Gout and pseudogout are types of arthritis caused by tiny crystals that build up in or around a joint. These crystals can trigger sudden pain, swelling, warmth and stiffness. The symptoms can look similar, but gout and pseudogout have different causes. Gout is caused by uric acid crystals, also called urate crystals. Pseudogout is caused by calcium pyrophosphate crystals. Early and accurate diagnosis can help guide the right treatment and reduce the risk of future flare-ups.
What is the difference between gout and pseudogout?
Gout and pseudogout both happen when crystals collect in a joint. The difference is the type of crystal:
- Gout is caused by uric acid crystals, also called urate crystals.
- Pseudogout is caused by calcium pyrophosphate crystals, a different type of crystal that can collect in joint cartilage.
Both conditions can cause acute inflammatory flares, often with similar symptoms such as pain, swelling, and reduced joint mobility. Because the symptoms can overlap, your specialist may recommend a physical examination, imaging tests or joint fluid analysis to confirm the diagnosis.
What causes gout and pseudogout?
Crystal arthritis can develop when tiny crystals collect in or around a joint and trigger inflammation. Common mechanisms include:
- Metabolic imbalance leading to crystal formation
- Age-related changes in joint cartilage
- Underlying medical conditions affecting mineral or uric acid metabolism
- Previous joint damage or osteoarthritis
Gout-specific causes:
Gout can develop when uric acid builds up in the blood. Uric acid is a waste product that usually leaves the body in urine. If levels become too high, uric acid crystals can form in the joints. Key risk factors include:
- Reduced kidney function
- Eating foods and drinks that can raise uric acid levels (e.g. red meat)
- Alcohol consumption
- Obesity
- Certain medications (e.g. diuretics)
Pseudogout-specific causes:
Pseudogout happens when calcium pyrophosphate crystals collect in cartilage, the smooth tissue that cushions joints. Key risk factors include:
- Increasing age
- Osteoarthritis
- Genetic predisposition
- Metabolic conditions (e.g. hyperparathyroidism, haemochromatosis)
What are the early symptoms of gout and pseudogout?
Both gout and pseudogout can present with sudden joint inflammation. You may experience:
- Sudden joint pain
- Swelling or stiffness
- Warmth or tenderness around the joint
- Reduced movement in the affected joint
Symptoms may occur in flare-ups or persist for several days depending on the severity of inflammation.
Gout
Gout often affects the big toe. It also can affect the ankles, knees and other joints. Attacks often develop rapidly and may be triggered during the night.
Pseudogout
Pseudogout most commonly affects the knees, although wrists, shoulders, and ankles may also be involved. Symptoms may develop more gradually and can resemble osteoarthritis in some cases.
When should you seek care for gout and pseudogout?
Seek specialist assessment if you have:
- Sudden or severe joint pain
- Joint swelling, warmth or redness
- Repeated flare-ups
- Trouble walking or using the affected joint
- Symptoms that do not improve with usual pain relief
- Joint swelling without a clear injury
How do we diagnose gout and pseudogout?
Dr Nuttall will take the time to understand your symptoms, medical history, and overall health before recommending targeted investigations. Diagnostic tests may include:
- Physical examination of affected joints
- Blood tests to measure uric acid levels and inflammatory markers
- Advanced imaging:
- Ultrasound
- X-ray
- Joint aspiration, a procedure that removes a small amount of fluid from the joint so it can be checked for crystals
Joint fluid analysis is the most definitive method for distinguishing between gout and pseudogout, helping to guide appropriate treatment. Different patients require different investigations, and your diagnostic pathway will be tailored to your symptoms and clinical findings.
Gout and pseudogout treatment and management:
Treatment depends on the underlying diagnosis, symptom severity, and frequency of flare-ups. For both conditions, treatment aims to ease pain, reduce swelling, and lower the chance of future flare-ups.
Gout management
Management of gout may include:
- Anti-inflammatory medicines, such as non-steroidal anti-inflammatory drugs (NSAIDs) or Colchicine, to reduce pain and swelling
- Corticosteroids (oral, intra-muscular or intra-articular) for acute flare-ups
- Long-term urate-lowering therapy to reduce crystal formation (Allopurinol, Febuxostat) will be carefully titrated against blood Urate levels to achieve concentration <360mmol/l.
- Lifestyle support, when appropriate, such as changes to diet, alcohol intake or weight management
Pseudogout management
Management of pseudogout focuses on symptom control and reducing joint inflammation:
- NSAIDs or Colchicine to relieve pain and swelling
- Corticosteroids (oral, intra-muscular or intra-articular) during acute episodes
- Treatment for any related health conditions that may contribute to crystal buildup
Dr Nuttall will tailor treatment to reduce inflammation, improve mobility, and support long-term joint health.
