Arthrosamid Injection

Pseudogout Treatment: What Works, What to Expect, and When to See a Doctor

12 July 2026

13 min read

✅ Medically reviewed | Updated July 2026

Pseudogout is one of those conditions that surprises people twice — first when a joint suddenly becomes agonisingly painful for no obvious reason, and again when they are told it is not gout, not an infection, and not an injury. It is something else entirely: calcium pyrophosphate crystals depositing inside the joint and triggering an acute inflammatory response that can be genuinely debilitating.

The good news is that pseudogout treatment is effective. The acute attack can be brought under control, usually within days. Recurrence can be reduced with the right long-term approach. And understanding what is actually happening inside the joint makes the treatment make much more sense — and helps you make better decisions about managing it.

This guide covers everything: what pseudogout is, how it is diagnosed, every treatment option available in the UK, and what to do when the knee remains painful between attacks.

What Is Pseudogout and Why Does It Cause Acute Pain?

Pseudogout — formally known as calcium pyrophosphate deposition disease (CPPD) — occurs when calcium pyrophosphate dihydrate crystals form and deposit inside a joint. The knee is the most commonly affected joint, though the wrist, ankle, shoulder, and other joints can also be involved.

When crystals deposit inside the joint cavity, white blood cells engulf them and trigger an intense acute inflammatory response. It is this inflammatory reaction — not the crystals themselves — that causes the sudden, severe pain, swelling, warmth, and redness of a pseudogout attack. The attack can come on with very little warning, sometimes overnight, reaching peak intensity within hours.

Pseudogout is closely associated with older age. It is uncommon before 60 and becomes increasingly prevalent in those over 80, where calcium pyrophosphate deposits in joint cartilage are found in the majority of people examined. Underlying metabolic conditions — including hyperparathyroidism, haemochromatosis, hypomagnesaemia, and hypothyroidism — can accelerate crystal deposition, particularly in younger patients.

How Is Pseudogout Diagnosed?

Accurate diagnosis is essential before treatment begins, because pseudogout looks similar to several other conditions that require completely different management.

The conditions that most commonly mimic pseudogout include:

Gout — caused by monosodium urate crystals rather than calcium pyrophosphate. The two are clinically very similar but require different long-term treatment approaches
Septic arthritis — a joint infection that is a medical emergency. A hot, swollen joint alongside a high temperature must be investigated urgently to rule this out
Rheumatoid arthritis — usually more gradual and symmetrical, but an acute flare in a single joint can occasionally resemble pseudogout
Osteoarthritis flare — common in older adults and can produce a swollen, painful knee

The definitive diagnostic test is joint fluid analysis — aspirating a sample of synovial fluid from the affected joint using a needle (arthrocentesis) and examining it under polarised light microscopy. Calcium pyrophosphate crystals appear as short, rhomboid-shaped, positively birefringent crystals. This immediately distinguishes pseudogout from gout (which shows needle-shaped, negatively birefringent urate crystals) and from infection (which shows bacteria on culture).

Blood tests help identify associated metabolic conditions. Thyroid function, calcium, phosphate, magnesium, iron studies, and parathyroid hormone levels are typically checked when pseudogout is confirmed, particularly in patients under 60 or those with recurrent attacks.

Imaging adds further information. X-rays can show chondrocalcinosis — calcification of the joint cartilage — which is a characteristic finding in calcium pyrophosphate deposition disease and visible as fine lines of increased density within the cartilage. Ultrasound is particularly useful for detecting crystal deposits in cartilage and synovial tissue. MRI provides the most detailed view when soft tissue inflammation or joint damage needs to be assessed.

Pseudogout Treatment — Treating the Acute Attack

There is no cure for pseudogout. However, treatment reliably controls the acute attack and reduces both its severity and duration. Starting treatment as early as possible — ideally at the very first sign of an attack — makes a significant difference to how quickly and completely it resolves.

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

NSAIDs are the first-line treatment for an acute pseudogout attack in patients who can tolerate them. Prescription-strength NSAIDs such as naproxen or indomethacin are typically used at therapeutic doses for the duration of the acute attack — usually five to seven days.

NSAIDs work by blocking the inflammatory enzymes (COX-1 and COX-2) that drive the acute inflammatory response to calcium pyrophosphate crystals. They are highly effective when started promptly and taken at an adequate dose.

NSAIDs carry significant risks in older adults — who make up the majority of pseudogout patients — including stomach bleeding, kidney damage, and cardiovascular events. They should be used at the lowest effective dose for the shortest necessary time, always alongside a stomach-protecting medication (proton pump inhibitor) in older adults. They are contraindicated in patients with active peptic ulcer disease, severe kidney disease, or recent cardiovascular events.

Colchicine

Colchicine is an effective alternative or addition to NSAIDs for acute pseudogout. It works by inhibiting the inflammatory response of white blood cells to crystal deposits. When started early — ideally within the first 12 to 24 hours of an attack — it significantly reduces pain and swelling.

Low-dose colchicine (0.5 mg twice daily) is better tolerated than the high-dose regimens historically used and remains effective for acute attacks. It is particularly useful for patients who cannot tolerate NSAIDs.

Colchicine is also prescribed at a low prophylactic dose to prevent recurrent pseudogout attacks in patients who experience frequent flares — typically 0.5 mg once or twice daily on an ongoing basis.

Corticosteroids

When NSAIDs and colchicine are contraindicated or ineffective, corticosteroids are the next treatment option. They can be given in two ways:

Oral corticosteroids — a short course of prednisolone, typically 30 to 35 mg daily, tapered over one to two weeks. This provides rapid, effective relief of acute pseudogout inflammation. Long-term or repeated courses carry significant risks including bone density loss, blood sugar elevation, weight gain, cataracts, and adrenal suppression — so they are reserved for acute use.

Intra-articular corticosteroid injection — a steroid injected directly into the affected joint. This is often the fastest and most targeted approach for pseudogout affecting the knee, delivering anti-inflammatory treatment directly to the inflamed joint cavity. Relief typically begins within two to seven days and lasts four to twelve weeks.

The injection also serves a diagnostic purpose — when combined with joint aspiration (removing the excess fluid first), it reduces swelling, removes some of the crystal burden, and delivers corticosteroid directly where it is needed. This dual approach — aspirate then inject — is the standard clinical practice for a pseudogout attack in the knee.

Repeated steroid injections into the same joint should be limited. While effective for acute flares, frequent cortisone use carries risks including cartilage damage over time — a concern that is particularly significant in a joint that may already have underlying osteoarthritis.

Joint Aspiration (Arthrocentesis)

Draining the excess fluid from a swollen knee during an acute pseudogout attack provides immediate relief by reducing the pressure inside the joint and removing some of the crystals driving inflammation. It also provides the synovial fluid sample needed for definitive diagnosis.

Joint aspiration alone can provide significant symptom relief within hours, even before any medication takes effect. It is typically performed in a clinical setting using a needle under ultrasound guidance for accuracy and safety.

Home Management During an Attack

While medical treatment is being arranged or taking effect, the following home measures help reduce discomfort:

Rest the joint. Avoid loading the affected knee for the first day or two. This does not mean complete immobility — gentle, pain-free movement helps maintain circulation — but avoid weight-bearing activity that aggravates the pain.

Apply ice. An ice pack wrapped in a cloth applied to the knee for 15 to 20 minutes, three to four times daily, reduces swelling and numbs the acute pain. Never apply ice directly to skin.

Elevation. Prop the leg above hip height when resting to encourage fluid drainage and reduce joint pressure.

Over-the-counter NSAIDs. Ibuprofen or naproxen sodium from a pharmacy can reduce pain and inflammation while you arrange medical assessment. Take them with food and at the recommended dose.

Pseudogout Treatment — Preventing Future Attacks

Unlike gout, where urate-lowering therapy (allopurinol) can dissolve existing crystal deposits and prevent future attacks by keeping uric acid below the crystallisation threshold, there is currently no equivalent proven therapy for pseudogout that removes calcium pyrophosphate deposits.

Long-term pseudogout management therefore focuses on reducing attack frequency rather than eliminating the underlying crystal deposits.

Low-Dose Colchicine Prophylaxis

For patients who experience frequent attacks — more than two or three per year — low-dose colchicine taken daily (typically 0.5 mg once or twice daily) reduces attack frequency significantly. It does not dissolve the crystals, but it suppresses the inflammatory response they trigger, preventing attacks from occurring even as crystals remain present.

Treating Underlying Metabolic Conditions

When pseudogout occurs in younger patients or with unusually high frequency, underlying metabolic conditions are often involved. Treating these conditions appropriately may slow the rate of further crystal deposition:

Hyperparathyroidism — elevated parathyroid hormone drives calcium imbalance; surgical or medical management improves outcomes
Haemochromatosis — iron overload accelerates CPPD; regular venesection reduces iron levels
Hypomagnesaemia — low magnesium levels are associated with CPPD; magnesium supplementation is occasionally helpful
Hypothyroidism — treated with thyroid hormone replacement

In older patients without an identifiable underlying cause, metabolic treatment is less relevant — crystal deposition in this group is a natural consequence of ageing cartilage.

Lifestyle and Joint Protection

While lifestyle modification has less direct impact on pseudogout than on gout, general joint health measures reduce the risk of osteoarthritis-related changes that can accelerate crystal deposition:

Maintaining a healthy weight reduces load on the knee joints
Low-impact exercise — swimming, cycling, walking — maintains joint mobility and muscle support without impact loading
Staying well hydrated maintains joint fluid health
Avoiding joint injury where possible — acute joint trauma can trigger pseudogout attacks in susceptible individuals

Pseudogout, Osteoarthritis, and the Knee — When Both Are Present

Pseudogout and knee osteoarthritis frequently co-exist. Calcium pyrophosphate crystals preferentially deposit in damaged or degenerating cartilage, which is why pseudogout becomes increasingly common in joints already affected by osteoarthritis. Managing both conditions simultaneously is a clinical reality for many older patients.

Between acute pseudogout attacks, patients with underlying knee osteoarthritis often have persistent background pain, stiffness, and functional limitation driven by the osteoarthritis itself — separate from the episodic crystal-driven flares.

For patients in this situation, controlling the pseudogout attacks addresses the acute episodes, but the ongoing osteoarthritis still needs management in its own right. This is where the treatment options for osteoarthritis — including physiotherapy, pain relief, and advanced injectable treatments — become relevant alongside the pseudogout management.

The Arthrosamid injection is a non-biodegradable hydrogel treatment for mild to moderate knee osteoarthritis — not for pseudogout itself. For patients whose knee pain between pseudogout attacks is significantly driven by underlying osteoarthritis, Arthrosamid may be worth considering once the acute inflammation has fully resolved. It integrates with the synovial tissue of the knee and has been shown in published clinical studies, including a 2025 five-year follow-up, to provide sustained improvements in pain and function in suitable patients from a single injection.

The key point is that any elective joint injection for osteoarthritis management should only be considered when the joint is not actively inflamed. An acute pseudogout attack must be fully resolved before any non-urgent joint procedure is performed.

For more on how different joint conditions and treatments relate to each other, our guides on knee swelling and pain without injury, can a swollen knee be dangerous, and gout in the knee cover the diagnostic and treatment landscape in useful detail.

For a clinical video explanation of how different conditions affect the knee joint — including the role of synovial fluid and crystals in both gout and pseudogout — visit the Dr SNA Clinic YouTube channel.

When to Seek Urgent Attention

Most pseudogout attacks, while extremely painful, are not medical emergencies. However, some situations require same-day attention:

Seek urgent medical care if:

The joint is severely hot, red, and swollen alongside a high temperature — possible septic arthritis, which is a medical emergency requiring hospital assessment
You are unable to bear any weight on the affected limb
The pain is rapidly worsening and not responding to any pain relief
You develop systemic symptoms — chills, nausea, feeling very unwell — alongside joint pain

See your GP promptly if:

This is your first unexplained episode of acute joint pain and swelling
You have had multiple attacks and have not yet had a formal diagnosis confirmed by joint fluid analysis
Existing treatment is not controlling your attacks adequately
You are due for a review of any underlying metabolic condition

A Practical Summary — Pseudogout Treatment Options

Situation	Treatment Approach
Acute attack — first-line	Prescription NSAID (naproxen or indomethacin) for 5–7 days
Acute attack — NSAID contraindicated	Low-dose colchicine or oral prednisolone
Acute attack in the knee — targeted relief	Joint aspiration followed by intra-articular corticosteroid injection
Recurrent attacks — prevention	Low-dose colchicine 0.5 mg daily or twice daily
Younger patient or unusual frequency	Blood tests to identify metabolic cause; treat underlying condition
Between attacks with persistent knee pain	Assess for co-existing osteoarthritis; consider physiotherapy or Arthrosamid
Hot, red joint with fever	Urgent medical assessment — rule out septic arthritis

About Mr Syed Nadeem Abbas — Knee and Joint Expert at Dr SNA Clinic London

Every knee assessment and treatment at Dr SNA Clinic is carried out personally by Mr Syed Nadeem Abbas, MBBS, MRCSEd, MSc (Distinction). Mr Abbas spent six years in NHS Trauma and Orthopaedics at major hospitals including Cambridge and Oxford — giving him a surgical-level understanding of joint anatomy and the clinical judgement to assess complex joint conditions, including the distinction between pseudogout, gout, osteoarthritis, and inflammatory arthritis.

He holds postgraduate membership of the Royal College of Surgeons of Edinburgh (MRCSEd) and an MSc in Aesthetic Plastic Surgery with Distinction from Queen Mary University of London. He holds formal certification in Arthrosamid injection therapy through the American Cellular Medical Association — one of a very small number of UK-based clinicians with this credential.

The clinic is based at 48 Wimpole Street, Marylebone, London W1G 8SF. CQC regulated. 4.9-star Google rating from verified patient reviews. Open Monday to Saturday, 10:00–18:00.