Pseudogout flares are treated with anti-inflammatory medications, joint drainage, and sometimes corticosteroid injections. Unlike gout, there’s no way to dissolve or prevent the calcium pyrophosphate crystals that cause the condition, so treatment focuses on controlling inflammation during attacks and reducing the frequency of future episodes.
What Happens During a Flare
Pseudogout occurs when calcium pyrophosphate crystals that have built up in joint cartilage shed into the joint space, triggering intense inflammation. The knee is the most commonly affected joint, though wrists, ankles, and other joints can be involved. A flare typically brings sudden pain, swelling, warmth, and redness that can look identical to gout or even a joint infection. Patients are usually symptom-free between attacks.
Because pseudogout can mimic a joint infection, your doctor will likely draw fluid from the swollen joint with a needle (a procedure called arthrocentesis). Examining that fluid under a microscope confirms the diagnosis by revealing the characteristic crystals. This same procedure also serves as a treatment: draining the excess fluid relieves pressure inside the joint and can provide significant pain relief on its own.
First-Line Medications for Acute Attacks
The primary medications used to treat pseudogout flares are the same ones used for gout: NSAIDs, colchicine, and corticosteroids. Which one your doctor chooses depends largely on your age, kidney function, and other health conditions.
- NSAIDs: Over-the-counter options like ibuprofen or naproxen, or prescription-strength versions, are a common first choice. However, because pseudogout tends to affect older adults, stomach, kidney, and cardiovascular side effects are a real concern, and NSAIDs may not be appropriate for everyone.
- Colchicine: European guidelines recommend colchicine for acute flares, typically taken in small doses multiple times per day. It works best when started early in an attack. It can cause digestive side effects like nausea and diarrhea, especially at higher doses.
- Corticosteroids: When NSAIDs and colchicine aren’t safe options, a short tapering course of oral steroids can quickly reduce inflammation. For flares limited to one or two joints, a corticosteroid injection directly into the affected joint is particularly effective and avoids the systemic side effects of oral steroids.
If only one large joint like the knee is involved, draining the joint and injecting a corticosteroid at the same time is often the most efficient approach. It addresses both the mechanical pressure of excess fluid and the underlying inflammation in a single visit.
When Standard Treatments Don’t Work
Some patients can’t tolerate any of the standard options, particularly older adults with kidney disease, heart failure, or active infections. In these cases, a biologic medication that blocks a specific inflammatory signal (interleukin-1) can be used. This type of drug, given as a daily injection under the skin for about three days, resolves flares in roughly 94% of cases, with most patients improving within one to three days. It has been used successfully in complex situations including patients on dialysis, organ transplant recipients, and those with active infections where other anti-inflammatory drugs would be too risky.
Supportive Care at Home
During a flare, basic supportive measures can meaningfully reduce your discomfort alongside medication. Resting the affected joint is important for the first several days. Avoid activities that put stress on the inflamed joint, though you don’t need to stay in bed entirely. Applying ice to the joint for 15 to 20 minutes at a time helps reduce swelling by constricting blood vessels and lowering the metabolic demand of inflamed tissues. Elevating the joint, when practical, helps drain inflammatory fluid and limits further swelling.
Diet and Pseudogout: Not the Same as Gout
If you’ve read about gout management, you might assume that cutting purines, limiting red meat, or avoiding alcohol would help with pseudogout. It doesn’t. No specific diet has been shown to reduce pseudogout flares or prevent crystal formation. The crystals involved are chemically different from the uric acid crystals in gout, and they form through a separate process that isn’t influenced by what you eat or drink.
The one dietary factor worth paying attention to is hydration. Dehydration is a known trigger for crystal deposition, so keeping up your fluid intake is a simple, practical step that may help reduce the likelihood of a flare.
Treating the Underlying Cause
Most pseudogout is age-related, with crystals accumulating in joint cartilage over decades. But in younger patients or those with unusually frequent attacks, an underlying metabolic condition may be driving the crystal formation. The most recognized triggers include low magnesium levels, excess iron storage (hemochromatosis), overactive parathyroid glands, and a rare inherited condition called hypophosphatasia.
These conditions all interfere with the same basic process: they allow a chemical precursor to the crystals to build up in joint tissue. Low magnesium, for example, disables an enzyme that normally breaks down this precursor, letting it accumulate. In a six-month controlled trial, patients with pseudogout who received magnesium supplements showed symptom improvement compared to those on placebo. For patients with overactive parathyroid glands, surgical correction of the parathyroid problem is the definitive treatment, though magnesium replacement is sometimes needed afterward to prevent a rebound flare.
If you’re under 60 and experiencing pseudogout, or if your attacks are unusually frequent at any age, it’s worth asking about blood tests for magnesium, iron, calcium, and parathyroid hormone levels. Correcting an underlying metabolic problem can reduce flare frequency in ways that anti-inflammatory drugs alone cannot.
Preventing Future Flares
There is currently no treatment that dissolves calcium pyrophosphate crystals once they’ve formed. This is a key difference from gout, where medications can lower uric acid levels and eventually shrink crystal deposits. With pseudogout, prevention centers on reducing the inflammatory response to crystals that are already present.
Low-dose colchicine taken daily is the most commonly used preventive strategy for patients with frequent flares. Staying well hydrated, correcting any metabolic abnormalities, and maintaining joint mobility through gentle activity can also help. For joints that have developed chronic damage from repeated inflammation, physical therapy helps preserve range of motion and strengthen the muscles that support the joint. In severe cases where a joint is badly damaged, surgical joint replacement may eventually become necessary, though this is typically a last resort after years of progressive disease.