What is Pseudogout?
Pseudogout, formally known as Calcium Pyrophosphate Deposition (CPPD) disease, is a form of arthritis caused by the formation of calcium pyrophosphate dihydrate (CPP) crystals within the joints. These crystals, which are different from the uric acid crystals that cause gout, can trigger sudden and intense bouts of inflammation, pain, and swelling. The knees are the most commonly affected joint, but episodes can also occur in wrists, ankles, shoulders, and elbows.
The Strong Link Between Aging and Pseudogout
Age is the single most significant risk factor for developing pseudogout. The prevalence of CPP crystals, which can lead to attacks, increases with each decade of life. While the exact mechanism is not fully understood, it is thought to be related to age-related changes in cartilage. Many older adults have these crystals in their joints without experiencing any symptoms, but others will develop painful flares.
Prevalence by Age Group
Data clearly shows a strong age-related trend for pseudogout prevalence:
- Under 40: The condition is extremely rare in individuals younger than 40. When it does occur, it is almost always associated with a genetic predisposition or a metabolic disorder.
- In Your 60s: Approximately 3% of people in their sixties show evidence of CPP crystals.
- Over 85: For individuals over 85, studies indicate a prevalence of 30% to 50% for CPP crystal deposits.
- In Your 90s: As many as 50% of people in their nineties may show evidence of these crystal deposits.
Risk Factors Beyond Age
While age is the most prominent factor, several other conditions can increase the risk of developing pseudogout at any age, and are especially important in younger patients.
- Joint Trauma: A previous serious injury or surgery on a joint significantly increases the risk of developing pseudogout in that specific joint.
- Genetic Predisposition: A family history of pseudogout can make a person more susceptible.
- Metabolic and Endocrine Disorders:
- Hypomagnesemia: Low levels of magnesium in the blood.
- Hyperparathyroidism: An overactive parathyroid gland, which results in high calcium levels.
- Hemochromatosis: A genetic disorder causing excessive iron in the body.
- Hypothyroidism: An underactive thyroid gland.
- Other Forms of Arthritis: Having osteoarthritis or rheumatoid arthritis can also be a risk factor.
Symptoms and Diagnosis
Pseudogout attacks typically involve a sudden onset of joint pain, swelling, warmth, and redness. Attacks can last for days or weeks. Diagnosis involves a combination of methods:
- Medical History and Physical Exam: Your doctor will assess your symptoms and conduct a physical examination of the affected joints.
- Joint Fluid Analysis: This is the gold standard for diagnosis. A sample of fluid is removed from the joint via arthrocentesis and examined under a microscope to confirm the presence of rhomboid-shaped CPP crystals.
- X-rays: Imaging can reveal joint damage and, in some cases, the presence of calcium deposits in the cartilage, a condition called chondrocalcinosis.
Pseudogout vs. Gout: A Comparison
Because their symptoms can be very similar, distinguishing between pseudogout and gout is crucial for proper treatment.
| Feature | Pseudogout | Gout |
|---|---|---|
| Cause | Calcium pyrophosphate (CPP) crystals | Uric acid crystals |
| Common Age | Most prevalent in older adults (>60), risk increases with age | Can affect younger individuals, though incidence also rises with age |
| Typical Joint | Most often affects large joints like the knee, wrist, and shoulder | Commonly affects the big toe, but can appear in other joints |
| Triggers | Often no specific trigger, though may follow surgery or injury | Triggered by diet (red meat, seafood), alcohol, and certain medications |
| Diagnostic Confirmation | Identification of CPP crystals in joint fluid | Identification of uric acid crystals in joint fluid |
Treatment and Management
There is no cure for pseudogout, as there is currently no way to dissolve the CPP crystals. Treatment focuses on managing symptoms and preventing future attacks.
- During a Flare-up:
- Joint Aspiration and Corticosteroid Injection: Draining the fluid from the affected joint can relieve pressure and pain. A corticosteroid may then be injected to reduce inflammation.
- Oral Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine are used to reduce pain and inflammation. Oral corticosteroids may also be prescribed for severe cases.
- Preventative Treatment: For individuals with frequent attacks, a low daily dose of colchicine or a nonsteroidal anti-inflammatory may help prevent future flare-ups.
Can You Prevent Pseudogout?
While there is no definitive way to prevent pseudogout from developing, managing underlying health conditions that are associated with it can reduce the risk or severity of attacks. This can include addressing issues such as hyperparathyroidism, hemochromatosis, or hypomagnesemia. Maintaining a healthy lifestyle, including a balanced diet and regular exercise, can support overall joint health, although dietary triggers are not a factor in pseudogout like they are with gout.
Conclusion
What is the common age for pseudogout? The answer is clear: this is primarily a condition of older adulthood. With prevalence increasing significantly for those over 60, especially after age 85, it is a key consideration in geriatric care. While age is the most dominant factor, a combination of genetics, metabolic conditions, and joint trauma also play a role. Recognizing the symptoms and understanding the risk factors is the first step toward effective management and maintaining quality of life as we age.
This information is for educational purposes only and should not be considered medical advice. Always consult with a healthcare professional for diagnosis and treatment. You can find more information from authoritative sources like the Arthritis Foundation.
