Dear Dr. Gott: In May 2008, I woke up with an inflamed neck and couldn’t recall any physical action that might have caused it. In August, I developed a swelling in my elbow, which was accompanied by nightly fevers of 100 F to 103 F degrees for a couple of weeks.
A rheumatologist drained the elbow twice. A culture showed it to be pseudogout rather than the expected staph infection. Then, in September, I developed a back problem, which also came on for no apparent reason. I started taking sulindac, and the fevers stopped.
My question concerns whether or not the pseudogout could have caused my neck and back issues. I have not been able to find out much about it and would welcome any information you might have. I am a 66-year-old male. I have a fairly extensive background of exercise and athletic participation.
Dear Reader: Pseudogout is a type of arthritis that appears as sudden, painful swelling of one or more joints, typically the knee. Each episode can last for days or even weeks. Attacks are more common in older adults.
The condition is similar to gout in that it is triggered by an accumulation of crystals in the joint lining. Gout is caused by urate crystals, while pseudogout is caused by calcium pyrophosphate dihydrate crystals (CPPD). Risk factors for developing these crystals include age, joint trauma, genetic predisposition and hemochromatosis, an inherited disorder that causes excess iron to build up in tissue near joints and organs.
Pseudogout is the common term (and just one feature) used for a larger condition known as calcium pyrophosphate deposition disease. Other symptoms may include joint cartilage calcification and joint degeneration. Nearly half of all people over the age of 90 have CPPD crystals in their joints, but most don’t experience any symptoms. It is not currently known why this happens.
There is no way to eliminate the offending joint crystals, so initial treatment is aimed at reducing signs. This includes non-steroidal anti-inflammatory drugs (NSAIDs) such as over-the-counter ibuprofen and naproxen or prescription indomethacin and sulindac (which you are currently taking) and resting the joint whenever possible. This might be followed by joint aspiration (to remove some of the fluid) and corticosteroid injections. Colchicine may be used by those who can’t tolerate NSAIDs.
Both gout and pseudogout can affect any joint in the body, but each typically affects a specific joint. Gout is most common in the big toe, whereas pseudogout is most common in the knee. Because your neck and back were both affected around the time you were diagnosed with pseudogout of the elbow, it is possible the disorder was the cause of the swelling and pain. However, without having had testing when you experienced symptoms, there is no way to be sure. Back pain often comes on suddenly and may have been caused by lifting something too heavy or moving in an awkward manner.
Should you develop symptoms in any of your other joints, I recommend you return to your physician and request testing. If they are caused by pseudogout, you may be a candidate for preventive treatment, such as low-dose colchicine daily rather than treatment to alleviate symptoms during an attack.
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