Pseudogout

Definition:
Pseudogout is a form of arthritis that occurs when a particular type of calcium crystal accumulates in the joints. As more of these crystals are deposited in the affected joint, they can cause a reaction that leads to severe pain and swelling. The swelling can be either short-term or long-term and occurs most frequently in the knee, although it can also affect the wrist, shoulder, ankle, elbow, or hand. The pain caused by pseudogout is sometimes so excruciating that it can incapacitate someone for days.

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It is a type of arthritis that, as the name implies, can cause symptoms similar to gout, but in reaction to a different type of crystal deposit.

As its name suggests, the symptoms of pseudogout are similar to those of gout (see “Gout“). Pseudogout can also resemble osteoarthritis or rheumatoid arthritis. A correct diagnosis is vital, as untreated pseudogout can lead to joint degeneration and osteoarthritis. Pseudogout is most common in the elderly, occurring in about 3% of people in their 60s and as many as half of people in their 90s.

Causes:
The cause of this condition is unknown. Because risk increases significantly with age, it is possible that the physical and chemical changes that accompany aging increase susceptibility to pseudogout.

Pseudogout develops when deposits of calcium pyrophosphate crystals accumulate in a joint. Crystals deposit first in the cartilage and can damage the cartilage. The crystals also can cause a reaction with inflammation that leads to joint pain and swelling. In most cases it is not known why the crystals form, although crystal deposits clearly increase with age. Because the condition sometimes runs in families, genetic factors are suspected of contributing to the disorder as can a severely underactive thyroid (hypothyroidism), excess iron storage (hemochromatosis), low magnesium levels in blood, an overactive parathyroid gland, and other causes of excessive calcium in the blood (hypercalcemia).

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Pseudogout also can be triggered by joint injury, such as joint surgery or a sprain, or the stress of a medical illness. If the underlying condition causing pseudogout can be identified and treated, it may be possible to prevent future attacks. Frequently, however, there is no identifiable trigger; in those cases there is no way to prevent pseudogout from recurring.


Who gets pseudogou

The calcium crystal deposits seen in pseudogout affect about 3 percent of people in their 60s and as many as 50 percent of people in their 90s. Any kind of insult to the joint can trigger the release of the calcium crystals, inducing a painful inflammatory response. Attacks of pseudogout also can develop following joint surgery or other surgery. However, not everyone will experience severe attacks.

Symptoms:
* pain, swelling, and stiffness around a single joint
* occasionally, more then one joint affected at a time
* fever, usually low-grade

Diagnosis:

It may be difficult to diagnose pseudogout because it shares so many symptoms with gout, infection, and other causes of joint inflammation. In fact, pseudogout often occurs in people with other joint problems, such as osteoarthritis. Therefore, even when pseudogout is correctly identified, it is important to investigate whether there are other conditions present as well.

Diagnosis is to be done on the basis of symptoms and medical tests. The physician will use a needle to take fluid from a swollen or painful joint to determine whether calcium pyrophosphate crystals are present.This is done with a needle, after applying a numbing medication to the joint.This joint fluid is then analyzed for evidence of calcium crystals, inflammation, or infection. Your doctor may also order tests for other conditions that can trigger pseudogout, including tests of calcium and thyroid function.

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An X-ray of the joint may be taken to determine whether calcium-containing deposits are present, creating a condition known as chondrocalcinosis. Other potential causes of symptoms, such as gout, rheumatoid arthritis, or infection, must be ruled out. Pseudogout often is present in people who have osteoarthritis.

Treatment:
To combat joint pain and swelling, your doctor may prescribe NSAIDs such as indomethacin and naproxen, or may give you glucocorticoid injections to keep the swelling down (see “Corticosteroid injections”). Your doctor may also remove fluid from the inflamed joint, a procedure called aspiration, as this may help to ease the pressure and inflammation.

The combination of joint aspiration and medication usually eliminates symptoms within a few days, although the doctor may also recommend treatment with oral corticosteroids over a short period of time. Daily use of a low-dose NSAID or colchicine, a medicine that is also used in the treatment of gout, may help to prevent further attacks. Unfortunately, there is no treatment available that can dissolve the calcium crystal deposits, although the joint degeneration that often goes along with pseudogout may be slowed by treatments that decrease joint swelling. Occasionally, people with recurrent or chronic pseudogout may develop osteoarthritis. In this case, surgery (such as joint replacement) may be the only effective treatment.


Prevention:

It is not known how to prevent pseudogout. If the condition has developed because of some other medical conditions, such as hemochromatosis (too much iron stored in the body), or parathyroid problems, treatment of that condition may prevent progression of other features of that potentially dangerous illness and may, in some cases, slow the development of pseudogout.

You may click to see:->Pseudogout – 10 Things You Should Know

Points to Remember:
When a patient complains of joint pain, physicians often do not consider pseudogout because it can be confused with gout and other types of arthritis. Diagnosis is confirmed by microscopic identification of calcium pyrophosphate crystals. Anti-inflammatory agents can help lessen symptoms but there is currently no way to eliminate the crystals themselves.
The rheumatologist’s role in the treatment of pseudogout

Rheumatologists are actively engaged in research into the causes of pseudogout to better prevent and treat this form of arthritis. Because people with pseudogout tend to be older and more susceptible to side effects from anti-inflammatory medications, they benefit from seeing rheumatologists, who offer valuable expertise in using such drugs.

Rheumatologists are experts at diagnosing pseudogout and direct a team approach to the chronic, degenerative consequences of crystal deposits. This is important because the patient may need advice about surgery or may require additional information and support from physical and occupational therapists and nurses.
To find a rheumatologist

For a listing of rheumatologists in your area, click here.
For more information

The American College of Rheumatology has compiled this list to give you a starting point for your own additional research. The ACR does not endorse or maintain these Web sites, and is not responsible for any information or claims provided on them. It is always best to talk with your rheumatologist for more information and before making any decisions about your care.

The Arthritis Foundation
www.arthritis.org

National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse
www.niams.nih.gov

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.rheumatology.org/public/factsheets/pseudogout_new.asp
http://www.everydayhealth.com/publicsite/index.aspx?puid=a2579e6f-f790-4eed-ad5e-e59719b4bff6&p=2

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