What is the difference between pseudogout and gout?

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Although gout and pseudogout have some similarities, they have different underlying causes and triggers, which lead to different treatment and flare management strategies.

What causes gout?

Gout occurs when there is too much uric acid, or urate, in the body. Uric acid is the byproduct of purines, organic compounds found in cells that naturally break down through biological processes and due to the digestion of certain proteins.

A condition called hyperuricemia develops when the body does not eliminate enough uric acid through urination. The excess uric acid builds up in the bloodstream and crystallizes, causing the body to respond with inflammation.

The Centers for Disease Control and Prevention (CDC) link gout to underlying factors such as:

• inadequate kidney function
• excessive alcohol consumption
• a diet high in purine-rich foods such as red meat, organ meats, and certain seafood
• chronic health conditions such as diabetes, hypertension, and metabolic syndrome
• obesity

What causes pseudogout?

Health experts do not have as clear of an understanding of the exact causes of pseudogout. However, researchers currently believe it results from an imbalance in the production of pyrophosphate, an immune-stimulating protein.

Pyrophosphate in joint tissue binds with calcium to form calcium pyrophosphate crystals. As in gout, these crystals trigger an immune response that results in joint inflammation.

Pseudogout may occur alongside conditions such as:

• hyperparathyroidism
• osteoarthritis
• rheumatoid arthritis
• hemochromatosis
• osteoporosis
• chronic kidney disease
• calcium supplementation

Triggers

While both conditions can have symptom flares, gout tends to flare in response to triggers such as:

• foods
• sugary beverages
• medications
• alcohol
• physical trauma
• illness
• environmental temperature and humidity
• dehydration

Pseudogout does not typically flare in response to triggers.

Gout symptoms often affect a toe or a lower extremity, although they can occur in any joint. Uric acid is temperature-sensitive and more likely to crystallize in areas of the body that are naturally cooler.

Over time, the same uric acid buildup that causes gout can lead to kidney stones and the formation of tophi, hard lumps of crystal under the skin that can damage bone or cause joint deformation.

Pseudogout’s symptoms are less influenced by factors such as body temperature. Arthritis symptoms in pseudogout tend to occur first in the large joints responsible for weight-bearing and movement.

Pseudogout and gout can present with the same joint symptoms, including:

• pain
• redness
• swelling
• heat

Gout flares tend to happen at night. According to the CDC, they can last for a few weeks, and between flares, a person may not have any symptoms. Some people experience frequent flares, while others go months or years between flares.

Pseudogout flares are not more likely to occur at a particular time of day. They can occur alongside other symptoms of systemic inflammatory response, such as fever and increased heart rate.

According to the Arthritis Foundation, doctors use many of the same tools and processes to diagnose pseudogout and gout. Diagnosis may involve:

• a physical exam
• a medical history check
• blood work
• joint fluid analysis
• imaging such as X-ray and ultrasound

However, once a doctor determines a diagnosis, they will use specialized treatment for either condition.

Doctors may treat gout with medical strategies in addition to recommending lifestyle changes.

When treating gout, doctors aim to manage pain, reduce flares, prevent damage from chronic uric acid buildup, and treat any other conditions a person may have.

Medications for gout can include:

• anti-inflammatories such as colchicine, ibuprofen, and naproxen
• corticosteroids
• xanthine oxidase inhibitors to reduce uric acid production
• uricosuric agents to remove excess uric acid
• drugs to break down uric acid

Dietary changes, moderation of alcohol consumption, and weight management efforts may also help.

Pseudogout treatment includes anti-inflammatory medications such as colchicine, ibuprofen, and corticosteroids. Doctors may also suggest applying ice packs and resting the affected joints.

When pseudogout occurs, doctors will aim to treat any metabolic disease that may predispose a person to pseudogout. Treatment may vary according to the specific condition a person has, but it may involve additional medication or lifestyle changes.

There are no medications to reduce pseudogout crystals. Current treatment approaches focus on managing symptom severity and flares.

A person should speak with a healthcare professional if they experience pain, swelling, or heat on and around the joints, especially if they do not have an obvious injury.

If a person does not receive treatment for gout or pseudogout, they may have an increased risk of experiencing long-term damage to joint tissue. In the case of gout, a lack of treatment may also increase the likelihood of complications such as kidney stones and tophi.

There is no cure for gout. Instead, doctors may prescribe medical treatment and recommend lifestyle strategies to manage symptoms and flares.

Similarly, no medications can reduce pseudogout crystals. Instead, doctors will aim to treat symptoms such as inflammation and any other health conditions a person is experiencing.

Both pseudogout and gout are forms of inflammatory arthritis that result from crystal deposits in the joints. However, calcium pyrophosphate dihydrate crystals cause pseudogout, while uric acid crystals cause gout.

These conditions have almost identical symptoms but typically affect different joints. They also have different triggers and treatment options.

If a person experiences joint pain or swelling, they should consult a healthcare professional. Doctors can use physical exams and medical imaging to diagnose gout and pseudogout.