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: first metatarsophalangeal joint (podagra) in ~50% of first attacks; Other sites: midfoot, ankle, knee, wrist, elbow, fingers; Self-limited untreated attacks resolve in 7-14 days;… | Acute monoarticular or oligoarticular swelling, pain, and warmth — most often knee or wrist; Onset over hours to a day; often precipitated by surgery, trauma, or acute medical illness; Less severe than typical gout but can be incapacitating; Chronic forms: insidious polyarticular arthritis mimicking RA or OA; Warm, swollen joint with… |
| 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 feasible.; Arthrocentesis with polarized microscopy — gold standard: needle-shaped, NEGATIVELY birefringent MSU crystals; inflammatory fluid (WBC 20,000-100,000, neutrophil-predominant);… | ACR/EULAR 2023 classification criteria for CPPD use clinical features + imaging + crystal identification.; Arthrocentesis with polarized microscopy — rhomboid or rod-shaped, POSITIVELY birefringent CPP crystals; inflammatory fluid; Gram stain and culture to exclude septic arthritis; Screen for underlying metabolic disease in patients… |
| Imaging | Plain radiographs — early attacks usually normal; chronic disease shows 'rat-bite' periarticular erosions with overhanging edges, sparing of joint space until late; Dual-energy CT (DECT) — color-codes MSU deposition (research/specialty use); Ultrasound — 'double-contour sign' along articular cartilage is highly specific | Plain radiographs — linear calcification within hyaline or fibrocartilage (chondrocalcinosis), classically in knee menisci, triangular fibrocartilage complex of wrist, symphysis pubis; Ultrasound — hyperechoic deposits within cartilage; DECT — less established than for gout |
| 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, HF, GI bleed); • Colchicine 1.2 mg PO, then 0.6 mg one hour later, then 0.6 mg daily-BID (renal dose adjustment; avoid in severe CKD or with strong CYP3A4/P-gp inhibitors); •… | Acute flare: Intra-articular corticosteroid injection (triamcinolone 40 mg) — preferred when septic excluded, especially for knee; Acute flare: Oral NSAIDs — ibuprofen, naproxen, indomethacin (full anti-inflammatory dose, short course); Acute flare: Colchicine 1.2 mg, then 0.6 mg one hour later, then 0.6 mg BID-TID; Acute flare:… |
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