Gout vs Pseudogout
Gout and Pseudogout are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Gout vs Pseudogout at a glance
- Gout: Acute monoarticular crystal arthritis from monosodium urate deposition; classically the first MTP joint.
- Pseudogout: Acute crystal arthritis from calcium pyrophosphate deposition; classic site is the knee with chondrocalcinosis.
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Side-by-side comparison
| Feature | Gout | Pseudogout |
|---|---|---|
| At a glance | Acute monoarticular crystal arthritis from monosodium urate deposition; classically the first MTP joint. | Acute crystal arthritis from calcium pyrophosphate deposition; classic site is the knee with chondrocalcinosis. |
| Classic presentation | Podagra: red, hot, exquisitely tender first MTP joint.; Sudden onset (often nocturnal) severe monoarticular pain peaking within 12-24 hours; Classic site:… | Acute monoarticular or oligoarticular swelling, pain, and warmth — most often knee or wrist; Onset over hours to a day; often precipitated by surgery, trauma,… |
| Workup / key labs | Definitive: identification of MSU crystals in joint fluid or tophus. 2015 ACR/EULAR classification criteria available for cases where aspiration is not… | ACR/EULAR 2023 classification criteria for CPPD use clinical features + imaging + crystal identification.; Arthrocentesis with polarized microscopy — rhomboid… |
| Imaging | Plain radiographs — early attacks usually normal; chronic disease shows 'rat-bite' periarticular erosions with overhanging edges, sparing of joint space until… | Plain radiographs — linear calcification within hyaline or fibrocartilage (chondrocalcinosis), classically in knee menisci, triangular fibrocartilage complex… |
| First-line treatment | Acute flare (treat ASAP, ideally within 24 h of onset):; • NSAIDs — indomethacin, naproxen, ibuprofen at full anti-inflammatory dose × 5-7 days (avoid in CKD,… | — |
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