What is the treatment for chondrocalcinosis?

Treatment of Chondrocalcinosis

Asymptomatic chondrocalcinosis requires no treatment, while acute calcium pyrophosphate crystal arthritis should be managed with cool packs, temporary rest, joint aspiration, and intra-articular steroid injections as first-line therapy. 1

Asymptomatic Disease

• No treatment is indicated for asymptomatic chondrocalcinosis detected incidentally on imaging. 1
• However, if chondrocalcinosis is detected in patients under 60 years of age, evaluate for associated metabolic conditions (hyperparathyroidism, hemochromatosis, hypomagnesemia, hypophosphatasia) and treat them appropriately. 1, 2

Acute Calcium Pyrophosphate (CPP) Crystal Arthritis ("Pseudogout")

First-Line Local Treatment

• Apply 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
  • This combination provides both diagnostic confirmation (identifying CPP crystals) and therapeutic benefit 3
  • Use proper sterile technique to avoid introducing infection 1

Systemic Pharmacological Options

When local treatment is insufficient or impractical:

• Oral NSAIDs with gastroprotective treatment if indicated 1
  • Use cautiously in elderly patients due to potential toxicity and comorbidities 1
• Low-dose oral colchicine 1
  • Adjust dosing in patients with renal impairment to avoid toxicity 1

Prophylactic Treatment for Recurrent Attacks

For patients experiencing frequent recurrent acute attacks:

• Low-dose oral colchicine 1
• Low-dose oral NSAIDs with gastroprotective treatment if indicated 1

Chronic Osteoarthritis with Chondrocalcinosis

• The management objectives and treatment options for osteoarthritis with calcium pyrophosphate deposition disease are the same as those for osteoarthritis without it. 1
• There is insufficient evidence to definitively establish that colchicine is effective for ameliorating symptoms of osteoarthritis, despite its established role in acute CPP crystal arthritis. 4

Key Clinical Pitfalls to Avoid

• Do not treat asymptomatic radiographic chondrocalcinosis - it is a common incidental finding, especially in elderly patients 1, 5
• Avoid NSAIDs and corticosteroids in elderly patients with significant comorbidities without careful risk-benefit assessment 1
• Always adjust colchicine dosing in renal impairment to prevent severe toxicity 1
• Ensure sterile technique with intra-articular injections to prevent septic arthritis 1
• Screen younger patients (<60 years) for underlying metabolic diseases when chondrocalcinosis is discovered 1, 2