Pseudogout

Overview

Pseudogout is a type of arthritis that causes sudden, painful swelling in one or more joints. It happens when tiny crystals of a substance called calcium pyrophosphate build up in the joint fluid. These crystals irritate the joint, leading to inflammation, pain, and stiffness. The name 'pseudogout' means 'false gout' because it feels like gout but is caused by different crystals.

Pseudogout is not as common as osteoarthritis but is a common cause of arthritis in older adults. It becomes more frequent with age.

Pseudogout most often affects people over the age of 60. It can also affect younger adults, especially if they have certain medical conditions or have had a joint injury.

Symptoms

Common symptoms

• Sudden, severe pain in one joint (often the knee)
• Swelling, warmth, and redness around the joint
• Stiffness that makes it hard to move the joint
• Joint pain that may feel like a flare-up of arthritis

Symptoms in children

• Pseudogout is very rare in children. If a child has joint pain and swelling, it is more likely due to other causes like injury or infection.

Symptoms in older adults

• Attacks may be less severe but can last longer.
• It can affect multiple joints at once, not just one.
• Older adults may also have more joint damage over time if attacks keep happening.

Causes

Main causes

• Pseudogout happens when calcium pyrophosphate crystals form in the joint fluid. This crystal formation is often linked to aging or medical conditions that affect mineral balance, such as hemochromatosis (too much iron), hyperparathyroidism (overactive parathyroid glands), or low magnesium levels.
• In many cases, the exact reason crystals form is unknown.

Risk factors

• Being over 60 years old
• Family history of pseudogout or similar crystal arthritis
• Joint injury or surgery in the past
• Medical conditions such as hemochromatosis, hyperparathyroidism, low thyroid function, or low magnesium
• Dehydration or certain medications (but you should not stop any medication without talking to your doctor)

When to see a doctor

See a doctor urgently if:

• If you have sudden, severe joint pain with fever or chills
• If the joint is very red, hot, and swollen and you cannot move it
• If you think you might have a joint infection (septic arthritis) – this is a medical emergency

Book a routine appointment if:

• If you have joint pain and swelling that lasts more than a few days
• If you have recurring episodes of joint pain
• If you notice joint stiffness that limits your daily activities

Diagnosis

Your doctor will ask about your symptoms and examine the painful joint. To confirm pseudogout, they will take a sample of fluid from the joint with a needle (called joint aspiration). The fluid is sent to a lab to check for calcium pyrophosphate crystals. This is the most reliable test.

Tests that may be done

• Joint aspiration (removing fluid from the joint)
• X-rays to look for calcium deposits in the cartilage (chondrocalcinosis)
• Blood tests to check for other conditions that can cause crystals, such as thyroid or mineral problems

What to expect at your appointment

Joint aspiration may sound uncomfortable, but the doctor numbs the area first. The procedure is quick and can also relieve pressure and pain. You may get results in a few days. Your doctor will explain the findings and discuss next steps.

Treatment

Treatment aims to reduce pain and swelling during an attack and to prevent future attacks. Most people feel better with simple measures and medications. There is no cure, but the condition can be managed well.

Self-care at home

• Rest the painful joint and avoid using it until the swelling goes down.
• Apply ice packs wrapped in a cloth for 15–20 minutes several times a day.
• Keep the joint elevated when possible to help reduce swelling.
• Take over-the-counter pain relievers like paracetamol or ibuprofen, but always follow the label and check with your doctor if you have other health conditions.

Medical treatments

Your doctor may prescribe medicines to reduce inflammation, such as non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids. For severe attacks, they may inject a steroid medicine directly into the joint. They may also prescribe a medicine called colchicine (used for gout) to prevent flare-ups, but this is not a cure. Always take medicines exactly as prescribed and tell your doctor about any side effects.

When is surgery considered?

Surgery is rarely needed for pseudogout. In very rare cases, if a joint is severely damaged by repeated attacks, a joint replacement (like a knee replacement) may be considered. Your doctor will discuss this if it becomes an option.

Living with this condition

Pseudogout can be unpredictable. You may have periods without symptoms and then sudden attacks. Learning to recognize early signs – like a twinge or stiffness – can help you rest the joint and reduce the severity. Most people adjust their activities during flare-ups.

Lifestyle tips

• Stay active between attacks to keep joints strong – gentle exercise like walking or swimming is good.
• Avoid putting too much stress on the joints that have had pseudogout.
• Wear supportive shoes and use assistive devices if needed, like a cane for a painful knee.
• Stay well-hydrated, especially in hot weather.

Diet and exercise

There is no specific diet proven to prevent pseudogout. However, eating a balanced diet with plenty of fruits, vegetables, and whole grains supports overall health. Some people find that staying hydrated helps. Exercise that strengthens muscles around the joints can provide stability and reduce strain. Talk to a physiotherapist for a tailored plan.

Mental health and emotional wellbeing

Living with a chronic condition that causes pain can be stressful. It is normal to feel frustrated, anxious, or down at times. Talk to your doctor or a mental health professional if these feelings affect your daily life. Remember, you are not alone – support is available. If you ever have thoughts of harming yourself, reach out to a crisis helpline or your local emergency number immediately.

Prevention

It is often not possible to prevent pseudogout because it is linked to aging and genetics. However, managing underlying conditions (like hemochromatosis or thyroid problems) may help reduce the risk of attacks. Staying hydrated and avoiding joint injury may also help.

Complications

If left untreated

• Frequent attacks can lead to joint damage and chronic pain.
• Large joint effusions (fluid buildup) that may need drainage.
• Bone spurs and loss of cartilage over time.

Long-term outlook

With proper treatment and good self-care, most people with pseudogout can control their symptoms and have a good quality of life. Attacks may become less frequent or less severe over time. While the condition is not curable, it is very manageable. Your doctor will help you find the best approach for you.

Find support

International organisations

• Arthritis Foundation (International resources)

Local organisations

• Versus Arthritis (UK) · United Kingdom

Helplines

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