Gout and pseudogout
Crystal-induced Arthritis (Gout and
Pseudogout)
Gout is the most common cause of
inflammatory arthritis in the world. It is due to high levels of
uric acid in the bloods, although not all people with high uric
acid suffer with gout. Kidney disease, family history, obesity,
alcohol intake and certain medications are frequent risk factors.
It tends to happen intermittently, with sudden episodes of painful,
warm and red joints. It commonly affects one joint at a time
(typically starting by the greater toe), lasting 3-7 days. The uric
acid can also cause lumps under the skin (tophi). If not treated,
gout episodes often become more severe, affecting more joints and
occurring more frequently which may lead to severe
joint damage and long-term disability. Treatment for gout is
divided into medications for acute attacks (e.g. non-steroidal
anti-inflammatories, colchicine, glucocorticoids), and preventative
uric acid lowering medications if attacks are severe or repeated
(e.g. allopurinol or febuxostat). GPs are very experienced at
managing gout, so we would usually only see patients with difficult
to treat disease which has not responded to these first line
treatments in the Rheumatology department.
Pseudogout is the second most
common crystal-induced arthritis. It is caused by the deposition of
calcium crystals into the joints. Similarly to gout, it is
characterised by an acute episode of joint pain and swelling, but
in the case of pseudogout the most typical affected joint is the
knee, followed by the wrist. It rarely affects individuals younger
than 60 years old, unless they are affected by other diseases than
can predispose to calcium crystal disease, such as
hyperparathyroidism or hemochromatosis. Often the calcifications
can be seen in the x-rays (chondrocalcinosis), but most of people
with calcified deposits in the x-rays will not develop pseudogout.
In general, crystal-induced arthritis can be managed in the
community, and your GP should be able to guide you on what
treatment you need to treat or prevent your joint
attacks.
More information for
patients:
Gout:
http://ukgoutsociety.org
Gout and diet:
http://www.ukgoutsociety.org/docs/goutsociety-allaboutgoutanddiet-0113.pdf
Calcium crystal disease:
https://healthshare.org.uk/HS_leaflets/PDFs/Calcium-crystal-diseases.pdf
More information for health
professionals:
The British Society of Rheumatology Guideline for
the management of gout:
https://academic.oup.com/rheumatology/article/56/7/e1/3855179
European League Against Rheumatism recommendations for
calcium pyrophosphate deposition. Part II: Management:
https://ard.bmj.com/content/70/4/571.abstract?sid=43e9b750-60bf-4a8a-9651-58ccc419078b
