the joint appears red or purplish, tight, and shiny.

Other common symptoms

The other symptoms of an attack can include fever, chills, a general sick feeling, and a rapid heartbeat. 

Complications

The big problem is that, after repeated attacks, especially if left untreated, gout can become severe and chronic and may lead to the destruction of tissue and a joint deformity. That’s why the early diagnosis and immediate treatment could be crucial.
What happens if it is left untreated? The joint motion becomes progressively restricted by the damage caused by deposits of urate crystals in the joints and tendons. Not only that, some hard lumps can be seen on joints as a result of crystals depositing. These deposits are called tophi. They can also be seen kidneys and some other organs, under the skin on the ears, in the tough band extending from the calf muscles to the heel (Achilles tendon), or around the elbows.

Diagnosis of gout

  • Joint fluid analyze

The doctor usually withdraws fluid from the affected joint to check for crystals of uric acid in patient’s white blood cells.  

  • Urine test

The patient may have a urine test to measure the amount of uric acid in his or hers excreting.

  • Blood test

The doctor may ask the patient to undergo a blood test to measure the uric acid level in patient’s blood.

  • X-rays

These tests may show the joint damage and the presence of tophi.

What exactly is pseudogout?

Pseudogout is a very specific condition very similar to gout with one difference - th deposits responsible for the arthritis attacks in the joints are made of calcium Pyrophosphate crystals. The condition is also called chondro-calcinosis.

The possible causes of pseudogout

It is proven that pseudogout results from the abnormal formation of calcium Pyrophosphate crystals in the cartilage. The whole process is later followed by the release of crystals into the joint fluid. This is causing the sudden attacks of arthritis, similar to gout. Unlike with gout, the cause of pseudogout is still unknown. There are several theories that tried to explain the mechanism behind this disorder. This buildup could form due to abnormal cells in the cartilage, or they may be produced as the result of another disease that damages cartilage. Sudden illness, joint injury or surgery are also considered possible triggers for the condition.This condition may also be hereditary.

Symptoms of pseudogout

The symptoms are similar to gout in that the pain and swelling occur in the joints around the elbows, wrists, ankles, knees, fingers, and toes. However, unlike gout, pseudogout can also affect the hips and shoulder joints, and attacks are not as severe.

Other possible symptoms include:

  • Sudden, intense joint pain.
  • Swollen joint that's warm to the touch.
  • Red or purple skin around the joint.

Who is at risk for developing pseudogout?

Pseudogout affects both men and women equally. It is proven that pseudogout occurs more frequently in people as they age, usually after the age of 60.
Research has proven that some people have an increased risk for pseudogout. Those are people who have:

  • thyroid condition,
  • kidney failure,
  • disorders that affect calcium, phosphate or iron metabolism

Diagnosis of pseudogout

Unlike gout, pseudogout cannot be diagnosed simply by a blood test.

An X-ray of the joint
This diagnostic tool could be used to seek for the presence of calcium containing crystals.

Analisys of the joint fluid
In this test, fluid is removed from the inflamed joint and analyzed under a microscope. The presence of CPP crystals indicates pseudogout.

Treatment of gout and pseudogout

Treatment of gout

Nonsteroidal anti-inflammatory drugs
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Colchicine®, ibuprofen (Advil®, Motrin®, others) and naproxen (Aleve®, others), may provide relief from the gout attacks.

The side effects of these medications include stomach pain, bleeding and ulcers. Colchicine® is the traditional first-step treatment but it isn’t so common nowadays. The joint pain usually begins to subside 12 hours after the treatment with Colchicine® has started and is gone within 36 to 48 hours.

Corticosteroids
Sometimes, in severe cases only, the doctor may prescribe a corticosteroid drug such as Prednisone®. Although steroids can provide dramatic relief, they can also cause serious side effects, including bones thinning, poor wound healing and decreased ability to fight the infections.

Medications for excretion of uric acid
Drugs that cause excretion of uric acid in the urine, such as sulfinpyrazone, can be used to lower the uric acid level in the blood.

Analgesics
If pain medication is needed, acetaminophen or other analgesics can be safely used instead.

Lifestyle changes
Once the acute attack is under control, the doctor may recommend a preventive treatment to slow the rate at which your body produces uric acid or to increase the rate at which it's excreted. Avoiding alcoholic drinks, losing weight, stopping drugs that cause elevated blood levels of uric acid, and eating smaller amounts of purines-rich foods may be all that is needed.

Treatment of pseudogout

There are no treatments to dissolve the crystal deposits that cause pseudogout making this disorder very hard to treat. The treatment focuses mainly on relieving the pain by controlling the joint inflammation and on preventing joint damage.

Nonsteroidal anti-inflammatory drugs
Nonsteroidal anti-inflammatory drugs such as ibuprofen, naproxen sodium, or Indomethacin, are available and very effective in relieving pain and swelling.

Corticosteroids
Sometimes, corticosteroids such as Prednisone and even some steroid-hormones can be injected directly into the joint to quickly stop the inflammation. Corticosteroids can also be taken orally, but are never used for more than a few days to avoid the side effects.

Cold compresses
Applying a cold compress to the painful joint and limiting movement during an attack may also provide some relief.

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