From the Guidelines
The treatment for Calcium Pyrophosphate Deposition Disease (CPPD) should be tailored according to clinical features, general risk factors, and the presence of predisposing metabolic disorders, with a focus on managing pain and inflammation during acute attacks and preventing future flares.
Treatment Approach
The management of CPPD involves both non-pharmacological and pharmacological modalities. For acute CPP crystal arthritis, optimal and safe treatment comprises application of ice or cool packs, temporary rest, joint aspiration, and intra-articular injection of long-acting glucocorticosteroids (GCS) 1.
Pharmacological Management
- Oral NSAIDs (with gastroprotective treatment if indicated) and low-dose oral colchicine are effective systemic treatments for acute CPP crystal arthritis, although their use is often limited by toxicity and comorbidity, especially in older patients 1.
- A short tapering course of oral GCS, or parenteral GCS or adrenocorticotrophic hormone (ACTH), may be effective for acute CPP crystal arthritis that is not amenable to intra-articular GCS injection and are alternatives to colchicine and/or NSAID 1.
Prevention of Recurrent Attacks
- Prophylaxis against frequent recurrent acute CPP crystal arthritis can be achieved with low-dose oral colchicine or low-dose oral NSAID (with gastroprotective treatment if indicated) 1.
Chronic Management
- For chronic CPP crystal inflammatory arthritis, pharmacological options in order of preference are oral NSAIDs (plus gastroprotective treatment if indicated) and/or colchicine, low-dose corticosteroid, methotrexate, and hydroxychloroquine 1.
Underlying Conditions
- If detected, associated conditions such as hyperparathyroidism, haemochromatosis, or hypomagnesaemia should be treated 1.
Asymptomatic Cases
- Currently, no treatment modifies CPP crystal formation or dissolution, and no treatment is required for asymptomatic chondrocalcinosis (CC) 1.
From the Research
Treatment Options for CPPD
The treatment for Calcium Pyrophosphate Deposition Disease (CPPD) is primarily focused on reducing inflammation, alleviating symptoms, and preventing acute flares. Some of the treatment options include:
- Non-steroidal anti-inflammatory drugs (NSAIDs) to manage acute CPP arthritis 2, 3, 4, 5
- Corticosteroids to reduce inflammation and manage acute flares 2, 3, 4, 5
- Colchicine to manage acute CPP arthritis and prevent recurrent flares 2, 3, 4, 5
- Anakinra, an interleukin-1 receptor antagonist, to alleviate acute flares in refractory cases 2, 3, 4
- Tocilizumab to manage refractory cases 2, 3, 4
- Hydroxychloroquine, low-dose glucocorticoids, and methotrexate to manage chronic CPP inflammatory arthritis 2, 3
Pharmacological Management
The pharmacological management of CPPD is challenging due to the lack of randomized controlled trials, making it difficult to establish evidence-based treatment protocols 2, 3, 4, 5. However, the available evidence suggests that the above-mentioned treatment options can be effective in managing CPPD.
Future Directions
There is a need for high-quality evidence to support specific treatment modalities for CPPD, and international working groups are working to establish classification criteria and validated outcome domains for CPPD to facilitate large multicentre studies 4. Additionally, potential future crystal-targeted approaches, such as nucleoside analogues and phosphocitrate, are being explored to attenuate calcification of human cartilage ex-vivo 4.