What is the treatment for chondrocalcinosis?

Treatment of Chondrocalcinosis

The treatment of chondrocalcinosis should be tailored to the clinical presentation, with asymptomatic chondrocalcinosis requiring no treatment, while acute calcium pyrophosphate (CPP) crystal arthritis should be managed with cool packs, temporary rest, joint aspiration, and intra-articular steroid injections. 1

Clinical Presentations and Treatment Approaches

Asymptomatic Chondrocalcinosis

• Asymptomatic chondrocalcinosis requires no treatment 1, 2
• Often an incidental finding and age-related feature in the normal population 1, 3

Acute CPP Crystal Arthritis (Pseudogout)

• First-line treatment includes:

  • Application of ice or cool packs to the affected joint 1
  • Temporary rest of the affected joint 1
  • Joint aspiration combined with intra-articular long-acting glucocorticosteroid injection 1
  • These measures are often sufficient for many patients 1

• Systemic pharmacological options include:

  • Oral NSAIDs with gastroprotective treatment if indicated 1, 4
  • Low-dose oral colchicine (0.5 mg up to 3-4 times daily with or without an initial dose of 1 mg) 1
  • Short tapering course of oral corticosteroids or parenteral corticosteroids for cases not amenable to intra-articular injection 1
  • Parenteral adrenocorticotropic hormone (ACTH) may be considered in some cases 1, 2

Prophylaxis Against Recurrent Attacks

• For patients with frequent recurrent acute attacks, prophylactic treatment includes:
  • Low-dose oral colchicine (0.5-1 mg daily) 1, 2
  • Low-dose oral NSAIDs with gastroprotective treatment if indicated 1

Chronic CPP Crystal Inflammatory Arthritis

• Pharmacological options in order of preference:
  • Oral NSAIDs with gastroprotective treatment if indicated 1
  • Low-dose colchicine (0.5-1.0 mg daily) 1
  • Low-dose corticosteroids 1
  • Methotrexate for cases refractory to other treatments 1, 4
  • Hydroxychloroquine 1, 2

Special Considerations

Associated Metabolic Conditions

• If chondrocalcinosis is detected, especially in patients under 60 years of age, evaluate for associated conditions: 1, 3

  • Hyperparathyroidism 4, 3
  • Hemochromatosis 4, 3
  • Hypomagnesemia 4, 3
  • Hypophosphatemia 4

• If these conditions are detected, they should be treated appropriately 1

• Magnesium supplementation may be used prophylactically in cases of hypomagnesemia 4

Osteoarthritis with CPPD

• Management objectives and treatment options are the same as those for osteoarthritis without CPPD 1
• May require additional treatment during acute flares using the approaches for acute CPP crystal arthritis 2

Treatment Limitations and Pitfalls

• Unlike gout, there is currently no specific treatment to eliminate CPP crystals 1, 4
• NSAIDs and corticosteroids should be used cautiously in elderly patients due to potential toxicity and comorbidities 1
• Colchicine dosing should be adjusted in patients with renal impairment to avoid toxicity 1
• Intra-articular steroid injections should be performed with proper sterile technique to avoid introducing infection 1
• Experimental treatments such as glycosaminoglycan polysulphate have shown some promise in reducing cartilage calcification but require further research 5

Treatment Algorithm

1. Determine clinical presentation (asymptomatic, acute attack, chronic arthritis)
2. For asymptomatic chondrocalcinosis: no treatment required 1
3. For acute attacks:
   • Start with local measures (ice, rest, joint aspiration with steroid injection) 1
   • Add systemic therapy if needed (NSAIDs, colchicine, or corticosteroids) 1
4. For recurrent attacks:
   • Implement prophylactic therapy with low-dose colchicine or NSAIDs 1
5. For chronic inflammatory arthritis:
   • Follow the order of preference: NSAIDs → colchicine → corticosteroids → methotrexate → hydroxychloroquine 1
6. Screen for and treat any underlying metabolic conditions 4, 3