Gout and pseudogout
Gout and pseudogout are types of arthritis, both caused by the accumulation of crystals in the joints. Gout is caused by deposits of urate crystals and most commonly affects the big toe.
Pseudogout is caused by deposits of calcium crystals and often affects larger joints, such as the knees and wrists.
It is more common in elderly patients and in joints which are already damaged by osteoarthritis or “wear and repair”.
Although gout and pseudogout have similar symptoms, the treatment might be different.
About our service
These conditions are often managed by your GP in primary care but we offer further assessment and advice on management in more difficult cases.
You may have to undergo tests, including blood tests and X-rays to help us find out whether you have the condition. We can then look at treatments to reduce the swelling and relieve pain.
If you have swelling in a joint, we might consider sampling this with a needle to send off for further testing.
Treatments
There are two treatment approaches for gout:
Firstly, an acute attack of gout can be managed with resting and elevating the affected joint and using ice packs. Medications for managing an attack of gout include non-steroidal anti-inflammatory drugs “NSAIDs” (such as ibuprofen), colchicine and steroid tablets, such as prednisolone.
Some affected joints can be injected with steroid by your GP or rheumatologist. Your GP or rheumatologist can help decide which of the above medications is best suited for you.
Secondly, medications including allopurinol and febuxostat are available. These reduce your levels of uric acid and help the crystals dissolve out of your joints. We begin treatment with a low dose, as lowering urate levels too quickly can trigger an acute attack.
We aim to get the urate level well below 360μmol/L, and in fact, recent guidelines suggest we set a target of below 300μmol/L.
Regular monthly blood tests will be needed to check your urate level and kidney function for the first 4-6 months.
Once you have been symptom-free for one to two years, we might be able to relax this target to 360µmol/L.
Allopurinol and febuxostat will not help during an acute attack and, in fact, during the early stages of treatment, you may experience more attacks as the crystals dissolve. We often recommend regular colchicine (500mcg once or twice a day) or NSAIDs to manage gout attacks while the urate level is lowered. The risk of acute attacks continues for at least six months after treatment initiation, but it is important not to stop the allopurinol/febuxostat if an attack occurs.
An increase in attacks of gout during the first six months of treatment does not mean treatment failure. The presence of kidney and heart problems may sometimes influence the choice of urate-lowering therapy.
It is important to try and adopt a ‘gout friendly’ lifestyle: maintaining a normal weight, eating a balanced diet low in fat and added sugar (in particular sugar-sweetened soft drinks), avoiding excessive intake of alcohol and high purine foods.
We do not recommend an ‘Atkins type’ diet, which is high in purines.
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