Gout and pseudogout are two types of arthritis that result in sore joints. With these types of arthritis, crystals form in the joint, causing irritation that is sometimes also present in the tendons near the joint. Joints can become swollen, painful, and red (Figure 1).
These conditions can affect joints all over the body. In gout, the first joint affected is often the big toe. The elbow, wrist, and finger joints are also common sites. In pseudogout, larger joints such as the knee or wrist are more commonly involved. Painful swellings can come and go in the same joint or in different joints.
Both of these conditions can appear suddenly with hot, red, or swollen joints. The joints can be so painful that they hurt to move. Sometimes joints look like they are infected, even though they are not.
Gout crystals can form white bumps called “tophi” that are often visible under the skin (Figure 2). The crystals in pseudogout are usually only visible on an x-ray (Figure 3).
The diagnosis for either disease is made based on a physical examination by your doctor, x-rays, and lab tests. You will be asked about your symptoms and how the disease has changed your activities. Because medications and other diseases can cause this condition, you will be asked to provide a medical history and a medication list.
X-rays are also helpful. Calcium in pseudogout can be seen on an x-ray. Uric acid does not show up on x-rays, but some bone changes can be visible with gout (Figure 4). If needed, fluid from the joint can be removed with a needle to confirm the diagnosis. Blood tests may be ordered to check for infection as well as uric acid levels.
When a painful episode of this condition begins, the goal is to decrease swelling, redness, and pain. New episodes are often treated with non-steroidal anti-inflammatory (NSAID) medication or a medicine called colchicine. Steroid pills and shots may be used as well.
Episodes of can come and go. When the episodes are infrequent, an NSAID or colchicine can be used as needed. For more frequent episodes, a specific medicine can be managed by your primary care doctor or a rheumatologist.
These conditions are usually treated without surgery. There are medicines, splints, and compressions to help swelling and lessen pain. If the disease has worn out the joints or if tendons have been hurt, surgery may be needed.
If gout is not treated, the inflammation can cause damage to joints and tendons. Crystal deposits on tendons can cause the skin to wear down, which can lead to infection. In addition, tendons can tear, which can lead to loss of function.
Pseudogout crystals are less likely to be deposited under the skin, so some of the problems seen with gout are less likely. The crystals in ligaments and cartilage may lead to joint injury. Loss of motion is common.
© 2013 American Society for Surgery of the Hand