Ask the Doctors: How do I stop gout-like pain?
Q: I was recently diagnosed with chondrocalcinosis, which is quite painful. I know it's similar to gout, though it is due to calcium crystals rather than urea. What treatments can help with pain? I don't want to have a second knee replacement.
A: You're correct that the term chondrocalcinosis refers to a buildup of calcium crystals, specifically calcium pyrophosphate dihydrate crystals, within a joint. Sometimes referred to as pseudogout, it's most often seen in the knee, but can also affect the elbow, shoulder, wrist and ankle joints. The accumulated crystals in the joint trigger an immune response, which results in inflammation, stiffness, swelling and pain within the joint. Episodes can last anywhere from several days to several months. The condition is often detected via an X-ray, which makes it possible to see the accumulation of calcium deposits. It's a tricky diagnosis, though, because stiff and aching joints, and additional symptoms such as warmth and redness, are also common to osteoarthritis and rheumatoid arthritis. For a definitive diagnosis, a bit of fluid is removed from an inflamed joint and tested for the presence of calcium pyrophosphate crystals.
Anyone can develop chondrocalcinosis, but the risk rises significantly with advancing age. According to some estimates, it's found in up to one-fifth of people over the age of 60, and in half of those 90 and older. As with gout, the condition can cause both short- and long-term swelling in the articulated, or movable, joints. Some people have flare-ups in more than one joint, and some also experiences a low-grade fever.
Although a specific cause for chondrocalcinosis hasn't yet been identified, it is seen more often in people who have high blood levels of calcium (hypercalcemia), of iron (hemochromatosis), or hypomagnesemia, which is too little magnesium. Diet does not appear to play a role in flare-ups.
We're sorry to say that at this time, there is no known way to dissolve or remove the calcium pyrophosphate crystals within the joint. Instead, the emphasis is on managing the condition. The goal is to ease inflammation and pain and to limit the degenerative tissue damage that the condition can cause. During flare-ups, nonsteroidal anti-inflammatory drugs, or NSAIDs, can ease pain, stiffness and swelling. For people who take blood thinners, or those who have stomach ulcers or poor kidney function, the use of NSAIDs may not be an option. In those cases, an aspiration procedure to remove fluid from the joint, along with an injection of a corticosteroid to manage inflammation, can provide relief. There is evidence that low doses of a medication used for gout, known as colchicine, can be effective in limiting flare-ups.
You mentioned the possibility of a knee replacement. This is a procedure that is sometimes recommended in more serious cases. If your particular case of chondrocalcinosis is severe enough that this has been presented as an option, we recommend that you seek guidance from a rheumatologist. These are physicians who specialize in the diagnosis and treatment of musculoskeletal disease and have an expertise in this painful and sometimes debilitating condition. Your health care provider should be able to provide you with a referral.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to firstname.lastname@example.org, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.
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