Gout - Diagnosis

Ruling Out Other Disorders

As part of the diagnosis, other disorders that produce gout-like symptoms or cause hyperuricemia should be ruled out. In general, it is easy to distinguish acute gout that occurs in one joint from other arthritic conditions. The two disorders that may confuse this diagnosis are pseudogout and septic arthritis. Chronic gout can often resemble rheumatoid arthritis. A number of other conditions may at some point in their course resemble gout.

Pseudogout. Pseudogout is a condition most likely to be confused with gout.

Pseudogout (Calcium Pyrophosphate Dihydrate Deposition Disease)

Pseudogout (also called calcic gout) is the third most common inflammatory arthritis among older adults. It is very similar to gout, but is caused by deposits of calcium pyrophosphate dihydrate crystals in and around the joints. (It is, in fact, medically referred to as calcium pyrophosphate dihydrate deposition disease, or CPPD.)

What Are the Symptoms of Pseudogout?

Though symptoms of pseudogout resembles gout in some ways, there are differences:

The first attack typically strikes the knee. Other joints commonly affected are the shoulders, wrists, and ankles. At least two-thirds of cases affects more than one joint during a first attack. It may involve any joint, although the small joints in the fingers or toes are not commonly affected.
The symptoms of pseudogout also appear more slowly than those of gout, taking days rather than hours to develop.
Pseudogout is more likely to first develop in elderly people, particularly those with osteoarthritis. (It affects between 10 - 15% of people over 65.)

Pseudogout is more likely to occur in the autumn while gout attacks are most common in the spring.

Who Gets Pseudogout?

Conditions that are associated with a higher risk for pseudogout in elderly patients include underlying acute medical conditions, trauma, or surgery. Medical conditions associated with pseudogout include hypothyroidism, diabetes, gout, and osteoarthritis. Liver transplantation also may increase the risk.

How Serious is Pseudogout?

There is no cure for pseudogout. It is a progressive disorder that can eventually destroy joints.

How Is Pseudogout Treated?

Treatments for pseudogout are similar to those for gout and are aimed at relieving the pain and inflammation and reducing the frequency of attacks:

NSAIDs are effective for treating inflammation and pain from pseudogout.
For acute attacks in large joints, fluid aspiration alone or with corticosteroids may help.
Oral colchicine for acute attacks may be given to appropriate candidates.
Oral magnesium carbonate may help dissolve crystals but existing hard deposits may remain.
Surgery may be required for joint replacement.