By The Doc

I’m afraid fake gout is no less painful than the real thing

I had a patient in last week who seemed to have gout.

She had experienced sudden pain, acute inflammation and swelling in a couple of joints. An ice pack had helped with the pain – one of the classic treatments to ease the discomfort of gout.

Older people tend to be affected by gout, and she was in her 80s.

But there were a few tell tale signs this was actually something else – pseudogout.

Pseudo, pronounced soo-doh, is ancient Greek for fake so the name literally means “fake gout”. It’s not any less painful, however.

To give the condition its proper name, it is acute calcium pyrophosphate (CPP) crystal arthritis.

It can be triggered by serious illness, dehydration, thyroid problems, arthritis, too much iron in the blood and long-term steroid use, to name a few potential causes.

We’re not sure what happens precisely, but all these can trigger CPP crystals to form in the joints.

These tiny crystals settle on joint tissues and irritate the area.

This is very similar to gout, where uric acid crystals form in the blood and similarly irritate joints.

There are a few differences, though. Gout tends to affect – although it’s certainly not limited to – joints in the foot, particularly the base of the big toe.

Pseudogout, meanwhile, is most likely to affect the knees, although it can appear in other joints, too.

An x-ray may give a clue. CPP crystals which have accumulated are visible on an x-ray, while uric acid crystals aren’t. But they might not be seen in an acute attack.

Taking fluid out of the joint and looking at it under a microscope can detect whether it’s CPP or uric acid crystals.

Attacks will generally clear up in a while with painkillers and sometimes steroid injection into the affected joint. But we need to be careful there’s no infection in the joint, which can give similar symptoms.

My patient used icepacks, which can help, as does resting the area.

Unlike gout, which is helped by medicines such as Allopurinol and making lifestyle changes including cutting down on red meat and alcohol, there isn’t an easy way to prevent pseudogout.

But treating any triggers and staying well-hydrated may help, while watching your weight and remaining active should reduce the risks.