Dr. Abhijeet Bhosikar
Crystal & Metabolic

Pseudogout (CPPD) — Treatment in Pune

Also known as: Calcium Pyrophosphate Deposition Disease · CPPD

Gout's mimic — same fury, different crystal, different treatment.

Book a consultationCall +91 70571 19999

What is Pseudogout (CPPD)?

Pseudogout results from calcium pyrophosphate dihydrate crystals depositing in cartilage. When they shed into the joint space they trigger an acute attack that can be clinically indistinguishable from gout.

The knee and wrist are the classic targets, unlike gout's preference for the big toe. It becomes considerably more common with age and often accompanies osteoarthritis.

Critically, urate-lowering drugs do nothing for pseudogout. Distinguishing the two by examining joint fluid prevents years of ineffective treatment.

A gloved hand placing a sample dish onto a laboratory microscopeIllustrative
Polarised microscopy of joint fluid is the only test that identifies a crystal definitively.

Symptoms of Pseudogout (CPPD)

Early signs

  • Sudden swelling, warmth and severe pain in the knee or wrist
  • An attack developing over 12–36 hours, often after surgery, illness or dehydration
  • Low-grade fever accompanying the attack
  • Chalky calcification of cartilage visible on X-ray (chondrocalcinosis)
  • Attacks lasting days to a few weeks, then resolving

If left untreated

  • Chronic CPPD arthritis mimicking rheumatoid arthritis in the wrists and knuckles
  • Progressive joint damage and secondary osteoarthritis
  • Neck pain and stiffness from crowned dens syndrome
  • Frequent recurrent attacks affecting multiple joints

Causes & risk factors

  • Advancing age — the strongest risk factor by far
  • Pre-existing osteoarthritis and previous joint injury
  • Hyperparathyroidism, haemochromatosis, hypomagnesaemia and hypophosphatasia
  • Acute illness, surgery or dehydration acting as a trigger
  • Familial forms with early onset

How Pseudogout (CPPD) is diagnosed

No single test diagnoses a rheumatic disease. The diagnosis comes from combining the pattern of symptoms, the examination findings, and only the investigations that answer a specific question.

  1. Joint aspiration and polarised microscopy

    Rhomboid, weakly positively birefringent crystals — the definitive distinction from gout's needle-shaped negatively birefringent crystals.

  2. X-ray chondrocalcinosis

    Linear calcification in knee menisci, the wrist triangular fibrocartilage and the symphysis pubis.

  3. Ultrasound

    Hyperechoic deposits within the cartilage itself, as opposed to gout's surface double-contour sign.

  4. Metabolic screening in younger patients

    Calcium, PTH, magnesium, phosphate, ferritin and alkaline phosphatase — pseudogout before 55 demands a search for an underlying cause.

  5. Exclusion of septic arthritis

    Always. Culture is sent on every aspirate, because infection and crystals can coexist.

Treatment options

Aspiration plus intra-articular steroid

Often the fastest and most effective treatment for a single large joint, and diagnostic at the same time.

NSAIDs or short-course oral steroids

For polyarticular attacks or where injection is impractical, chosen with attention to kidney function in older patients.

Colchicine

Both for acute attacks and as low-dose prophylaxis in patients with frequent recurrences.

Treating the underlying metabolic cause

Correcting hyperparathyroidism, magnesium deficiency or iron overload reduces future attacks.

Long-term joint care

Muscle strengthening, weight management and monitoring for progressive structural damage.

Seek urgent medical attention if you have

  • Fever with a hot swollen joint — septic arthritis must be excluded by aspiration
  • Severe neck pain with fever and stiffness (crowned dens syndrome)
  • Pseudogout under age 55 — screen for metabolic disease
  • Rapid joint destruction on serial imaging

Do not wait for a scheduled appointment for any of the above. Call the clinic on +91 70571 19999 or attend the nearest emergency department.

Frequently asked questions about Pseudogout (CPPD)

How is pseudogout different from gout?
Different crystal, different joints, different treatment. Gout involves urate crystals, usually starts in the big toe and is prevented by lowering uric acid. Pseudogout involves calcium pyrophosphate crystals, favours knees and wrists, and does not respond to urate-lowering drugs at all.
Can pseudogout be prevented?
There is no drug that dissolves calcium pyrophosphate crystals. Prevention focuses on low-dose colchicine for frequent attackers, correcting any underlying metabolic disorder, and maintaining hydration and joint strength.
Why did it start after my surgery?
Acute illness, surgery, trauma and dehydration all destabilise existing crystal deposits and cause them to shed into the joint. Post-operative pseudogout is a well-recognised and often misdiagnosed event.

Get an expert opinion on Pseudogout (CPPD) in Pune

Consultations at the Ravet clinic in Pimpri-Chinchwad. Bring your previous reports — a properly reviewed history usually saves repeating tests.

Book an appointmentWhatsApp the clinic

Part of a wider group

Gout & Crystal ArthritisThe most curable arthritis there is — and the most commonly mistreated.

Related conditions

  • Gout

    The most curable form of arthritis — and the most commonly mistreated.

  • Osteoarthritis

    India's most common joint disease — and far more treatable than 'nothing can be done'.

  • Rheumatoid Arthritis

    Symmetric small-joint swelling that responds best when treated within the first 12 weeks.

CallWhatsAppBook