Pseudogout is the term that some people use to refer to calcium pyrophosphate deposition disease (CPPD), which occurs when calcium pyrophosphate crystals form and build up in the joints and surrounding tissues. CPPD is a type of arthritis that presents with symptoms similar to those of gout.

Gout is also a type of arthritis, but its symptoms result from a buildup of a different type of crystal. Healthcare professionals may need to check which crystals are present to distinguish between gout and pseudogout.

There is no cure for CPPD, but treatments are available, and a person can also take steps at home to manage the condition.

This article explains what CPPD is and how it differs from gout. It also looks at the symptoms, causes, risk factors, and treatment options.

CPPD is a type of arthritis that is painful and begins suddenly.

It occurs when calcium pyrophosphate crystals build up in the joints and the tissues that surround them. This buildup causes symptoms that can appear similar to those of gout. However, gout results from a different type of crystal.

The Arthritis Foundation (AF) states that a person is more likely to develop CPPD as they age. Nearly half of those over the age of 85 years have developed the crystals. However, many people do not have symptoms.

Without treatment, a person can experience painful and severe attacks or chronic inflammation and pain. Over time, CPPD can lead to joint damage and long-term disability.

Although no treatment is available to dissolve the crystals, a person can take medications to help manage the symptoms.

The symptoms of CPPD can arrive suddenly and last for days or weeks. They may also come and go.

Although it typically affects the knees, CPPD can also affect other joints, including the:

  • wrists
  • hands
  • elbows
  • ankles
  • shoulders

A person may experience bouts of symptoms that include:

  • swelling
  • joint pain
  • stiffness
  • fever

The affected joint may also be warm to the touch.

Over time, CPPD can lead to long lasting inflammation and joint damage. These symptoms can appear similar to those of rheumatoid arthritis and osteoarthritis, and they may be present at all times.

If the condition becomes chronic, symptoms may include:

  • joint pain
  • stiffness
  • inflammation
  • decreased joint function
  • stiffness and fatigue upon waking
  • swelling at the joint

Healthcare professionals do not know the exact cause of CPPD.

However, a person is more likely to develop CPPD as they get older. The American College of Rheumatology notes that CPPD affects 3% of those in their 60s and 50% of those in their 90s.

Although it can occur at any age, the American Society for Surgery of the Hand (ASSH) states that CPPD most often occurs in males over the age of 60 years.

CPPD occurs more often in those who have:

  • a family member with CPPD
  • a thyroid disorder
  • kidney failure
  • a calcium disorder
  • an iron metabolism disorder

The condition can also develop in joints following an injury or surgical procedure.

There is no cure for CPPD. Researchers are yet to discover a way to get rid of the crystals that cause the condition.

Instead, people can work with healthcare professionals to reduce the frequency of attacks and ease the symptoms.

If an attack occurs, the ASSH suggests that people try the following for symptom relief:

People who have poor kidney function, take blood thinners, or have a history of stomach ulcers are unable to take NSAIDs. In these cases, the healthcare professional may drain the joint fluid and inject a corticosteroid.

Additionally, the AF notes that some foods can help fight the inflammation. People can try including plenty of the following foods in their diet:

  • Fruit: Good options include cherries, strawberries, raspberries, and citrus fruits.
  • Fish: People can try eating salmon, herring, tuna, sardines, scallops, and anchovies.
  • Nuts: The AF particularly recommends walnuts, pine nuts, almonds, and pistachios.
  • Beans: Kidney beans and pinto beans are particularly rich in antioxidants.
  • Olive oil: People should aim for 2–3 tablespoons daily.
  • Whole grains: These include oatmeal, brown rice, and quinoa.
  • Nightshade vegetables: Examples include eggplant, potatoes, tomatoes, and red bell peppers. Some people believe that these foods trigger arthritis flares, so it is best to monitor symptoms when eating them.

People should avoid processed foods and those high in saturated fats.

Doctors might prescribe anti-inflammatory drugs to help with the pain and swelling. Sometimes, they may also recommend corticosteroid injections or low doses of colchicine to help prevent future attacks.

Various medical treatments are available for people with more severe CPPD, and they work by reducing the swelling that leads to the symptoms. These treatments include:

  • hydroxychloroquine
  • methotrexate
  • anakinra

If none of these medicines work, a person may need to undergo an operation to repair or replace the damaged joint or joints.

The AF notes that although gout and CPPD are both types of arthritis, they have different causes.

Gout occurs when high levels of uric acid cause monosodium urate crystals to form in and around the joint. This causes inflammation and damage to the joints. CPPD occurs when calcium pyrophosphate crystals form and build up in the joints and surrounding tissues, resulting in pain and inflammation.

In some cases, a healthcare professional may need to look at the crystals under a microscope to give a correct diagnosis because the symptoms can be similar.

Both conditions begin with an abrupt onset of painful, swollen, and hot joints. However, gout typically affects only one joint initially. This tends to be the big toe, but gout can also affect the:

  • foot
  • ankle
  • wrist
  • knee
  • elbow
  • finger

CPPD can affect one or more joints, but symptoms are most common in the knee.

In some cases, CPPD can affect the spinal ligaments, which can lead to pain, typically in the cervical or thoracic spine.

The American College of Rheumatology says that CPPD is challenging to diagnose because it is so similar to gout and other types of arthritis.

If the doctor suspects that the person has pseudogout, they will usually:

  • ask about the symptoms, such as when they started and how long they last
  • ask about the individual’s family and medical history
  • image the joint using X-rays or ultrasound, CT, or MRI scans

They may also use a needle to take a small amount of fluid from the affected joint and send it to a laboratory. Technicians will look for the presence of calcium pyrophosphate crystals.

There is no cure for CPPD, but people can manage the condition using medications and lifestyle adjustments.

However, over time, the calcium pyrophosphate crystals can cause more damage to the joint. In some cases, this damage can result in disability.


Can a person prevent CPPD?



The use of low dose colchicine and avoidance of foods high in purine content, such as red meat and shellfish, can help prevent future attacks of pseudogout. Also, endocrine and metabolic disorders, such as hyperparathyroidism, hypothyroidism, and hemochromatosis, can be associated with CPPD and should be considered in the evaluation of CPPD. Treatment of these underlying conditions may help prevent CPPD attacks. Certain mineral imbalances, such as too much calcium or iron or a low magnesium level, can also contribute to the onset of pseudogout and should be included in the diagnostic workup for CPPD.

Brenda B. Spriggs, M.D., FACP, FACR, MPHAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
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Anyone who suspects that they have CPPD should speak with a doctor as soon as possible.

The doctor can diagnose or rule out CPPD and help put a treatment plan in place if necessary. Without treatment, the condition can cause long-term damage.

Pseudogout is a condition that the medical community generally refers to as CPPD. It is a type of arthritis that happens when calcium pyrophosphate crystals build up in the joints and surrounding tissues.

Doctors do not know what causes CPPD. However, it typically develops as a person ages. In some cases, a person can develop the crystals but not experience any symptoms.

If symptoms do occur, a person may experience swelling, pain, and stiffness at the affected joint or joints, which will also be warm to the touch.

There is no cure for CPPD, but a person can take medications to help ease the symptoms and prevent future attacks. If an attack occurs, they should rest the affected joint, apply ice packs, and take pain relievers.

Anyone who suspects that they may have CPPD should speak with a doctor. Without treatment, the condition can cause long-term damage to the joints.