What is the treatment for chondrocalcinosis?

Treatment of Chondrocalcinosis

Asymptomatic chondrocalcinosis requires no treatment, while acute calcium pyrophosphate (CPP) 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 radiographic chondrocalcinosis in the absence of symptoms. 1
• However, if chondrocalcinosis is detected in patients under 60 years of age, evaluate for associated metabolic conditions including hyperparathyroidism, hemochromatosis, hypomagnesemia, and hypophosphatemia, and treat these appropriately. 1, 2

Acute CPP Crystal Arthritis (Pseudogout)

First-Line Local Therapy

• Apply ice or cool packs to the affected joint for symptomatic relief. 1
• Provide temporary rest of the affected joint during the acute attack. 1
• Perform joint aspiration combined with intra-articular long-acting glucocorticosteroid injection as the preferred initial intervention. 1
  • This approach provides both diagnostic confirmation (identifying positively birefringent CPPD crystals) and therapeutic benefit. 2
  • Ensure proper sterile technique during injection to avoid introducing infection. 1

Systemic Pharmacological Options

When local therapy alone is insufficient or impractical:

• Oral NSAIDs with gastroprotective treatment (if indicated) are effective for acute attacks. 1, 2

  • Use cautiously in elderly patients due to potential toxicity and comorbidities. 1

• Low-dose oral colchicine is an alternative systemic option. 1, 2

  • Adjust dosing in patients with renal impairment to avoid toxicity. 1

• Small doses of systemic glucocorticoids can be used when NSAIDs and colchicine are contraindicated. 2

  • Keep amounts small if prolonged use is necessary. 2

Prophylactic Treatment for Recurrent Attacks

For patients experiencing frequent recurrent acute attacks:

• Low-dose oral colchicine is the preferred prophylactic agent. 1, 2
• Low-dose oral NSAIDs with gastroprotective treatment (if indicated) can be used prophylactically. 1
• Magnesium supplementation may have prophylactic benefit in select cases. 2

Chronic Arthropathy Associated with CPPD

• Management objectives and treatment options for osteoarthritis with CPPD are identical to those for osteoarthritis without CPPD. 1
• This includes standard analgesics, physical therapy, and joint replacement when indicated. 3
• In small uncontrolled series, methotrexate showed effectiveness for chronic inflammatory manifestations when other treatments fail. 2

Key Clinical Pitfalls

• NSAIDs and corticosteroids require particular caution in elderly patients who represent the majority of chondrocalcinosis cases (prevalence 10-15% in ages 65-75, >40% in those over 80). 1, 2
• Colchicine dosing must be adjusted for renal function to prevent serious toxicity. 1
• No disease-modifying treatment exists that can prevent progression of joint destruction in chondrocalcinosis. 3, 2
• Acute attacks can mimic septic arthritis or gout, making joint aspiration essential for accurate diagnosis. 3, 4