Pseudogout Vs Gout: Whats The Difference
If you experience the sudden onset of a red, swollen, and painful joint, you might be experiencing gout or pseudogout. Both conditions are types of arthritisan autoimmune condition that leads to joint inflammationthat occurs when crystals build up in your joints, leading to pain and swelling.
- Gout is caused when uric acid leads to crystal buildup in the joint.
- Pseudogout, refers to the acute attacks of calcium pyrophosphate deposition disease , which are caused by calcium crystals in the joints.
Its very difficult to tell the difference between gout and pseudogout. In fact, pseudogout got its name, which means false gout, because its so hard to distinguish between the conditions.
Determining whether you have gout or pseudogout is important because treatments vary. Heres what you should know about the difference between gout and pseudogout.
Can You Have Gout Without Swelling
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Can you have gout without swelling?
How Is Pseudogout Treated
Though gout and pseudogout generally resolve on their own without treatment, they get better much more quickly with medication. Also, a person who has repeated episodes of gout or pseudogout may want to take something on a daily basis to prevent future attacks.
It is important to make a clear diagnosis of pseudogout to allow for the best treatment plan. The right medication depends in part on the severity of your symptoms and in part on your other medical illnesses and other medications you take.
There are 3 kinds of medicines that treat acute attacks of pseudogout. Nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen are effective. Colchicine can also bring the inflammation under control. Steroids, either by mouth or injected directly into the joint, are also highly effective. However, each of these medicines has its risks as well as its benefits, and treatment should be tailored to each individual patient. If a person has repeated attacks of pseudogout, the same medications can be used to prevent attacks as well.
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Signs And Symptoms Of Gout
Any joint can be affected by gout, but it usually affects joints towards the ends of the limbs, such as the toes, ankles, knees and fingers.
Signs and symptoms of gout include:
- severe pain in one or more joints
- the joint feeling hot and very tender
- swelling in and around the affected joint
- red, shiny skin over the affected joint
Symptoms develop rapidly over a few hours and typically last three to 10 days. After this time the pain should pass and the joint should return to normal.
Almost everyone with gout will experience further attacks at some point, usually within a year.
Read more about the complications of gout.
Treating And Preventing Gout Pain
Gout pain is generally treated in two ways:
- Medications to relieve gout attacks in the short-term
- Preventive medications taken regularly to lower uric acid and stop gout attacks from occurring
While inflammation-fighting drugs are used to relieve pain during gout flares, different medicines are used to lower uric acid levels to prevent future attacks. These include:
Another medication called pegloticase may be recommended for people with chronic gout who have not responded to other uric acid-lowering medication.
While many people with gout can be treated by their primary care physician, if gout is not responding to medication or is progressing with worsening or frequent flares or developing tophi gout deposits, then your primary care physician may refer you to see a rheumatologist who specializes in treating diseases that affect joints, muscles, bones and the immune system.
Taking medication to reduce uric acid levels and reduce the risk of gout progression is important, Dr. FitzGerald stresses. If you have risk factors for bad gout, such as kidney disease, or are experiencing frequent attacks, early treatment is better.
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Which Joints Are Involved In Gouty Arthritis And Why Is It Most Common In The Foot
As with all other known types of arthritis, Gout has particular joints it tends to attack, and the foot is its most common location. Gout especially favors the bunion joint, known as the first metatarsophalangeal joint , but the ankle, midfoot and knee are also common locations, as is the bursa that overlies the elbow.
The bunion joint is the first joint involved in 75% of patients and is ultimately involved in over 90% of those with this condition. . It is thought that this joint is especially involved in gout because it is the joint that receives the highest pounds per square inch of pressure when walking or running.
Late in gout, if untreated, multiple joints can be involved, including the fingers and wrists. The shoulder joint is very rarely involved by gout and the same is true of the hip.
Figure 5: Location of Gout Attacks
Is It Gout Or Something Else
The pain and redness of gout can look like an infection or other conditions.
- Pseudogout is another form arthritis. The crystals formed in this condition are made of calcium pyrophospate, not uric acid. But like regular gout, the attack comes on all of a sudden. Joints become swollen, warm, painful, and stiff.
- Reactive arthritis is a reaction to infection that has similar signs.
- Psoriatic arthritis and infectious arthritis can look like gout, too.
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Damage To The Cartilage At The Back Of The Kneecap
Knee pain that feels worse when you go up or down stairs could be a sign of a damaged kneecap, called chondromalacia patellae.
This should not cause any redness or heat around the knee.
The cause is not understood, but it can be linked to overuse of the knee.
You can treat this problem yourself with anti-inflammatory medicines, such as ibuprofen, an icepack and rest.
Shellfish Must Be Avoided At All Cost
Before anything else, I must mention that some type of sea animals must be avoided at all cost. This refers to seafood, lobsters, and shellfish in general. All of them are rich in purine, which will increase the levels of uric acid in your body which can mean only one thing. Your symptoms will get more severe or you will develop gout if you are a primary type of a gout sufferer.
Not only that, these foods must be avoided, but they must not be an addition to a regular diet. As I have mentioned, they must be avoided at all cost, so dont even try to eat them despite the fact they are delicious. If it has a shell, it must be avoided.
I personally like lobsters very much, but I must avoid them, sad truth. You will have to follow my directions if you are looking for a way to ease the symptoms and make gout bearable.
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How Is Gout Treated
Gout can be effectively treated and managed with medical treatment and self-management strategies. Your health care provider may recommend a medical treatment plan to
- Manage the pain of a flare. Treatment for flares consists of nonsteroidal anti-inflammatory drugs like ibuprofen, steroids, and the anti-inflammatory drug colchicine.
- Prevent future flares. Making changes to your diet and lifestyle, such as losing weight, limiting alcohol, eating less purine-rich food , may help prevent future attacks. Changing or stopping medications associated with hyperuricemia may also help.
- Prevent tophi and kidney stones from forming as a result of chronic high levels of uric acid. Tophi are hard, uric acid deposits under the skin. For people with frequent acute flares or chronic gout, doctors may recommend preventive therapy to lower uric acid levels in the blood using drugs like allopurinol, febuxostat, and pegloticase.
In addition to medical treatment, you can manage your gout with self-management strategies. Self-management is what you do day to day to manage your condition and stay healthy, like making healthy lifestyle choices. The self-management strategies described below are proven to reduce pain and disability, so you can pursue the activities important to you.
How To Distinguish Gout From Similar Conditions
This article was medically reviewed by Troy A. Miles, MD. Dr. Miles is an Orthopedic Surgeon specializing in Adult Joint Reconstruction in California. He received his MD from the Albert Einstein College of Medicine in 2010, followed by a residency at the Oregon Health & Science University and fellowship at the University of California, Davis. He is a Diplomat of the American Board of Orthopaedic Surgery and is a member of the American Association of Hip and Knee Surgeons, American Orthopaedic Association, American Association of Orthopaedic Surgery, and the North Pacific Orthopaedic Society. This article has been viewed 23,301 times.
Gout can be confused with a number of other conditions, including pseudogout, septic arthritis, rheumatoid arthritis, and osteoarthritis. If you are concerned that you may have gout, your doctor will examine your signs and symptoms. He will also perform diagnostic tests to determine if your condition is in fact gout.
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When Is Surgery Considered For Gout
The question of surgery for gout most commonly comes up when a patient has a large clump of urate crystals , which is causing problems. This may be if the tophus is on the bottom of the foot, and the person has difficulty walking on it, or on the side of the foot making it hard to wear shoes. An especially difficult problem is when the urate crystals inside the tophus break out to the skin surface. This then can allow bacteria a point of entry, which can lead to infection, which could even track back to the bone. Whenever possible, however, we try to avoid surgery to remove tophi. The problem is that the crystals are often extensive, and track back to the bone, so there is not a good healing surface once the tophus is removed. In some rare cases, such as when a tophus is infected or when its location is causing major disability, surgical removal may be considered.
Since it is hard to heal the skin after a tophus is removed, a skin graft may be needed. For this reason, we often try hard to manage the tophus medically. If we give high doses of medication to lower the urate level, such as allopurinol, over time the tophus will gradually reabsorb. In severe cases, we may consider using the intravenous medication pegloticase , since it lowers the urate level the most dramatically, and can lead to the fastest shrinkage of the tophus.
What Is Gout Know The Signs And Risk Factors
4 Minute Read
Medically Reviewed by UPMC Orthopaedic Care
Gout is a potentially debilitating form of inflammatory arthritis that causes pain, redness, stiffness, and swelling in your joints. More than 8 million people in the United States have gout.
The condition usually affects one joint at a time. About half of all gout attacks begin in the big toe, but it also can occur in the ankles, heels, knees, wrists, fingers, and elbows.
Although gout can cause pain, it can be managed with proper treatment.
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We Always Hear How A Deep Vein Thrombosis Can Cause Pain Swelling And/or Redness In The Affected Area Which Is Commonly The Calf
The blood clot may also form in the upper leg or behind the knee.
If youve always told yourself, I cant possibly have a DVT because theres no swelling or redness, its time to overhaul this way of thinking.
Cana deep vein thrombosis ever cause pain in the leg without any sign of swelling, redness or even pinkness?
Yes, it is possible especially early in the development of the DVT, says Susan L. Besser, MD, with Mercy Medical Center, Baltimore Diplomate, American Board of Obesity Medicine and board certified by the American Board of Family Medicine.
Of course, other things can cause calf pain too , adds Dr. Besser.
Unexplained New Pain in the Calf or Upper Leg
If the pain is in both calves and began about the same time, and there are no other symptoms, this is reassuring and does not point to a blood clot.
If its in one leg, ask yourself what you did recently that might be bringing it on.
Did you try a step aerobics class for the first time the day before? Did you go on a hard hike or do any jumping exercises?
Did you suffer an acute calf cramp overnight? The pain can linger into the day but will not cause a blood clot.
If the pain in your calf is activated only when you walk or climb stairs, this points to a sore muscle, but if it doesnt go away after several days, the suspicion for DVT increasingly rises, especially if you have risk factors.
Lengthy time flying with little movement of the legs can cause blood clot formation.
Purines And Uric Acid
The crystallized uric acid that causes gout pain is created by the breakdown of a substance called purines. Purines are part of every cell that make up all plant and animal food sources. Purines are also produced by the human body itself.
Some foods, namely proteins like meats and beans, are higher in purine content that others. One way that high levels of uric acid accumulate in the blood is by eating these types of foods. Another way is by consuming drinks and foods that are made with a generous amount of high fructose corn syrup.
However, the true problem is that the kidneys are temporarily not able to balance the pH of the body chemistry as they normally do. Kidney function can become impaired for a number of reasons in addition to consuming certain types of foods toxic environmental chemicals in the air and water, stress hormones, dehydration, skin contact with toxic substances, physical over-exertion, and others.
When the kidneys are overloaded, the uric acid may not be properly processed and excreted. Normally, uric acid is produced and used by the body as a protective antioxidant, but when over-abundant, its corrosive nature can become problem.
The alternative that nature has provided is to allow the excess uric acid to crystallize in a joint far from the vital organs to protect them this is the fundamental point to understand when the question, what is gout? comes up.
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The Role Of Medication In Prevention Of Gout
Table 3: Medications to pevent attacks of gout
Standard medications in preventing gout attacks
i. Colchicine : using the matches analogy discussed above1, using colchicine can be seen as dampening the uric acid matches. Colchicine does not lower the bodys store of uric acid, but it decreases the intensity of the bodys inflammatory reaction to these crystals. Recent studies have shown that at least one mechanism of colchicines action is by acting to prevent a cascade of reactions that lead to the production of interleukin 1-beta, which is an inflammatory protein , which is important in gouty inflammation.8
ii. Allopurinol: This agent is presently the most commonly used drug for the prevention of gout. Allopurinol blocks the enzyme xanthine oxidase, which blocks the breakdown of purines, thus decreasing the bodys total amount of uric acid. Allopurinol is effective in preventing gout no matter what the mechanism of the elevated uric acid was. Whether a person is making too much uric acid, or has difficulty excreting it via the kidney, allopurinols decrease in uric acid production leads to the same goal: a decreased total body uric acid.
Table 4: Reasons to use medication to lower uric acid
Treatments Your Physician May Prescribe
The goals of treatment of gout are to reduce the pain associated with acute attacks, to prevent future attacks from occurring, and to avoid the formation of tophi and kidney stones.Your physician may recommend one or more of the following treatments for acute attacks:
- Rest and elevation of the affected joint
- Anti-inflammatory medications, including ibuprofen, naproxen, or indomethacin
- Corticosteroids such as triamcinolone injections or prednisone pills
- Low-purine diet
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When To See A Healthcare Provider
Not everyone with gout will experience worsening symptoms or need urate-lowering therapy. With that being said, if you ignore symptoms or fail to take action to avoid attacks, you may end up causing yourself long-term harm.
People with gout will sometimes think that the prolonged absence of symptoms means that the disease has spontaneously disappeared. This is usually a fallacy. Unless the underlying cause of high uric acid levels is controlled, the disease can advance silently and reap irreversible harm.
For some guidance on talking with a medical professional about your gout, use our Healthcare Provider Discussion Guide below. It can help you start a conversation with your healthcare provider about symptoms, treatment options, and more.
Gout Healthcare Provider Discussion Guide
Get our printable guide for your next healthcare provider’s appointment to help you ask the right questions.
The following are reasons why you should definitely see a healthcare provider about your gout:
- This is your first attack. Even if treatment is not prescribed, you might benefit from lifestyle modifications to reduce the risk of future attacks.
- Your symptoms don’t improve after 48 hours or last for more than a week. If you are on therapy, this may be an indication that changes need to be made, including dietary and lifestyle interventions.
- You have a high fever. While a mild fever can accompany a gout attack, a high fever may be a sign of an infection.