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

Treatment for Pseudogout (Calcium Pyrophosphate Deposition Disease)

The first-line treatment for acute pseudogout attacks includes joint aspiration with intra-articular glucocorticosteroid injection for monoarticular or oligoarticular attacks, oral NSAIDs, or low-dose colchicine, with the choice depending on the clinical presentation and patient comorbidities. 1

Acute Attack Management

• Joint aspiration combined with intra-articular long-acting glucocorticosteroid injection provides rapid symptom relief for monoarticular or oligoarticular pseudogout attacks 1
• Application of ice/cool packs and temporary joint rest help reduce inflammation and pain 1
• Oral NSAIDs are effective first-line agents for acute pseudogout attacks, with dosing similar to that used for acute gout 1
• Low-dose colchicine (0.5 mg up to three to four times daily with or without a 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
• In patients with frequent flares and contraindications to colchicine, NSAIDs, and corticosteroids, IL-1 blockers may be considered (though this recommendation comes from gout management) 2

Prophylactic Treatment

• For patients with frequent recurrent pseudogout 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 crystal-dissolving therapy for pseudogout as the disease involves calcium pyrophosphate crystals rather than uric acid 1
• Prophylaxis should be fully explained and discussed with the patient, similar to the approach in gout management 2

Management of Chronic CPPD

• Treatment for chronic CPPD should address both pain management and functional improvement 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 is recommended for overweight or obese patients with CPPD and osteoarthritis 1
• Analgesics should be used as needed for pain control in patients with chronic CPPD 1

Special Considerations

• In patients with pseudogout secondary to metabolic disorders (hyperparathyroidism, hemochromatosis, hypomagnesemia), treating the underlying condition is essential 1
• Patient education is crucial - every person with crystal arthropathy should be fully informed about the pathophysiology of the disease, available treatments, associated comorbidities, and management principles 2
• Patients should receive lifestyle advice including weight loss if appropriate, regular exercise, and dietary modifications 2

Common Pitfalls to Avoid

• 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
• Colchicine and NSAIDs should be avoided in patients with severe renal impairment 2
• Colchicine should not be given to patients receiving strong P-glycoprotein and/or CYP3A4 inhibitors such as cyclosporin or clarithromycin 2
• Failing to screen for associated comorbidities and cardiovascular risk factors, which should be addressed as part of comprehensive management 2

Treatment Algorithm

1. For acute attacks:

   • Single/few joints: Joint aspiration and intra-articular corticosteroid injection 1
   • Multiple joints or when injection not feasible:
     • First choice: NSAIDs (with PPI if appropriate) 1
     • Alternative: Low-dose colchicine (0.5 mg up to 3-4 times daily) 1
     • If contraindications to above: Oral corticosteroids (prednisone 30-35 mg/day for 3-5 days) 2, 1
     • Last resort: IL-1 blockers for refractory cases 2

2. For prophylaxis in frequent attacks:

   • Low-dose colchicine (0.5-1 mg daily) 1
   • Alternative: Low-dose NSAIDs if tolerated 1

3. For chronic management:

   • Treat underlying metabolic disorders if present 1
   • Standard osteoarthritis management if associated with OA 1
   • Physical therapy and appropriate exercise 1
   • Weight management 1