Pseudogout (SOO-doe-gout) is a form of arthritis characterized by sudden, painful swelling in one or more of your joints. These episodes can last for days or weeks. The most commonly affected joint is the knee

To diagnose pseudogout, first of all you have to have the clinical history to suspect pseudogout. So, those symptoms from the history would include acute onset of pain and swelling in a joint, typically a knee or a wrist or an elbow. Typically, there’s a history that they’ve had it before. There may be a history months ago or a year ago that one had a hot, swollen joint, and this has come back months or years later.

Once you’ve suspected the diagnosis of pseudogout, then there are blood tests, and x-rays and special tests that you’ll consider doing. Typically, the blood tests you will do would include a blood test to look for markers of inflammation, so an elevated ESR or CRP. You’ll also want to do a uric acid level, because if the uric acid level is high, it’s much more likely gout than pseudogout. A local chiropractor may work with your local massage therapist and your local physiotherapist to create the best health or rehabilitation plan for your situation. 

There are other blood tests that your specialist might want to do, because pseudogout can sometimes be associated with changes in the blood, so it will be important to do some blood test to rule out that as an associated problem. Your specialist will want to do an x-ray of the joint, because it’s not uncommon to see minor calcification along the cartilage of the joint, and that increases the likelihood of the diagnosis of being pseudogout. often seeing your local family physician for a referral to rheumatologist, physiotherapits or registered dietician 

The best way to confirm the diagnosis of pseudogout is to put a needle in the joint and remove some fluid. When you remove the fluid, you want to do it for two reasons: One is you want to exclude the fact that you might have an infection, so you’ll send the fluid—the synovial fluid—for a culture, but as importantly, it’s to analyze the fluid for pseudogout crystals.

And under the microscope, with a special manoeuvre to look at it, one can demonstrate the presence of these pseudogout crystals. Sometimes, one’s not able to get a suitable amount of fluid from a joint, and then there are other special tests that one can do to help confirm or deny a diagnosis of gout or pseudogout.

There is one test called the dual energy CT study, which is an x-ray-based CT that can look at joints—the small and large joints—and help decide whether or not the inflammation in a joint is because of pseudogout or gout. This is a test that’s been available for a number of years now, and is a very useful way of helping diagnose pseudogout if you’ve not been able to get any fluid out from the joint.

If you have any questions or concerns about the diagnosis of pseudogout, speak to your family physician, Rheumatologist, registered Dietician,  athletic therapist and a pharmacist  healthcare provider or your specialist.

Presenter: Dr. John Wade, Rheumatologist, Vancouver, BC

Local Rheumatologist Practitioners:

Colchicine is a medication you need to respect, because it has side effects. Side effects of colchicine commonly include nausea and diarrhea. And if you push the dose of colchicine too high, sometimes the side effects of the medication are worse than the symptoms of the disease.

So your specialist, local rheumatologist  will recommend you take one, two, three, perhaps colchicine for the first day. And then subsequently they may recommend that you reduce the dose of the colchicine in the coming days and then after a number of days, it would be recommended that you stop or come off the colchicine. Occasionally, pseudogout can be a chronic condition, and there are some times that your specialist will recommend that you stay on very low-dose colchinine on a daily basis. Sometimes you can reduce that to every other day. In treating this condition, often seeing a local massage therapist for muscle tension, a local personal trainer for muscle strength and a physiotherapist for release and conditioning is a good option. Getting a referral to a rheumatologist or your local pharmacist is also important in dealing with Arthritic conditions.  

If you can’t take colchicine and you can’t take anti-inflammatories, there are some newer medications that are very effective in treating pseudogout. Those medications are biologic drugs, known as IL-1 inhibitors. The most common IL-1 inhibitor readily available is a drug called anakinra. Anakinra is a drug you give yourself, or a nurse gives you, on a daily basis. The dose is 100mg in a prefilled syringe. You will inject it under the skin, and usually taking anakinra 100 milligrams daily for three to six days is an extremely effective way of resolving the acute symptoms of pseudogout, if you fail the other therapies.

If you have any questions or concerns about the treatment of pseudogout, speak to your healthcare provider or your specialist. Presenter: Dr. John Wade, Rheumatologist, Vancouver, BC

 Now Health Network Local Practitioners: Rheumatologist