There is still a lot to be studied regarding how and why calcium pyrophosphate crystals build up in joints, and why these crystals may or may not eventually lead to a pseudogout attack.
The risk factors that are known are listed below:
Age. Most people who develop pseudogout are 60 or older, with the likelihood significantly increasing with age. According to the American College of Rheumatology, the prevalence of calcium pyrophosphate crystals increases from only 3% of people in their 60s to as high as 50% of people in their 90s.1
Joint trauma. A joint injury, surgery, or sepsis can trigger a pseudogout flare up. Experts believe this is because a trauma can cause joint cartilage to shed the calcium phosphate crystals that have accumulated within it. Once released, the crystals activate an immune system response that leads to swelling and other pseudogout symptoms.2
Family history. Genetics plays a role, making some people more prone to accumulating calcium pyrophosphate crystals in their joints. Recent research suggests that a person who inherits a mutation in the ANKH gene, a gene that helps regulate metabolism, is more likely to get pseudogout and more likely to develop symptoms at an earlier age compared to people without the genetic mutation.3-5
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Underlying condition. There are several metabolic and endocrine disorders that can predispose a person to pseudogout (CPPD),including:
- Hemochromatosis, an inherited disorder that causes the body to store excess iron in the organs and tissues around the joints.
- Hyperparathyroidism, which can cause abnormal amounts of calcium in the blood.
- Hypophosphatasia, a metabolic disorder that affects bones and teeth.
- Hypomagnesemia, a condition in which there is abnormally low magnesium levels in blood.
- Thyroid disease, including hyperthyroidism, hypothyroidism, and benign thyroid disease and thyroid cancer.
- Acromegaly, a condition in which there is too much growth hormone and the body tissues get larger over time.
- Wilson's disease, an inherited disorder in which there is too much copper in the body's tissues.
- Alkaptonuric ochronosis, a rare hereditary metabolic condition that can cause the discoloration of urine, skin, and internal joint tissues, such as cartilage.
Unlike gout, pseudogout does not seem to be more common in people who are overweight, drink alcohol, or eat certain foods. Gender and ethnicity do not seem to have an impact on whether or not a person gets pseudogout.6