Educational video describing the condition of gout and pseudogout.
The most common joint affected by gout is the 1st metatarsophalangeal joint. The most common joint affected by pseudogout is the knee joint. Gout and pseudogout are similar problems with different causes.
Gout is caused by the buildup of uric acid crystals inside a joint. The best test to diagnose gout is with a joint fluid analysis. Elevated uric acid is not a good criterion. 90% of patients suffering from gout are men between the ages of 4060 years. Gout crystals are needleshaped and negatively birefringent. When placed under polarized light they will be yellow. Uric acid builds up in the body by two main mechanisms:
1Excessive urate production.
2Diminished urate clearance
Uric acid is produced from the breakdown of proteins inside the body and from the proteins of food that is eaten. The sudden attack of gout can be brought on by anything that increases the level of uric acid in the blood such as:
•Dehydration
•Increased consumption of alcohol
•Eating large amount of meat or seafood
•Trauma/surgery
Aspiration and analysis of the joint fluid is the best method for diagnosis. There are blood tests such as white blood cell count, Creactive protein, erythrocyte sedimentation rate and uric acid level that are helpful in supporting the diagnosis if elevated, but if normal cannot definitively rule out gout or pseudogout.
Pseudogout or chondrocalcinosis is the deposition of calcium pyrophosphate dihydrate crystals in the hyaline cartilage or fibrocartilage (CPPD). Pseudogout is a metabolic disease where calcium pyrophosphate dihydrate crystals (CPPD) are formed within the joint space. Most often affects the knee, occurs more in older patients. Calcification of fibrocartilage (chondrocalcinosis).pseudogout crystals are rhomboid shaped and positively birefringent. Crystals will be blue when placed under polarized light. Associated conditions:
•Hyperparathyroidism
•Rheumatoid arthritis
•Gout
Gout and pseudogout both show a sudden onset of pain, redness and swelling typically affecting a single joint in 80% of the cases. Gout symptoms and signs include pain, swelling and arthritis.
Patients with gout have periarticular erosions along with the formation of uric acid soft tissue masses in and around the joint which can be seen on xray. Soft tissue tophus deposition with periarticular erosions call “punchout” lesions. Xrays in pseudogout will show thin calcification in the articular cartilage or menisci, with involvement of the patellofemoral joint. Calcifications of the synovium, tendon and ligaments can also be seen.
Treatment of Gout & pseudogout
•Acute gout: indocine, colchicine (be aware of peptic ulcer)
•Chronic gout: allopurinol (xanthine oxidase inhibitor), colchicine.
•Uricosuric drugs such as probenecid which increase uric acid excretion by the kidneys may be helpful.
•Treatment of pseudogout: NSAIDs, intraarticular injections.

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