Pseudogout Treatment

The recommended treatments for pseudogout focus on reducing joint inflammation and pain. In addition to alleviating symptoms, treatment can help minimize the risk of long-term joint damage associated with repeated episodes of pseudogout.

Pseudogout is also known as acute calcium pyrophosphate (CPP) crystal arthritis and is a form of calcium pyrophosphate deposition (CPPD) disease. The crystals that cause pseudogout cannot be removed from joints.

See What Is Calcium Pyrophosphate Crystals Deposition (CPPD)?

Common treatment recommendations for pseudogout as well as another CPPD disease called chronic CPP arthritis are described below.

Treating Underlying Conditions

Certain medical conditions increase the risk of pseudogout, such as hypothyroidism. Treating the underlying condition may reduce or prevent future episodes of joint pain.

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Treating a Pseudogout Flare

To alleviate sudden, severe pseudogout pain, a health care provider may recommend:

Ice

A cool compress applied to the affected joint can help relieve discomfort and decrease swelling.

Rest

It is usually painful to use the affected joint. Resting it for a day or two can help alleviate inflammation, pain, swelling, and other symptoms.

Elevation

If possible, elevating the affected limb can help help reduce swelling. If the knee is affected, sitting down with the foot resting on a footstool or lying down with the foot propped up on a pillow may provide symptom relief.

Aspiration

A doctor can aspirate a joint by inserting a needle into the affected joint and removing some of the fluid that has accumulated. Aspiration relieves pressure, making the patient more comfortable.

See What Is Arthrocentesis (Joint Aspiration)?

Corticosteroids injections

A steroid injection to reduce inflammation one of the most common medical treatments to be recommended.1,2 This injection is typically done following an aspiration.

See Cortisone Injections (Steroid Injections)

If more than two joints are affected then corticosteroid injections are typically not advised.

See Cortisone Injection Risks and Side Effects

Colchicine

If a corticosteroid injection is not appropriate or ineffective, a prescription drug called colchicine may be prescribed to treat a pseudogout attack.

People who have multiple pseudogout attacks may be advised to take a small daily dose of colchicine to prevent attacks from occurring.3

Non-steroidal anti-inflammatory medications (NSAIDs)

An over-the-counter or prescription-strength NSAID, such as ibuprofen and naproxen, can be used to relieve pseudogout pain.

Prednisone

The oral steroid prednisone may be prescribed if the patient cannot tolerate NSAIDs or colchicine. Long-term oral steroid treatment can have side effects. Oral steroids should not be taken with NSAIDs.

Intravenous steroids may be recommended if oral steroids are not appropriate.2

Interleukin-1β inhibitors (biologics)

Unlike conventional drugs that treat general inflammation after it has begun, interleukin-1β inhibitors can stop inflammation from happening. Interleukin-1β inhibitors are a type of biologic medication. They are typically taken via injection or infusion and are more costly than traditional medications.

A doctor may prescribe a biologic only if other medications do not work or are not appropriate.

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Treating Chronic CPP Arthritis

While chronic CPP arthritis causes less severe pain than pseudogout, the symptoms are longer-lasting.

When chronic CPP requires medical treatment, a physician may recommend one or more of the following1:

  • Joint aspiration
  • Corticosteroids injections
  • Colchicine
  • Prednisone
  • Interleukin-1β inhibitors (biologics)
  • Methotrexate
  • Hydroxychloroquine

Methotrexate and hydroxychloroquine are immune-suppression medications commonly used to treat autoimmune diseases.

Surgery

Neither acute nor chronic CPP crystal inflammatory arthritis can be treated with surgery. However, if left untreated, these conditions can contribute to joint degeneration that requires surgical repair or replacement.

Several of the treatments described on this page involve taking medication. People are advised to talk to their doctor or pharmacists about potential side effects and interactions before starting any new medication. Older people who are most likely to get pseudogout are also more likely to be sensitive to medications or take prescription medications that could interact with medications prescribed for pseudogout.

References

  • 1.Rosenthal AK, Ryan LM. Calcium Pyrophosphate Deposition Disease. N Engl J Med. 2016;374(26):2575-2584. doi: 10.1056/NEJMra1511117
  • 2.Slobodonick A, Toprover M, Pillinger M. Crystal Arthritis. In: Efthimiou P, ed. Absolute Rheumatology Review. Springer Nature Switzerland AG; 2020; chap 15. Accessed September 15, 2020. https://doi.org/10.1007/978-3-030-23022-7_15
  • 3.Zhang W, Doherty M, Pascual E, Barskova V, Guerne PA, Jansen TL, Leeb BF, Perez-Ruiz F, Pimentao J, Punzi L, Richette P, Sivera F, Uhlig T, Watt I, Bardin T. EULAR recommendations for calcium pyrophosphate deposition. Part II: management. Ann Rheum Dis. 2011 Apr;70(4):571-5. Epub 2011 Jan 20. PubMed PMID: 21257614.
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