Pseudogout vs. Gout: What’s the Difference?

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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 arthritis—an autoimmune condition that leads to joint inflammation—that occurs when crystals build up in your joints, leading to pain and swelling.

  • Gout is caused when uric acid leads to crystal build-up in the joint.
  • Pseudogout, refers to the acute attacks of calcium pyrophosphate deposition disease (CPPD), which are caused by calcium crystals in the joints. 

It’s very difficult to tell the difference between gout and pseudogout. In fact, pseudogout got its name, which means “false gout,” because it’s so hard to distinguish between the conditions.

Determining whether you have gout or pseudogout is important because treatments vary. Here’s what you should know about the difference between gout and pseudogout. 

person with gout holding foot
Jan-Otto / Getty Images

Symptoms

Gout and pseudogout have very similar symptoms. Most often, these conditions are characterized by a sudden onset of pain in a joint. The joint that is bothering you often appears red, hot and swollen.

However, there are small details that can help you determine whether your pain is caused by gout or pseudogout. Here are the specific symptoms of each:

Pseudogout

Pseudogout usually appears first in the:

  • Knees
  • Ankles
  • Wrists

As the condition progresses, the symptoms of pseudogout can occur in the

  • Hips
  • Shoulders
  • Elbows
  • Fingers
  • Toes

It rarely occurs in the neck.

Even after diagnosis, it can be difficult to relieve the symptoms of pseudogout. 

Gout

Gout often appears in just one joint, especially if you’re just starting to experience the disease. Gout often reaches its maximum intensity within 24 hours of onset. Oftentimes, gout first appears in the big toe. It can also present initially in the:

  • Foot
  • Ankle
  • Knee

It can also appear in other places are the disease progresses, including the:

  • Elbow
  • Wrist
  • Finger

Gout appears suddenly, but the symptoms will lessen within a week or two.

The pain and inflammation of pseudogout can come on suddenly, and the episodes often last longer than gout, with symptoms lingering for up to three months.

Causes

Pseudogout and gout are both caused when crystals get into your joints, causing pain and inflammation. However, the type of crystals and what causes them differ between the conditions. 

Pseudogout

Pseudogout happens when calcium pyrophosphate crystals accumulate in the joints. Scientists aren’t sure what causes these crystals, but the deposits are more common in older individuals.

Doctors believe there are multiple contributing factors to the formation of crystals, including:

  • Hyperparathyroidism
  • Magnesium level
  • Iron levels
  • Genetics

Half of the people who are older than 85 years old have calcium pyrophosphate crystals, but they don’t all have symptoms of pseudogout.

Gout

Gout is caused by the build-up of uric acid crystals that can occur due to overproduction of uric acid or due to the body's ability to excrete uric acid in the urine (this is most common). People with gout may have increased levels of uric acid in the blood due to many factors that include—but are not limited to—genetics and decreased kidney function.

For people who are predisposed to gout attacks, diet can play an important role. Some common foods that can increase the levels of uric acid in the blood and trigger a gout attack include:

  • Red meats
  • Sugars
  • Alcohol, especially beer
  • Soft drinks

Another common trigger of gout attacks is stress to the body and dehydration. As a result, it is not uncommon for patients to experience a got attack after surgery.

Uric acid is a byproduct produced when your body breaks down purines. This acid is then expelled from your body in your urine and feces. 

However, if you have high levels of uric acid—which can happen when you eat a diet with lots of meat, sugar, or other purine-rich foods—your body isn’t able to expel all the uric acid. The acid that is left in your blood can create sharp crystals that accumulate in your joints, causing gout.

Diagnosis

To determine whether you have gout or pseudogout, you’ll need to see a doctor. To diagnose, the doctor will ask you about your symptoms and family history, especially since both of these conditions can run in families.

For both conditions, diagnosis involves withdrawing fluid from your sore joint and analyzing it to see if calcium pyrophosphate or uric acid crystals are present. 

Imaging

The doctor may also use imagining technology including ultrasound, x-ray and CT scans to diagnose gout or pseudogout.

Treatment

Since pseudogout and gout can be very painful, it’s important to start treatment in order to restore your quality of life. The course of treatment for gout and pseudogout is similar. Your doctor might recommend treating symptoms with:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, Indocin, or other prescription pain relievers to reduce pain and swelling.
  • Corticosteroids like Medrol or prednisone to reduce inflammation.
  • Colchicine to reduce joint swelling and prevent further attacks of gout or pseudogout. This must be taken within 24 hours of symptoms starting.

Treatment might also include removing fluid from the joint with a needle in order to reduce swelling.

The sooner acute gout is treated, the more likely the attack can be controlled quickly.

If your doctor removes fluid, she may also inject corticosteroids into the joint to help reduce inflammation.

Pseudogout

There is no treatment that can eliminate the calcium pyrophosphate crystals in your joint once you’ve developed pseudogout. In order to keep symptoms at bay, your doctor might recommend anti-inflammatory medications or pain relievers.

If your joint has a significant buildup of calcium pyrophosphate crystals that are causing severe pain, your doctor might recommend joint-replacement surgery.

Joint replacement surgery is sometimes needed when CPPD arthritis is associated with severe degenerative arthritis, also called osteoarthritis.

Gout

Treatments specific to gout involve lowering the uric acid in your blood, which can help reduce symptoms and stop future attacks. You can reduce your risk for future episodes of gout by making lifestyle changes, including:

  • Avoiding alcohol and sweetened beverages, but drink lots of water
  • Reducing stress
  • Avoiding high-purine foods like red meat and sweets
  • Exercising
  • Losing weight

In addition to those lifestyle changes, there are uric acid-reducing drugs that can help control your uric acid levels. 

A Word From Verywell

Suddenly experiencing pain and limited mobility can be frightening. Whether your condition is caused by gout or psuedogout, it’s important to talk to a doctor in order to receive a diagnosis and learn the best course of action for managing symptoms. 

If you have psuedogout, you’ll focus on controlling symptoms like pain and inflammation. If you have true gout, lifestyle changes and prescription medications to manage your uric acid levels can reduce the risk of future episodes of the condition, and allow you to live without pain. 

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