From the Guidelines
Treatment for calcium pyrophosphate deposition disease (CPPD) should focus on managing acute flares and preventing future attacks, with nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine being first-line treatments. For acute flares, NSAIDs like naproxen (500mg twice daily) or indomethacin (25-50mg three times daily) are typically continued for 7-10 days until symptoms resolve 1. For patients who cannot take NSAIDs due to kidney disease or gastrointestinal issues, colchicine is an effective alternative, starting with 1.2mg followed by 0.6mg one hour later, then 0.6mg once or twice daily until the flare subsides 1.
Key Treatment Options
- NSAIDs: naproxen (500mg twice daily) or indomethacin (25-50mg three times daily) for 7-10 days
- Colchicine: starting with 1.2mg followed by 0.6mg one hour later, then 0.6mg once or twice daily until the flare subsides
- Corticosteroids: oral prednisone (30-40mg daily with a taper over 7-10 days) or joint injections (typically methylprednisolone acetate 40-80mg) for single-joint involvement
- Joint aspiration to remove inflammatory fluid can provide immediate relief
Chronic Management
- Low-dose colchicine (0.6mg once or twice daily) may help prevent recurrent attacks
- Physical therapy and joint protection strategies are important for maintaining function in affected joints
- Addressing any underlying metabolic conditions like hyperparathyroidism or hemochromatosis that may contribute to CPPD is also essential for comprehensive management 1.
From the Research
Treatment Options for CPPD
- The current treatment options for CPPD are mainly based on expert opinion and evidence derived from the treatment of gout 2.
- Commonly used treatments for CPPD include non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, and corticosteroids, which are often used to ameliorate the inflammatory response and reduce the frequency and severity of clinical symptoms 3, 4.
- Other treatment options that have shown efficacy in CPPD include methotrexate, hydroxychloroquine, magnesium carbonate, intramuscular and intra-articular glucocorticoids, ACTH, anakinra, tocilizumab, intra-articular injections of glycosaminoglycan polysulphate, hyaluronic acid, and yttrium, as well as synovial membrane destruction by laser irradiation 2.
- There is a need for high-quality evidence to support specific treatment modalities for CPPD, as the current evidence is limited and mostly derived from studies on gout 2, 3, 4.
Efficacy of Treatment Options
- A systematic review of 22 eligible studies and 403 unique patients found that methotrexate, hydroxychloroquine, and magnesium carbonate have shown efficacy in reducing pain intensity in CPPD patients 2.
- Another study found that anakinra and tocilizumab can be used in refractory cases of CPPD, and that nucleoside analogues and phosphocitrate may have potential as crystal-targeted treatments 3.
- A retrospective analysis of colchicine in combination with NSAIDs therapy in patients with systemic form of adult-onset Still's disease with serositis found that 65% of patients responded to this combination of anti-inflammatory drugs 5.
Safety and Efficacy of NSAIDs
- A Cochrane review of 32 trials found that NSAIDs are slightly more effective than placebo in reducing pain intensity and improving disability in patients with acute low back pain, but the magnitude of the effects is small and probably not clinically relevant 6.
- The review also found that there is no clear difference in the proportion of participants experiencing adverse events when using NSAIDs compared to placebo, but the quality of the evidence is very low 6.