What is the treatment for pseudo gout (calcium pyrophosphate deposition disease)?

Treatment for Pseudogout (Calcium Pyrophosphate Deposition Disease)

For acute attacks of pseudogout, first-line treatment includes NSAIDs, colchicine, or corticosteroids (oral or intra-articular), with joint aspiration and ice packs providing additional relief. 1

Acute Attack Management

• Joint aspiration combined with intra-articular long-acting glucocorticosteroid injection is highly effective for monoarticular or oligoarticular attacks, providing rapid symptom relief 1
• Application of ice or cool packs and temporary rest of the affected joint(s) help reduce inflammation and pain 1
• Oral NSAIDs are effective first-line agents, with dosing similar to that used in acute gout attacks 1
• Colchicine at lower doses (0.5 mg up to three to four times daily with or without loading dose of 1 mg) is recommended to minimize side effects while maintaining efficacy 1
• For patients with contraindications to NSAIDs and colchicine, oral corticosteroids (e.g., prednisone) can be used effectively 1

Prophylactic Treatment

• For patients with frequent recurrent attacks, prophylactic low-dose colchicine (0.5-1 mg daily) may be considered 1
• NSAIDs at lower doses can also be used for prophylaxis in patients who tolerate them well 1
• Unlike gout, there is no specific urate-lowering therapy for pseudogout as the disease involves calcium pyrophosphate crystals rather than uric acid 1

Management of Chronic CPPD

• Treatment should be individualized based on clinical presentation, severity, and comorbidities 1
• For patients with CPPD associated with osteoarthritis, standard OA management approaches should be employed, including:
  • Physical therapy and appropriate exercise programs 1
  • Weight loss if overweight or obese 1
  • Analgesics for pain control 1

Special Considerations

• In patients with pseudogout secondary to metabolic disorders (hyperparathyroidism, hemochromatosis, hypomagnesemia), treating the underlying condition is essential 1
• For patients with chronic renal failure, dosing adjustments for medications like colchicine and NSAIDs are crucial to avoid toxicity 2
• Spinal involvement with pseudogout is rare but can present with neck pain or even myeloradiculopathy, requiring surgical intervention in cases of spinal cord compression 3, 4

Common Pitfalls to Avoid

• Misdiagnosis is common as pseudogout can mimic gout, rheumatoid arthritis, or osteoarthritis; definitive diagnosis requires identification of calcium pyrophosphate crystals in synovial fluid 5
• Unlike gout, pseudogout does not always show chondrocalcinosis on radiographs, so absence of calcification does not rule out the diagnosis 5
• Overuse of colchicine with traditional high-dose regimens can lead to severe gastrointestinal side effects; lower doses are now recommended 1
• Long-term NSAID use carries significant risks, particularly in elderly patients who commonly develop pseudogout, including gastrointestinal, renal, and cardiovascular complications 1

Treatment Algorithm

1. For acute attacks:

   • First step: Joint aspiration (if feasible) + intra-articular corticosteroid injection for monoarticular presentation
   • For polyarticular attacks or when joint injection is not possible: Oral NSAIDs, colchicine, or systemic corticosteroids
   • Adjunctive measures: Ice application and rest of affected joint(s)

2. For frequent recurrent attacks:

   • Consider prophylactic low-dose colchicine or NSAIDs
   • Identify and treat any underlying metabolic disorder

3. For chronic CPPD with osteoarthritis:

   • Focus on symptom management with physical therapy, appropriate exercise
   • Use analgesics as needed for pain control
   • Consider assistive devices if functional limitations are present