Pseudogout is an inflammatory type of arthritis, occurring due to deposition of calcium pyrophosphate crystals around the joints and surrounding tissues. Pseudogout in elbow occurs when there is deposition of calcium pyrophosphate crystals in and around the elbow joint, resulting in an inflammatory reaction around the joint. This leads to pain, stiffness, swelling and difficulty in moving the elbow joint.
It is similar to deposition of uric acid crystal deposition in gout, hence this condition is called pseudogout, which means false gout. Due to deposition of calcium pyrophosphate crystals, the condition is also known as calcium pyrophosphate dihydrate (CPPD) deposition disease.
Pseudogout in elbow causes breakdown of cartilage and makes it appear similar to other forms of arthritis, with joint inflammation and pain. The crystal deposition and characteristics of arthritis in pseudogout are very similar to those in gout. Hence a proper diagnosis is important to begin appropriate and timely treatment, which can help to control the progression of pseudogout in elbow and protect the elbow joint from permanent damage.
What is Pseudogout?
Pseudogout is a condition that develops due to excess production of calcium pyrophosphate in the joints. The causes and mechanism regarding the deposition of calcium pyrophosphate crystals in the elbow joints is not very clear, however, there seems a relation with increasing age in many cases. Due to the presence of calcium pyrophosphate crystals in the joint area, particularly the synovial fluid, which is normally not the case, the body reacts to it as if there were foreign bodies and begins an inflammatory reaction. This causes sudden swelling, pain and tenderness in the elbow joint.
With repeated attacks and continued deposition of these crystals in the elbow joints, it can damage the cartilage in between the joint, which normally acts as a cushion. This can lead to increased friction of the bones and bone erosion causing increased pain and further lead to deformity in the elbow joints.
Pseudogout can affect different joints and tissues in the body. The commonest in joints are the knees, the ankles, the elbows, the hips and other joints too can get involved. It often begins suddenly and the clinical picture can appear like an infective type of arthritis. Hence proper diagnosis is required and early treatment to manage pseudogout and treating the underlying causes can help to a great extent.
What Causes Pseudogout in Elbow?
The exact cause of pseudogout in elbow is not clear, however certain factors have been identified to increase the risk of occurrence of pseudogout in elbow. Not all people having calcium pyrophosphate crystals in their elbow joints suffer from pseudogout in elbow, but some of them may be at an increased risk.
The rate of deposition of calcium pyrophosphate crystals is believed to increase with a person's increasing age. Genetics may play an important role and sometimes increase the risk of a person, if there are close relatives suffering from pseudogout in elbow or in other joints. If there is a familial disposition of pseudogout in elbow in some families, there are chances that the condition can begin in younger ages.
Other factors that can contribute to the risk of pseudogout in elbow or deposition of calcium pyrophosphate crystals in elbow include
- Injury to a joint; trauma or surgery of the elbow joint, increases the risk of pseudogout in elbow,
- Excess iron storage and an imbalance of other minerals in the body,
- Low levels of magnesium in the blood,
- Increased levels of calcium in the blood (hypercalcemia),
- An overactive parathyroid gland (hyperparathyroidism), particularly with an underactive thyroid (hypothyroidism)
Some medical ailments like parathyroid disorders, hemochromatosis or the treatment given for these conditions may sometimes influence the symptoms of pseudogout, which needs to be properly assessed by the treating physician.
What are the Symptoms of Pseudogout in Elbow?
Not all, but many people with calcium pyrophosphate crystal deposition may have symptoms of pseudogout in elbow. Attacks of pseudogout in elbow appear suddenly and are very severely painful, just like those in gout. The episodes of pseudogout in elbow may last for few days or even weeks. While, pseudogout can commonly affect large joints like the knees, ankles and other joints, pseudogout in elbow in also fairly common. When it attacks the elbow joints, it may result in the elbow joint becoming red, swollen, tender to touch and stiff, with inability to move the elbow. There may be a general feeling of being unwell and may be accompanied with fever. While gout in elbow mostly affects when the person wakes up from sleep, pseudogout in elbow can affect during any time of the day.
Common symptoms noticed in pseudogout in elbow include
- Sudden, severe pain in the elbow joint and there may be involvement of other joints like knees, ankles, shoulders, wrists or hands
- Swelling and tenderness in the affected elbow
- Redness, warmth and difficulty in movement of elbow
- Low grade fever and signs of inflammation
- Acute episodes that last for days, weeks or months that show response to anti-inflammatories
When such episodes of pseudogout in elbow continue repeatedly, it can affect the elbow joint and can even lead to damage and deformities of the elbow. With continued attacks of pseudogout in elbow, both the elbow joints can get involved and gradually other areas can get affected. If left untreated, the condition can progress and involve other joints of the body, which can appear like chronic arthritic condition, which is characterized by fatigue, elbow joint pain, general pain in many joints, difficulty in elbow joint movement, affected elbow joint function and joint damage.
Progression of pseudogout in elbow also causes more damage to the cartilage in the elbow joint, which can contribute to worsening of degeneration of the elbow joints. This can cause a worsening of symptoms of arthritis and can cause more pain, swelling and stiffness in joints.
What are the Signs of Pseudogout in Elbow?
Pseudogout in elbow mostly presents with the involvement of a single joint initially. While there are chances of other joints getting involved, it is necessary to examine other joints as well, to check for signs of inflammation like those in the affected elbow joints. Signs of inflammation are commonly noted, swelling, warmth, redness and tenderness.
The redness over the affected elbow joint may appear scaly with desquamation of the skin over it. The joint capsule of the elbow joint is swollen and loss of range of motion and tender to touch. Due to the nature of pseudogout in elbow being of sudden onset of signs and symptoms in a single joint, it is necessary to look out for signs of infection as well.
How to Diagnose Pseudogout in Elbow?
Pseudogout in elbow is diagnosed based on the personal history, which includes medical illnesses, ongoing medications and other treatments, history of infections, injuries, kidney disorders, etc. Past history includes information about previous episodes, which may have been like pseudogout in elbow, past illnesses, surgeries and treatments taken in the past. Family history to understand familial predisposition, presence of pseudogout in elbow in close family members and other medical details are noted.
Characteristics features like sudden onset of arthritis, which shows redness, swelling, warmth and severe pain in the joint, which may have developed just in a day, involvement of a single joint or varying joints, without any symmetry, more attacks of acute arthritis, may rise a suspicion that the form of arthritis could be pseudogout. Hence detailed investigations are needed to confirm pseudogout in elbow and rule out other forms of arthritis.
Confirmatory factors to diagnose pseudogout include elbow joint inflammation with sudden, severe pain, swelling, redness and warmth and presence of calcium crystals in the inflamed elbow joint.
Investigations help to diagnose pseudogout in elbow and include some of the following tests.
There are no blood tests to detect and diagnose pseudogout in elbow, however blood tests may be done to rule out other forms of arthritis. Blood tests like CBC, ESR, CRP, may also be done to detect inflammation and understand its severity; to rule out possibility of septic or infective arthritis, or other forms of arthritis; detecting blood uric acids levels to rule out gout in elbow, RF, rheumatoid factor to rule out rheumatoid arthritis and other tests to rule out autoimmune disorders.
Imaging studies like X-rays, CT scans and MRI can help to detect changes in the bone, joint deformities and damage occurring to other tissues. Damage to the cartilage and bony erosions can be detected through these imaging studies. X-ray of the elbow joint can help to detect calcium-containing deposits in the cartilage, which appearance is called chondrocalcinosis in the elbow joint. This is mostly due to calcium pyrophosphate crystal deposition in the elbow joint.
Performing these tests may be also useful in monitoring the progress of the disease and efficacy of the treatment plan, wherein damage to the joints and tissues needs to be studied.
Joint Fluid Analysis for Pseudogout in Elbow
Pseudogout in elbow causes sufficient amount of swelling around the elbow joint. The elbow becomes tender to touch, severely painful and becomes stiff. Joint fluid aspiration is performed as a diagnostic procedure to aspirate the excess fluid accumulated in the elbow joint. As no other tests can clearly detect pseudogout in elbow, the only way is to find presence of calcium pyrophosphate crystals in the synovial fluid accumulated in the swollen elbow joint with joint fluid aspiration or arthrocentesis.
Joint fluid aspiration is a procedure performed taking aseptic precautions, in which a sterile needle is inserted into the elbow joint space around the swollen area. The excess synovial fluid is accumulated in the swollen area, is aspirated through the needle. The aspirated fluid is sent for laboratory testing, where fluid analysis is done to detect the presence of calcium pyrophosphate crystals, which can confirm the diagnosis of pseudogout in elbow. Inflammatory process in the elbow joint due to pseudogout in elbow, also shows presence of other cells like white blood cells, etc. which can aid in the diagnosis.
Any presence of uric acid crystals can direct towards the diagnosis of gout and bacteria or pus cells towards an infection. Fluid analysis helps to detect the presence of pus cells, white blood cells, bacteria, which can help to rule out other forms of arthritis including septic arthritis and tuberculosis.
What is the Treatment for Pseudogout in Elbow?
Treatment of pseudogout in elbow in aimed at relieving pain, reducing swelling and associated symptoms during acute attacks, prevent further episodes of pseudogout attack, protect the elbow joint in the longer run and minimize the risk of permanent damage to the elbow joint.
Some of the treatment modalities for pseudogout in elbow include:
Medical Management of Pseudogout in Elbow
Acute attacks of pain, swelling and inflammation of the elbow joint are treated with non-steroidal anti-inflammatory medicines (NSAIDs) that can provide relief in the elbow joint symptoms of inflammation. These medicines can cause irritation of the gastric mucosa and the one that suits an individual should be taken.
Another medicine named Colchicine is commonly used during acute pain episodes for the treatment of pseudogout in elbow. Although this drug is approved for treatment of pseudogout in elbow, it too does have some side-effects. Colchicine, which helps to control inflammation during pain episodes and also prevents inflammatory episodes by controlling white blood cells from attacking the crystals in the joints. It thus prevents the initiation of the inflammatory reaction in the elbow joint. Colchicine is used if the above treatment with NSAIDs is not effective or not being tolerated well. Also, it may be considered in repeated attacks of pseudogout in elbow.
Steroids are anther class of medicines that can help to fight inflammation and bring quick relief. There are oral and injectable steroids, which can also be taken directly into the inflamed elbow joint for immediate relief of symptoms.
All medications and their side-effects should be discussed with the treating physician to plan the most effective and safe treatment plan.
Additionally, any other medical illnesses or factors contributing to pseudogout in elbow needs to be treated appropriately, to help slow down the progression of the pseudogout in elbow. Specific treatment for the underlying conditions, like hemochromatosis, etc. can help to protect the elbow joint and provide relief in complaints.
Pain Management of Pseudogout in Elbow
In acute attacks of elbow pain due to pseudogout in elbow, pain management aims at reducing the pain and swelling in the elbow joint. Resting the affected elbow joint is essential until the acute attack subsides. Sometimes, light compression of the elbow joint can help in reducing the swelling and also allows the joint to rest, but care should be taken and not kept for too long, not too tight or not while sleeping.
Applying cold compresses, ice packs rolled in a cloth and gently rubbing over the inflamed area can help. Elevation of the joint and keeping the elbow joint raised above the heart level can help to reduce the swelling and pain of pseudogout in elbow.
Joint Aspiration for Pseudogout in Elbow
Joint aspiration for pseudogout in elbow is commonly performed when there is a huge swelling in the elbow joint that has affected the movement of the elbow. Stiffness and pain in the elbow joint is often unbearable and removing some excess accumulated fluid can help in relieving the pressure of the swollen elbow. Aspiration of fluid from the elbow joint helps to relieve pain, pressure and reduces the swelling in the elbow joint, thus giving relief in symptoms. It also helps to improve the elbow joint movements and its functioning.
Surgical Management for Pseudogout in Elbow
Surgical Management may not be considered for the treatment of pseudogout in elbow. However when medical management, preventive treatment and all other treatment modes have failed and there is increasing elbow joint destruction, surgical intervention may be required. Surgery for pseudogout in elbow may be considered when there is sufficient amount of joint damage and there is a need to restore the elbow joint function with the help of surgery.
Surgery for joint replacement in pseudogout in elbow – Surgery for joint replacement involves removing the damaged elbow joint and replacing it with an artificial joint. This joint replacement surgery is aimed at providing relief of joint symptoms, reducing elbow pain, maintain joint flexibility, movement and function of the elbow joint.
FAQs on Pseudogout in Elbow
Answers to some of the common questions about pseudogout in elbow can help in dealing with it in a better way. Learning about pseudogout in elbow and understanding ways to manage it can help to plan better treatment regimen and lifestyle changes for pseudogout in elbow.
How Often Can Pseudogout in Elbow Attacks Occur?
Similar to gout, attacks of pseudogout in elbow also occur repeatedly and can affect the same joint or other joints, particularly more, if appropriate treatment is not initiated in time. The initial episodes of pseudogout in elbow can last from five to 12 days and can occur frequently if proper diagnosis and treatment is not initiated. With repeated attacks, the severity of pseudogout in elbow episodes can increase and can cause more damage to the elbow joint. It can also develop in other joints and involve many joints with more severe symptoms.
Is pseudogout in Elbow Related to Diet?
Unlike with gout, which is linked to diet rich in purines like seafood, organ meats and alcohol consumption, pseudogout in elbow is not caused or triggered by any specific diet. Hence, there are no specific foods that need to be avoided in pseudogout in elbow. However, if there is an underlying condition that affects the metabolism in a person, it may lead to deficiencies of certain minerals like magnesium, imbalance of iron, etc. In such cases, a proper diet plan must be followed under expert's guidance.
Also, diet plays an important role in maintaining general health, managing weight and prevention of many lifestyle disorders. It is advisable to a have balanced, healthy meal that includes fresh fruits, vegetables, grains and limit sugar, salt, high fatty food and alcohol. Drinking enough water is needed to maintain joint function. Diet is also important in overweight people, as reducing weight can help in relieving pressure on the joints and protect them from further damage.
What Causes Calcium Deposition in Elbow Joints?
Calcium crystals are hard substances, which are meant to be in structures like bones and teeth. However, when hard calcium crystals get accumulated in other areas like the joint space, they rub the soft tissues and cause damage to those structures. Hence in pseudogout in elbow, the deposited calcium crystals cause breakdown of the cartilage in the elbow joint and also trigger an inflammatory reaction. This leads to an inflamed elbow joint, swelling and pain, which when continued, causes further damage to the elbow joint.
Normally, although calcium is present in the blood, it does not form crystals in the elbow joints. The changes usually occur with the aging process and due to the presence of certain other medical conditions that cause an imbalance of calcium in the body. These include thyroid or parathyroid disorders, metabolic disorders affecting calcium regulation, deficiency of magnesium, haemochromatosis, certain kidney disorders, sometimes diabetes and some genetic factors.
What Triggers Pseudogout in Elbow Episodes?
While certain risk factors are noted, an acute episode of pseudogout in elbow can occur without any known obvious cause. Sometimes, certain factors may be present like injury to the elbow joint or nearby areas that can possibly promote the calcium crystals to move and get accumulated in the elbow joint space. This can trigger an inflammatory reaction within few days. Another common possibility is an attack of viral or bacterial infection, surgery, a major illness or sometimes even stress that disturbs the body and can result in triggering a pseudogout in elbow episode.
Can Pseudogout in Elbow Episodes Worsen Elbow Osteoarthritis?
Elbow osteoarthritis is a degenerative condition, often seen in aging people. Pseudogout is also commonly triggered with aging and there are more chances that the elbow joints have some osteoarthritic changes by then. Sometimes, people with elbow osteoarthritis, may have calcium deposition in their elbow joints. It is known as osteoarthritis with calcium pyrophosphate crystal deposition (osteoarthritis with CPPD). Presence of calcium crystals damage the joint cartilage and causes narrowing of the cartilage. This can worsen the elbow osteoarthritis symptoms and also lead to further damage to the elbow joint. Recurrent attacks of joint inflammation are also more common in such joints. Narrowing of cartilage and thickening of bone due to elbow osteoarthritis is likely to worsen with repeated pseudogout in elbow episodes.