From the Guidelines
The treatment for Calcium Pyrophosphate Deposition Disease (CPPD), also known as pseudogout, primarily involves the use of NSAIDs and colchicine to manage acute attacks, with the goal of reducing inflammation and pain while minimizing side effects and considering the patient's quality of life and potential for morbidity and mortality. When considering treatment options, it is essential to weigh the benefits against the potential risks, particularly in older patients with comorbidities, as evidenced by the high incidence of side effects associated with NSAIDs and colchicine 1. The use of NSAIDs, such as naproxen or indomethacin, is often recommended for acute attacks, but their use must be carefully considered due to the risk of gastrointestinal bleeding, cardiovascular events, and renal impairment, especially in patients with pre-existing kidney problems or gastrointestinal issues 1. Alternatively, colchicine can be an effective option, particularly when started early in the course of an acute attack, with a recommended lower-dose regimen of 0.5 mg up to three to four times daily to minimize side effects such as diarrhea 1. In addition to these pharmacological treatments, addressing underlying conditions that may contribute to calcium pyrophosphate deposition, such as hyperparathyroidism, hemochromatosis, or hypothyroidism, is crucial for long-term management and improving the patient's quality of life. Key considerations in the treatment of CPPD include:
- The use of NSAIDs and colchicine as first-line treatments for acute attacks
- The importance of minimizing side effects, particularly in older patients with comorbidities
- The need to address underlying conditions that may contribute to calcium pyrophosphate deposition
- The consideration of alternative treatments, such as corticosteroids or joint aspiration, in patients who cannot tolerate NSAIDs or colchicine.
From the Research
Treatment for Calcium Pyrophosphate Deposition Disease (CPPD)
The treatment for CPPD, also known as pseudogout, includes:
Acute Treatment
Acute treatment for pseudogout is similar to acute gouty arthritis treatment, focusing on relieving short-term suffering 3.
Long-term Treatment
There is no standard regimen for long-term chronic therapies of pseudogout, unlike gout which has urate-lowering therapy to prevent recurrent attacks 3.
Considerations
It is essential to understand the pathophysiology of pseudogout to facilitate recognition and appropriate treatment in primary care settings 3.