reference presentation true The Foot and Ankle Knowledgebase, L.L.C., L.L.C., L.L.C. 2000 en-US Pseudogout | Causes and treatment options cppd,pseudogout,what is pseudogout,pseudogout crystals,diet for pseudogout,information for patients with pseudogout,causes of pseudogout,treatment of pseudogout,gout vs pseudogout,pseudo gout Learn more about the onset, symptoms and treatment of pseudogout - part of the Foot and Ankle Knowledge Base.

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Pseudogout, also know as calcium pyrophosphate dihydrate crystal deposition disease, (CPPD), is a disease very similar to gout. Gout and CPPD are often confused due to their clincal similarities in onset and presentation. The cause of CPPD is unknown and seems to effect both men and women equally.  The incidence of CPPD increases in patients in their 9th and 10th decades of life.  The most common joint effected by CPPD is the great toe joint although it can also affect the knee, hips and elbows.  CPPD is a polyarticular form of arthritis.  CPPD affects people of all cultures equally.


  • Acute onset of severe joint pain
  • Pain decreases over a period of days
  • Erythema and warmth to touch
  • Most common joint affected is the great toe joint


Pseudogout is a crystal deposition disease specific to joint space.  Pseudogout and gout are very similar in their onset and clinical presentation and therefore difficult to differentiate.  Inflammation in the joint caused by pseudogout is a result of the intense inflammation (synovitis) that occurs when calcium pyrophosphate is deposited in the joint and changes from a liquid to a crystal.  Although the clinical pathway for gout is well defined, the clinical pathway that results in CPPD is poorly understood.

Causes and contributing factors

The contributing factors to CPPD include age.

Differential diagnosis

The differential diagnosis for CPPD include;

Freiberg's infraction
Hallux limitus
Hallux valgus
Metatarsal fracture
Septic arthritis
Sesamoid fracture
Turf toe


The most significant consideration in the treatment of CPPD is controlling the frequency of attacks. Frequent attacks (more than one a year) will result in progressive erosion of the joint, leading to painful chronic arthritis. Isolated attacks (less that one a year) lead to minimal destruction of the joint. The frequency of CPPD attacks determines whether treatment is merely for each attack, or whether daily medication should be taken to lower levels of inflammation.

The diagnosis of CPPD can only be made with arthrocentesis (withdrawl of joint fluid) and analysis of the synovial fluid.  Microscopic evaluation of the synovial fluid will show a unique shape and unique staining characteristics of the crystals.

Treatment of acute attacks includes the use of non-steroidal anti-inflammatory medications such as Indocin or Clinoril. Injection of the affected joint with steroids is also a common method of treatment.  Control of pain may require a mild narcotic such as codeine. Recurrent attacks may be controlled by the use of an NSAID.

When to contact your doctor

All cases of suspected CPPD should be evaluated by your podiatrist or orthopedist.


References are pending.

Author(s) and date

Dr. Jeffrey OsterThis article was written by medical director Jeffrey A. Oster, DPM.  

Competing Interests - None

Peer Reviewed - This article is peer reviewed by an open source editorial board.  Your comments and suggestions to improve this paper are appreciated.

Cite this article as: Oster, Jeffrey. Pseudogout.

Most recent article update: December 23, 2015.

Creative Commons License  Pseudogout by is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License.

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