Pseudogout is similar to gout mainly in terms of the symptoms that occur. If chondrocalcinosis, which often initially remains asymptomatic, leads to symptoms, these can usually be controlled with medication.
What is chondrocalcinosis?
Chondrocalcinosis (also known as pseudogout) is a disease of the joints. In chondrocalcinosis, cartilage calcification usually occurs in the hip, hand, or knee joints. Chondrocalcinosis was given the name pseudogout because it can lead to symptoms similar to those of gout; however, these symptoms are usually less pronounced. In contrast to gout, pseudogout leads primarily to complaints in the knee. In medicine, a distinction is made between two forms of chondrocalcinosis: so-called primary chondrocalcinosis usually has a chronic course and increasingly affects people of advanced age. Secondary chondrocalcinosis is a pseudogout that is merely a symptom of other underlying diseases. Because chondrocalcinosis is often initially asymptomatic, its distribution is largely unclear.
Causes
Often, the causes leading to chondrocalcinosis are unclear. If symptoms occur in pseudogout, they are usually caused by crystals of calcium pyrophosphate that are deposited in the cartilage of the joints, for example. In the context of pseudogout, these crystals can attack the cartilage or lead to joint inflammation. In medicine, various possible causes are discussed that can lead to chondrocalcinosis: For example, there is a possibility that especially the primary form of chondrocalcinosis may be hereditary. The secondary form of pseudogout may possibly be favored by various existing metabolic diseases. These include hyperparathyroidism, hypothyroidism and gout. In addition, pre-existing joint changes may provoke the development of secondary chondrocalcinosis.
Symptoms, complaints, and signs
Pseudogout may progress for months or even years without symptoms. The first signs often become apparent only when the joint disease is already very advanced. Initially, the disease causes typical symptoms such as sudden pain and swelling in the affected joint. The hand and knee joints are particularly affected. These pseudogout attacks proceed in a similar way to an acute gout attack: cramping, severe pain reactions and often inflammation in the joints occur. The symptoms subside again in the course of four weeks, but can recur again and again. An episodic increase of the symptoms is also conceivable. These episodes can last several weeks to months and often turn into a chronic disease. Chronic chondrocalcinosis causes permanent pain. In the long term, arthrosis develops, which contributes to the joint closure and can spread to other joints such as the shoulder or hip in the course of the disease. Accompanying symptoms include fever or a general feeling of illness. In the course of pseudogout, crystals may also be deposited on tendons, ligaments and intervertebral discs. This is associated, among other things, with movement restrictions, pain and paralysis symptoms.
Diagnosis and progression
Chondrocalcinosis can be diagnosed, for example, by looking at the affected joint with the help of an X-ray examination. Often, calcifications of the articular cartilage can be detected on the X-ray images in the presence of chondrocalcinosis. Another diagnostic option for chondrocalcinosis is joint puncture. In this case, synovial fluid is removed from the joint. If pseudogout is present, this joint fluid usually contains microscopic calcium pyrophosphate crystals. Chondrocalcinosis is often initially symptom-free. If an affected person develops symptoms over time, these can usually be alleviated quickly by administering the appropriate medication. In some cases, however, chondrocalcinosis also takes a chronic (longer-term) course: In this case, joint arthrosis (wear and tear of the joints) can attack the joints, leading to functional disorders and pain in affected joints.
Complications
In most cases, chondrocalcinosis results in a delayed diagnosis because there are no meaningful symptoms at the onset of the disease. These usually appear only as the chondrocalcinosis progresses. Inflammation of the joints and knees occurs, and knee pain is also present. The knees are often swollen, resulting in restricted movement. It is not uncommon for the patient to be dependent on walking aids. In addition to the pain, there is also a severe fever. The pain and restriction of movement can lead to psychological discomfort and depression in the patient and is usually treated by a psychologist. The treatment itself usually takes place with the help of medication and can stop chondrocalcinosis relatively well. Likewise, various therapies and treatments with cold and heat are possible to relieve the symptoms. In severe cases, surgery is necessary. In addition to chondrocalcinosis, metabolic disorders often occur and may also have various complications. Life expectancy is not affected by the disease in most cases. As a rule, a healthy lifestyle also has a positive effect on the course of the disease and prevents further complications.
When should you see a doctor?
In the event of sudden pain and swelling in a joint, medical advice is always required. Repeated joint inflammation or chronic joint pain should also be medically clarified, as there is probably a serious underlying condition. The doctor can determine whether this is chondrocalcinosis and suggest suitable treatment for the sufferer. If pseudogout is not treated, further complications may occur. Warning signs that the disease may already be more advanced are increasing restrictions in the movement of tendons, ligaments and intervertebral discs. Anyone who experiences these complaints in conjunction with a high fever should consult a physician. Further contacts are internists and rheumatologists. If the symptoms have led to bed rest or serious circulatory problems, it is best to call an emergency physician. Subsequently, a longer hospital stay – at least one to two weeks – is indicated. In addition, because chondrocalcinosis progresses in episodes and thus can recur repeatedly, a physician must be consulted regularly to monitor the progress of the disease.
Treatment and therapy
Antirheumatic drugs are often used to treat acute symptoms associated with chondrocalcinosis; these are drugs that exert effects against inflammatory processes, pain, and fever. Often, an acute attack of chondrocalcinosis can be stopped with the help of these drugs. If an accumulation of fluid in the knee joint occurs in the course of acute pseudogout, this fluid can be removed by a specialist, for example with the aid of a hollow needle. At the same time, cortisone-containing preparations can be injected into the joint cavities if medically necessary. In the acute phase of chondrocalcinosis, the use of cold treatments can also have a supportive effect. If a chronic form of pseudogout is present, one treatment component may be the application of heat treatments. Occasionally, chronic pseudogout may require surgical intervention. The aim of such an operation may be, for example, to remove menisci (a cartilage substance) in the knee that have been attacked by the chondrocalcinosis. If there is a secondary form of pseudogout, for example, to which joint changes or metabolic disorders have contributed, a useful therapy for chondrocalcinosis usually includes treatment of these underlying disorders.
Outlook and prognosis
Initially, chondrocalcinosis is symptom-free and there is no cause for concern. The patient does not notice any impairment in his or her daily life as a result of the disease. The outlook of the disease ultimately depends on the future course of the disease. If complaints occur in the further course, they can be treated well with medication. The prognosis of chondrocalcinosis can be considered favorable at this stage and degree. The symptoms regress quickly and without problems with medical care. Most patients therefore suffer no further damage or permanent impairment.The prognosis changes when chondrocalcinosis changes to a chronic course. Since osteoarthritis may develop during this course of the disease, the prognosis is unfavorable. The treatment plan is more extensive and the symptoms do not reduce as much when medications are administered. In some patients, permanent damage sets in, resulting in permanent motor function disorders. Restrictions of movements and discomfort of the joints occur. Normally, however, chondrocalcinosis has a good chance of relief and no further progression of the disease. The symptoms disappear within 10 days after the start of treatment. The earlier medical care is given, the better the healing process. Without treatment, the risk of the chronic development described above increases.
Prevention
Prevention of chondrocalcinosis is possible only to a limited extent. To reduce the risk of secondary chondrocalcinosis, it may be useful to have early treatment for metabolic diseases or joint changes that may lead to pseudogout as they progress. A general risk-reducing influence of a healthy and balanced diet is discussed.
Follow-up
Chondrocalcinosis or pseudogout can be favorably influenced after successful therapy by specific follow-up treatment. Among other things, it makes sense to lose weight if you are overweight. This reduces the load on the affected joints. A healthy level of physical activity helps, as does a healthy diet. Physical measures also help to maintain joint function and relieve pain. After surgical treatment of the condition, the physician prescribes pain medication and therapy that promotes joint decongestion. This is followed by a precisely graded exercise program designed to build up the muscles. Coordination and regeneration are also important elements of aftercare. The muscle training involves moving the joint in a uniform manner. This provides the cartilage, including the replacement tissue, with the necessary supply of nutrients. At the same time, the rebuilt cartilage must not be overloaded. To find the right balance, it makes sense to consult a physiotherapist or sports therapist. In this way, the rehabilitation phase leads to the desired success over time. Once patients have a handle on the exercises, they can perform them on their own. In this way, aftercare functions simultaneously as prevention against renewed complaints.
Here’s what you can do yourself
Patients who develop pseudogout do not initially have severe symptoms. Nevertheless, a doctor should be consulted promptly, since the earlier therapy is started, the more successfully the disorder can be treated. If sufferers seek medical help too late, the disease can quickly become chronic, resulting in the destruction of the affected joint. Patients can support medical therapy with appropriate self-help measures. Targeted physiotherapy can maintain or improve the mechanics of the affected joints. However, such measures should only be performed while the patient is not suffering from an acute attack. If chondrocalcinosis is acute, many patients respond positively to heat. Warm full baths are helpful, although it is often also sufficient just to immerse the affected limbs in warm water or to warm them with a compress. Irradiation with red light also has a beneficial effect. Acetylsalicylic acid is usually prescribed against the pain and inflammatory processes. In less severe cases or in addition to allopathic medications, patients can also use preparations based on willow bark. Willow bark is infused with hot water and drunk as a tea. Tablets based on willow bark extract are also available in pharmacies and health food stores. In addition, naturopathic treatment approaches include a change in diet, towards a plant-based diet.
