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When Is Gout Not Gout? When It’s “Pseudo Gout”

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Gout has been described as a form of arthritis caused by too much uric acid in the blood, damaging, joints, tendons, and other tissues. It can cause burning pain, stiffness, and swelling in a joint (usually a big toe), and attacks can happen over and over unless it is treated. It is different from "pseudo gout" in that it is not a symptom of a deadly genetic disease, as is the case with the "pseudo gout" of hemochromatosis.

Very often if people are overweight, drink too much alcohol, or eat too much meat and fish that are high in chemicals called purines, this can result in a flare-up, but mercifully such attacks can also be few and far between. Most of the time, having too much uric acid is not harmful. On the other hand, too much iron, which causes hemochromatosis, is potentially fatal. The agony of pseudo gout is not only excruciating; it is a red flag for that disorder.

The Number One Inherited Disorder

As I have explained in previous articles on the subject, hemochromatosis is the number one genetic disorder while, paradoxically, it is also the one that is most often dismissed as "rare." Because it so often goes unrecognized, it is seldom diagnosed before it is clinically manifest. Most of the suffering associated with the disease is preventable if potential victims are detected in time; even when it has become symptomatic, many serious complications are reversible, but only by timely diagnosis and treatment.

Symptoms vary, but many hemochromatotics experience chronic fatigue, severe abdominal pain, bouts of nausea, diminished memory, and disorientation for many years before diagnosis. In later years, there could be some degree of hearing loss.However, I have, for years, been campaigning for the prompt recognition of chondrocalcinosis (also known as "pseudo gout") to be recognized as one of the most prominent symptoms. In my book The Bronze Killer I have described how my husband’s aching hands would lock on the steering wheel of the car, and also describe a segment from a TV interview with the CBC in which he — once thought to be possibly the best jazz mandolin player in the world — had been handicapped by the crippling of those once agile hands.

At Last This Is Being Taken Seriously!

In a recent report by A.E. Timms and colleagues published in the Annals of the Rheumatic Diseases and and titled "Genetic testing for haemochromatosis in patients with chondrocalcinosis," the authors write that "…Given the early mortality associated with untreated haemochromatosis … routine screening for haemochromatosis in patients with appreciable chondrocalcinosis is recommended."

Calcium Pyrophosphate Dihydrate Crystal Deposition Disease (CPDCDD)

Chondrocalcinosis, also known as "pseudo gout" and sometimes "acute arthritis," is caused by CPD crystal-induced inflammation, and is nearly as common as "real" gout — which is caused by uric acid crystals. Like gout, it causes what many have described as excruciating pain when it flares up. CPDC stands for "calcium pyrophosphate dihydrate crystals," and another name for chondrocalcinosis or psuedo gout is "calcium pyrophosphate dihydrate crystal deposition disease." (One only has to think of fireworks as pyrotechnics to sympathize with anyone who suffers from this!)

What Is It?  CPDCDD is a condition that causes pain, redness, heat, and swelling in one or more joints, eventually resulting in damage to the affected joints (mostly those of the knees, thumbs, wrists, and the one between the pubic bones in the front of the pelvis). Sufferers will know at once what is meant by the "painful handshake," as one of the earliest symptoms is "arthritis" of the thumb joint and the knuckles of the first and second fingers. This telltale swelling is a classic manifestation, and if I had my way, the knuckles of every person afflicted with "arthritis" would be examined for possible hemochromatosis.

What Causes It? Deposits of calcium pyrophosphate dihydrate crystals in a joint, which weaken the cartilage and cause it to break down more easily. The presence of these tiny CPDC crystals in the joints, and the body's reaction to these crystals, creates often agonizing inflammation as ‘A’ cells rush to attack the crystals. A fruitless exercise, as the crystals are indestructible, and, during one of the attempted A-cell rescue operations, they lose the battle — causing the patient’s immune system to be temporarily compromised, as a result.

Often dismissed as arthritis, CPDCDD has been reported by many homozygous people with whom I have worked (i.e. those who carry two genes) as having been the presenting symptom of the onset of hemochromatosis. Over the years I have learned, however, that that it is also possible for heterozygotes (persons carrying only one gene) to be afflicted. I have known some with knees so swollen that the fluid has had to be aspirated.

Physicians do not readily prescribe oral cortisone for the treatment of CPDCDD, but from my personal experience, I can tell you that an injection into an afflicted joint can work wonders!

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About Marie Warder

Born in South Africa, became a journalist and later trained as a teacher before establishing my own school - "Windsor House Academy, of which I remained the principal until I emigrated to Canada. Love to write, and have published 27 books. Played the piano in my husband's dance band for 33years. Founder and President Emerita of the the Canadian, South African and in International Association of Hemochromatosis Societies, http://en.wikipedia.org/wiki/Marie_Warder
  • Arthur

    This is news to me. Completely astounding! Can’t thank you enough. I suffer so intensely from CPDCDD that there are times when I cannot bear even a sheet to touch the affected joints, and painkillers don’t help.
    I have an uncle who died of what he referred to as “iron overload” and now I come to think of it, that was once referred to as Hemochromatosis.

  • Too Shy

    I am extremely grateful for this information; mainly because it led to a shattering discovery. (By the way, I would advise you to provide the ISBN for the e-BOOK version of The Bronze Killer as well. I searched for it, found a link, downloaded a free reader and sample chapter on the Net, bought the book and read it straight through from beginning to end. Hence my remark about the “shattering discovery!”)
    You write so freely about sexual dysfunction in the book. Why have you never done so for this magazine?

  • Marie Warder

    Firstly,I did provide the ISBN for the E-Book, but my editor probabaly thought it was “overkill” to post two identical images of the cover.

    Regarding your “shattering discovery”, I promise to remedy that oversight in a future article.

  • Maureen

    My 86 yr. old mother has suffered with pseudogout for almost 30 years, not long after also being diagnosed with biliary cirrhosis of the liver. She just went through a flare-up which healed but has flared up again in the same joint (left hand) – which has never happened to her before. Her iron levels were very high but the doctors want to retest everything when her pseudogout is healed because they said that iron levels are usually high in people with any acute infection. Our thoughts are why would it hurt to test for ferritin saturation levels while she is sick?? There are also two nieces and one nephew (all from the same family) on my mom’s side that have been diagnosed with hemochromatosis. I would really like to approach this in the right way (with the doctors) for my mom to get better and get some answers. She also has experienced side effects with arthritic drugs they have tried to give her over the years so she is very hesitant to take anything, even cortisone shots, which they have suggested, all because she fears the affect on her already damaged liver (which they just took an ultrasound of and it was obvious there was damage to it). I would really like to push to have tests done even now. Is there any reason that they would not want to do this that you know of??

  • Marie Warder

    Give me a day or two and I’ll try to get back with a sensible response. Meawhile, can you please clear up one or two details for me.
    First of all, do you mean “transferrin” saturation, and to what do they ascribe the liver damage? And secondly, which joint in her hand is affected?

  • Maureen

    Yes sorry – I mean transferrin saturation. She was very sick with a high temperature 40 years ago(my sister clarified that with me) and they thought it could have been a viral infection that damaged her liver. Also, when she was in the hospital at the beginning of May, her ferritin level was at 1760. I just talked to my mom by phone and she has major swelling in her whole left hand (wrist and fingers) with pain radiating from her left elbow to shoulder. Thank you so much for looking into this.

  • MW

    Sorry I have kept you waiting for so long, and even now I have no definitive reponse for you. Understandably none of the experts I have emailed seem willing to commit themselves to online diagnosis on the grounds that they do not have access to the bloodwork etc. Response from suffers is almost unanimous, however. All say that they would go for the cortisone rather than suffer such agony.

  • Jon

    To make a very long story short, I began suffering from extreme shoulder and tendon pain nearly 10 years ago…shortly after I was diagnosed with B-cell CLL. It took the 10 years to find out that grapes and grape products would bring on an attack that would last up to 48 hours. I have been fighting the CLL with pau d’arco, graviola, green tea extract, but with diminishing results. Then I came upon an article about transferrins which are abnormally high in cancer cells and rheumatoid arthritis (which came upon me at about the same time) synovial fluid. I have subsequentally began taking apo lactoferrin, a natural iron balancer, which starves cancer cells of iron, and feeds healthy red cells. I know my RA has improved and my CLL blood test is tomorrow. I am going to ask to be tested for transferrin saturation…hemochromatosis.

  • Jon

    Addendum…I have always had a hard time taking vitamins with iron in them…grapes are high in iron. I know my Dad had a lot of severe pain in his shoulders, but never figured out the cause…he loved grapes. I am certain that the root cause is my body not properly handling the iron…the result being hemochromatosis.

  • http://en.wikipedia.org/wiki/Marie_Warder Marie Warder

    Thank you for your kind comments, Jon. Be sure to fast from midnight before you go for those tests, because what you eat may inluence the result. And thank you, too, deepa.

  • Jamie

    I must have pseudo gout because I get gout in my big toe every year and it is painful but I am NOT overweight or eat red meat or drink any kind of alcohol…???

  • MW

    Pseudo gout is usually a part of Hemochromatosis (iron Overload). When it causes a knee — for instance –to swell with fluid, that fluid can be aspirated ( removed) and tested to see whether it results from uric acid or calcium pyrophosphate. If the latter, you should be checked for Hemochromatosis.
    If I were you I would ask my doctor for an iron profile,in any case.

  • Ashley

    We have been trying to connect the dots in the trail leading to hemachromatosis in our family. Of five siblings, two were discovered to have high iron. The medical community has little information for us so far. My brother has been treated with phlebotomy – twice so far and is soon to see a doctor specializing in hemachromatosis. My doctor refuses to treat my high iron with phlebotomy until I have confirmed genetic testing results. It has been six months of confusion, pain and exhaustion. Soon, I hope to have answers. Neither my brother or I have confirmed diagnosis of HH. We both have all the classic symptoms. We both have had many bouts of joint pain and what we were told was out. Our father suffered with gout for many decades before dying of acute
    leukemia.
    My son wanted to check his own iron levels and his doctor had him tested for hereditary hemachromatosis when he was told about elevated iron readings in the immediate family. The results came back positive for C282Y/C282Y. So at least now I know the gene He had to come from both me and my spouse.

  • Marie Warder

    I hope to discuss this in greater detail at a later date, but,meanwhile, can you please let me know if it is possible to “donate blood where you live.