Gout Crystal Classifications, Therapies, and Preventive Strategies
Gout and Calcium Pyrophosphate Deposition Disease (CPPD), also known as pseudogout, share some similarities but have distinct differences in their causes, symptoms, treatment options, and prevention strategies.
Causes
Gout is caused by the deposition of monosodium urate crystals in the joints due to elevated levels of uric acid in the blood (hyperuricemia). On the other hand, CPPD results from the deposition of calcium pyrophosphate dihydrate crystals, often related to altered cartilage metabolism, increased pyrophosphate production, and sometimes associated with aging or other metabolic conditions.
Symptoms
Gout usually presents as recurrent acute inflammatory arthritis, often affecting the big toe and smaller joints of the hands or feet. It causes intense pain, swelling, redness, and may develop into chronic tophaceous gout with urate crystal deposits. CPPD, however, frequently affects larger joints such as the knees, wrists, shoulders, and hips. It can be asymptomatic but commonly causes acute attacks of joint pain, stiffness, swelling, and redness resembling gout but with different crystals involved.
Treatment Options
Both conditions use Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), colchicine, and corticosteroids to manage acute attacks. For gout, long-term urate-lowering therapy (e.g., allopurinol) is key to reducing uric acid levels and preventing future flares. For CPPD, chronic management may include colchicine or disease-modifying anti-rheumatic drugs (DMARDs) if there is chronic arthropathy, but there is no therapy aimed at eliminating the crystal deposits.
Prevention Methods
Gout prevention focuses on controlling serum urate levels through lifestyle modification (diet, reducing alcohol intake, weight loss) and adherence to urate-lowering medications to prevent crystal formation and flares. For CPPD, prevention is less clear because crystal deposition mechanisms are not fully understood; controlling underlying metabolic conditions and joint health may help, but no specific crystal-lowering therapy exists.
In summary, while both are types of crystal-induced arthritis causing similar inflammatory joint symptoms, gout is caused by urate crystals mainly affecting small joints with effective urate-lowering treatments available. CPPD involves calcium pyrophosphate crystals typically affecting larger joints, with treatment focusing on symptom control rather than crystal elimination.
For those who are unable to use NSAIDs, steroids may be beneficial. A doctor may insert a needle into the affected joint to remove the joint fluid and inject a corticosteroid into the joint. Colchicine can help reduce some of the swelling and pain that a person may experience during a gout attack.
If a person experiences intense joint pain, they should contact a healthcare professional. A person with fever and a joint that is painful and hot to the touch should seek immediate medical attention, as this combination of symptoms could indicate an infection. Home remedies for gout flare-ups include resting the joint, applying ice packs, maintaining a moderate weight, choosing low impact exercises, and managing purine intake. Surgery may also be an option if the joints become too damaged.
Gout affects more than 3 million people in the United States, while CPPD affects 3% of people in their 60s and 50% of people in their 90s. Both gout and CPPD are types of inflammatory arthritis. Medical treatments for gout attacks can include NSAIDs, colchicine, and steroids. Once the initial gout attack has subsided, a healthcare professional may prescribe medications to reduce uric acid levels, such as febuxostat, probenecid, allopurinol, and pegloticase. The time it takes for the drugs to eliminate the crystals can range between a few months and a few years.
If other medications are ineffective, pegloticase can reduce the levels of uric acid quickly and is administered. The rheumatologist may diagnose gout or CPPD based on the symptoms a person is experiencing and the appearance of their joints. At this time, there is no treatment that can dissolve the deposits of CPPD crystals in the body. A person may be referred to see a specialist called a rheumatologist.
[1] Arthritis Foundation. (n.d.). Gout vs. Pseudogout. Retrieved from https://www.arthritis.org/health-wellness/disease-management/gout/complications/gout-vs-pseudogout
[2] Mayo Clinic Staff. (2019, July 22). Calcium pyrophosphate deposition disease (CPPD). Retrieved from https://www.mayoclinic.org/diseases-conditions/calcium-pyrophosphate-deposition-disease/symptoms-causes/syc-20369969
[3] National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2019, October 18). Gout. Retrieved from https://www.niams.nih.gov/health-topics/gout
[4] National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2019, October 18). Preventing gout attacks. Retrieved from https://www.niams.nih.gov/health-topics/gout/prevention
[5] UpToDate. (2020, July 23). Calcium pyrophosphate deposition disease (CPPD) — clinical manifestations and diagnosis. Retrieved from https://www.uptodate.com/contents/calcium-pyrophosphate-deposition-disease-cppd-clinical-manifestations-and-diagnosis
- The field of science has identified health-and-wellness conditions like gout and chronic-diseases such as Calcium Pyrophosphate Deposition Disease (CPPD) as distinct medical-conditions, though they share some similarities in the symptoms they cause.
- In managing gout, medical professionals usually employ urate-lowering medications, such as allopurinol or febuxostat, for long-term treatment, while the prevention of CPPD remains less clear, requiring controlling underlying metabolic conditions and joint health.
- Pain or discomfort is a common symptom for both gout and CPPD, with gout often targeting the smaller joints of hands and feet, while CPPD tends to affect larger joints like the knees, wrists, shoulders, and hips.
