Management of Calcium Pyrophosphate Deposition (CPPD) Disease

Clinical Presentations and Treatment Approach

The European League Against Rheumatism recommends that the optimal treatment of CPPD requires tailored pharmacological and non-pharmacological approaches based on clinical presentation, patient factors, and presence of any underlying metabolic disorders 1, 2
For asymptomatic chondrocalcinosis, no treatment is required 1
For acute CPP crystal arthritis, first-line treatments include application of ice or cool packs, temporary rest, joint aspiration, and intra-articular injection of long-acting glucocorticosteroids (GCS) 1, 2, 3
For monoarticular or oligoarticular attacks, joint aspiration with intra-articular GCS injection is highly effective and safe 2, 3
Oral NSAIDs with gastroprotection and low-dose oral colchicine are recommended for systemic treatments when intra-articular injection is not feasible 1, 4, 3
A short tapering course of oral GCS, parenteral GCS, or ACTH can be used for patients with contraindications to NSAIDs or colchicine 1, 5

Low-dose oral colchicine and low-dose oral NSAIDs with gastroprotection are recommended for prophylaxis against recurrent attacks 1, 6
For chronic CPP crystal inflammatory arthritis, first-line treatments include oral NSAIDs and/or colchicine, and second-line treatments include low-dose corticosteroid, methotrexate, or hydroxychloroquine 1, 7

The American College of Rheumatology recommends treating associated conditions such as hyperparathyroidism, hemochromatosis, or hypomagnesemia if detected 1

Failing to start treatment early significantly reduces effectiveness 3
Using traditional high-dose colchicine regimens leads to marked side effects 3
Intravenous colchicine should be avoided due to high risk of serious toxicity 4, 6
Carefully consider comorbidities and age when selecting treatments, as CPPD predominantly affects older patients 7
Monitor for side effects of long-term treatments, particularly with NSAIDs, colchicine, and methotrexate 7