What Is Pseudogout?

Symptoms, Causes, Treatment, and More

Medically reviewed by David Ozeri, MD

Pseudogout is a term used to refer to calcium pyrophosphate deposition disease (CPPD). It results from calcium pyrophosphate crystals forming and building up in the joints and nearby tissues. Pseudogout is a type of arthritis that presents with symptoms like those seen in gout. Gout is also a type of arthritis resulting from a buildup of another crystal type.

Episodes called flares or flare-ups of pseudogout cause swelling, pain, tenderness, redness, and warmth of affected joints. Pseudogout often affects the knees and wrists, but any joint might be affected. Pseudogout might be confused with other types of arthritis that cause inflammation.

This article will cover pseudogout signs and symptoms, causes of flares, diagnosis, and more.

<p>wutwhanfoto / Getty Images</p>

wutwhanfoto / Getty Images

Pseudogout Symptoms

The joint most affected by pseudogout is the knee, followed by the wrist. The hand joints and the joint at the base of the big toe might also become inflamed. If the big toe is inflamed, pseudogout might be mistaken for gout, which is a main characteristic of gout.

Pseudogout causes inflammation with varying severities. These severities fall into three basic types:

  • Acute (short-term) arthritis flares of one joint

  • Chronic (long-term) inflammation of multiple joints

  • Rapidly progressive degeneration of cartilage (the smooth, white tissue covering the ends of bones where they meet the joints) in affected joints

Episodes of joint pain, swelling, redness, tenderness, and warmth are common in pseudogout flares. Fever might also be present during these episodes.

Chronic pseudogout causes inflammation in several joints at once. This type of inflammation is less intense, but it is more widespread. If chronic pseudogout affects several joints, it might be mistaken for rheumatoid arthritis (RA). RA is an autoimmune arthritis that causes inflammation of the synovial linings of joints, leading to severe joint destruction.

With chronic pseudogout, symptoms may include:

Rapidly progressive pseudogout can lead to joint damage that is seen in people with severe osteoarthritis (OA). OA is a degenerative disease that comes with age and wear and tear of the joints. Severe OA leads to extensive joint damage, pain, and reduced range of motion.

People who experience pseudogout in this way will experience less inflammation, but the presence of the calcium crystals can cause the cartilage lining to deteriorate rapidly. As with the other severity types, the knee is most commonly affected.

Pseudogout vs. Gout

While pseudogout and gout can cause similar symptoms, they are different conditions, with the following characteristics:

  • Gout results from high levels of uric acid in the blood, while pseudogout results from CCP crystals. Uric acid crystals build up in a joint, leading to swelling and pain. By contrast, CCP crystals build up the joint cartilage, leading to pain and inflammation.

  • Pseudogout often affects multiple joints, with knees and wrists most frequently affected. Gout will affect one joint at a time, and most often the big toe. Other joints, including the knees and wrists, can also be involved.

  • Flares associated with pseudogout can occur at any time, while gout flares tend to start in the middle of the night.

  • Pain associated with pseudogout can be severe and last longer than what is seen with a gout flare.

  • Gout flares often have triggers, such as diet, stress, and medicines, while pseudogout does not have clear triggers.

Why Does Pseudogout Flare?

According to a 2018 New England Journal of Medicine report, pseudogout affects between 4% and 7% of the adult population in the United States and Europe.

What causes pseudogout is unknown but seems more common in older adults, mainly people assigned male at birth. Pseudogout is considered a disease of aging and is rare in people under age 60, and prevalence tends to increase with age.

CPP crystals can sometimes exist without causing any joint problems. Symptoms will occur when the crystals are released from cartilage tissues into nearby joints.

Stress, illness, injury, or surgery might trigger a pseudogout episode. Flares may also occur with any triggering event. In most instances, pseudogout attacks are self-limiting and last a few days to a few weeks.

Previous trauma is also a risk factor for pseudogout, especially in the meniscus of the knee. It may also occur following surgery and other bone, joint, and tissue injuries. 

Additional risk factors for pseudogout include:

There is a genetic component to pseudogout, and when there is a family history, it may affect adults in middle age. The ANKH gene is linked to pseudogout. It controls cell proteins that help transport pyrophosphate out of the body. A gene mutation causes CPP crystals to stay in the body and reach the joints.

Other genes, including mutations of CCAL1 and CCAL2, are also linked to the development of pseudogout, but they are much rarer.

Related: What Are the Crystals That Cause Gout and Pseudogout?

Diet typically does not affect the onset or development of pseudogout. It is also not considered a trigger for flare-ups of the condition.

While pseudogout is not an autoimmune disease, it does lead to an immune system inflammatory response, resulting in arthritis and synovitis (inflammation of the joint lining). Autoimmune diseases occur when the immune system malfunctions and attacks healthy tissues.

Getting Pseudogout Diagnosed

An early and accurate pseudogout diagnosis is the best way to prevent severe joint and cartilage damage. Pseudogout can mimic other types of arthritis, including RA, OA, and gout, leading to treatment delays. The sooner you see a medical provider, the better your care will be.

You should see a rheumatologist if you are experiencing ongoing joint pain, swelling, and stiffness. A rheumatologist is a medical doctor specializing in diagnosing and treating arthritis and other rheumatic conditions.

If healthcare providers suspect pseudogout, they will:

  • Start by asking about your symptoms, including when they started and how long they last

  • Ask about your personal medical history and family history

  • Request joint imaging, such as X-rays, ultrasound, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans

Your healthcare provider may also perform a joint aspiration procedure. This involves using a needle to take a small amount of fluid from an affected joint and sending it to the laboratory to look for the presence of calcium pyrophosphate crystals. Synovial fluid aspiration and crystal analysis are considered the joint standard for diagnosing pseudogout.

Blood and urine tests might be done to help your healthcare provider come up with a diagnosis. But, these tests are typically done to rule out other conditions, including RA.


Pseudogout is sometimes misdiagnosed, leading to its being treated incorrectly. It is often confused with other types of arthritis, including:

Pseudogout Treatment Options

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil or Motrin (ibuprofen) and Aleve (naproxen) can control pain and swelling during a pseudogout episode. Corticosteroid drugs, given orally or by injection into the affected joint, can control pain and inflammation if a pseudogout attack is severe or affects multiple joints.

To prevent future pseudogout attacks, your healthcare provider can prescribe low-dose Colcrys (colchicine), which has been found to block crystal formation linked to pseudogout and gout.

For people with chronic pseudogout, additional treatments like hydroxychloroquine and methotrexate (disease-modifying antirheumatic drugs used to treat autoimmune arthritis) may reduce swelling and slow down the processes in the body that cause inflammation.

Joint drainage may relieve pain and pressure on a pseudogout-affected joint. A needle is used to remove the fluid and some of the crystals. The joint is then injected with a numbing drug and a corticosteroid to reduce inflammation.

If none of these medicines work, joint damage may occur. In these cases, surgery can repair and replace damaged joints.

While diet has no role in forming crystals that lead to pseudogout, changing your diet to eliminate inflammation-producing foods might help. You will want to avoid sources of trans fat (i.e., margarine and polyunsaturated vegetable oils), junk foods, baked goods, refined sugars, and alcohol.

Instead, add anti-inflammatory foods, including fatty fish, fruits, vegetables, spices (like turmeric), and olive oil, to your diet.

Related: How to Follow an Anti-Inflammatory Diet (and Why You Should)

How to Manage Pseudogout Flares

You can manage a pseudogout flare at home. This includes over-the-counter NSAIDs, such as ibuprofen and naproxen sodium, to help manage pain and reduce inflammation.

Additional ways to manage flare symptoms and ease discomfort include:

  • Using cold compresses against the affected joint to relieve discomfort and swelling

  • Resting the affected joint and using it as little as possible

  • Elevating the affected joint by lying down or placing a pillow underneath

Contact a healthcare provider if at-home treatments do not help or symptoms worsen. They can prescribe a more potent NSAID or a corticosteroid to help manage symptoms.

You should also inform a healthcare provider if you experience frequent or severe flares. They can prescribe medications to prevent crystal build-up or control underlying processes that might lead to inflammation.


Pseudogout is a type of arthritis that happens when crystals build up in the joints and surrounding tissues. It is unknown what causes it, but the risk for the condition increases with age. Pseudogout also runs in families and may be linked to an injury or certain health conditions, including kidney or thyroid disease.

Pseudogout is characterized by periods of flare-ups, when symptoms worsen. Symptoms include swelling, pain, tenderness, warmth, and swelling in the affected joints. The most commonly affected joints are the knees and wrists, but the condition can affect any joint.

The condition is classified by its severity and the number of joints affected. It can be acute and affect only a few joints, chronic and affect multiple joints, or rapidly progressive, leading to cartilage and joint damage.

Contact a healthcare provider if you suspect you might have pseudogout. Treatment is vital to avoiding long-term damage to the joints.

There is no cure for pseudogout, but it can be treated with medications to ease symptoms and prevent future flares. If you are experiencing a pseudogout episode, take the time to rest and elevate affected joints, apply ice to bring down swelling, and take NSAIDs to manage pain and inflammation.

Let your healthcare provider know about severe and frequent flare-ups. They can reassess you and provide additional treatments to help.

Read the original article on Verywell Health.