What is the treatment for chondrocalcinosis?

From the Guidelines

The most effective treatment for chondrocalcinosis involves a combination of non-pharmacological and pharmacological modalities, tailored to the individual's clinical features, general risk factors, and presence of predisposing metabolic disorders, as recommended by the EULAR guidelines 1. When managing chondrocalcinosis, it is essential to consider the specific clinical presentation, such as acute attacks, chronic CPPD management, or osteoarthritis with CPPD.

• For acute CPP crystal arthritis, treatment options include application of ice or cool packs, temporary rest, joint aspiration, and intra-articular injection of long-acting glucocorticosteroids (GCS), as well as oral NSAIDs or low-dose oral colchicine 1.
• In cases where intra-articular GCS injection is not feasible, a short tapering course of oral GCS, parenteral GCS, or adrenocorticotrophic hormone (ACTH) may be effective alternatives 1.
• For prophylaxis against frequent recurrent acute CPP crystal arthritis, low-dose oral colchicine or low-dose oral NSAIDs with gastroprotective treatment may be used 1.
• The management objectives and treatment options for patients with osteoarthritis and CPPD are similar to those for osteoarthritis without CPPD, focusing on symptom management and improving quality of life 1.
• In patients with chronic CPP crystal inflammatory arthritis, pharmacological options include oral NSAIDs, colchicine, low-dose corticosteroids, methotrexate, and hydroxychloroquine, with the goal of reducing inflammation and managing pain 1. It is crucial to identify and treat associated conditions, such as hyperparathyroidism, hemochromatosis, or hypomagnesemia, which can contribute to the development of chondrocalcinosis 1. Ultimately, the treatment approach should prioritize the individual's specific needs and clinical presentation, with the goal of improving symptoms, reducing morbidity, and enhancing quality of life 1.

From the Research

Treatment Options for Chondrocalcinosis

• The treatment for chondrocalcinosis, also known as calcium pyrophosphate deposition disease, varies depending on the severity and type of the condition 2.
• Radiographic chondrocalcinosis is asymptomatic and requires no therapy 2.
• Acute calcium pyrophosphate arthritis is treated with the goal of aborting the flare, and treatment options include:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) 2, 3, 4, 5, 6
  • Colchicine 2, 4
  • Oral corticosteroids 2
  • Parenteral corticosteroids 2
  • Intraarticular corticosteroids 2
  • IL-1 inhibitors 2
  • Parenteral adrenocorticotropic hormone (ACTH) 2
• Chronic calcium pyrophosphate arthritis is treated with the goal of suppressing acute flares, and treatment options include:
  • Maintenance therapy with NSAIDs, colchicine, or corticosteroids 2
  • Methotrexate 2
  • Hydroxychloroquine 2
  • Anakinra and tocilizumab for refractory cases 4

Safety Considerations for NSAIDs

• NSAIDs are widely used for their anti-inflammatory and analgesic effects, but they have been associated with adverse events affecting the gastrointestinal, cardiovascular, and renal systems 3, 5, 6.
• The safety of NSAIDs in osteoarthritis patients has been a concern, particularly in older patients, and the use of gastroprotective agents may reduce the risk of gastric adverse events 5.
• The choice of NSAID should be based on a patient's risk of developing adverse GI and CV events, and celecoxib has been shown to have a better lower-GI-tract tolerability profile than non-selective NSAIDs plus a proton-pump inhibitor 6.