What is the treatment for chondrocalcinosis of the joint?

Treatment of Chondrocalcinosis

Asymptomatic Chondrocalcinosis

No treatment is required for asymptomatic chondrocalcinosis detected incidentally on imaging. 1, 2

• The presence of calcium pyrophosphate crystals in cartilage without symptoms does not warrant intervention 1
• Currently, no treatment exists that can modify crystal formation or promote crystal dissolution 1

Acute CPP Crystal Arthritis (Pseudogout)

For acute attacks, the optimal first-line approach combines ice application, temporary joint rest, joint aspiration, and intra-articular glucocorticosteroid injection. 1, 2

Local Treatment (Preferred)

• Apply ice or cool packs to the affected joint 1, 2
• Implement temporary rest of the affected joint 1, 2
• Perform joint aspiration followed by intra-articular injection of long-acting glucocorticosteroids 1, 2
• For many patients, these local measures alone may be sufficient without requiring systemic therapy 1

Systemic Treatment Options

When local treatment is insufficient or not feasible:

• Oral NSAIDs with gastroprotective treatment if indicated (particularly in elderly patients or those with GI risk factors) 1, 2
• Low-dose oral colchicine: 0.5 mg up to 3-4 times daily, with or without an initial 1 mg loading dose 1, 2
• Short tapering course of oral glucocorticosteroids or parenteral glucocorticosteroids/ACTH for polyarticular attacks or when intra-articular injection is not feasible 1, 2

Critical Safety Considerations

• NSAIDs and colchicine use is often limited by toxicity and comorbidity, especially in elderly patients 1, 2
• Colchicine dosing must be adjusted in patients with renal impairment to avoid serious toxicity 2
• Intra-articular injections require proper sterile technique to prevent introducing infection 2

Prophylaxis for Recurrent Acute Attacks

For patients experiencing frequent recurrent acute CPP crystal arthritis, prophylactic treatment with low-dose oral colchicine (0.5-1 mg daily) or low-dose oral NSAIDs with gastroprotection is recommended. 1, 2

• Low-dose colchicine: 0.5-1 mg daily 1, 2
• Low-dose NSAIDs with gastroprotective treatment if indicated 1, 2

Chronic CPP Crystal Inflammatory Arthritis

Pharmacological options in order of preference include: oral NSAIDs (with gastroprotection), colchicine (0.5-1.0 mg daily), low-dose corticosteroids, methotrexate, and hydroxychloroquine. 1

• This hierarchy reflects both efficacy and safety considerations 1
• Methotrexate may be considered when other treatments fail, based on small uncontrolled series showing effectiveness 3

Osteoarthritis with CPPD

The management objectives and treatment options for osteoarthritis with CPPD are identical to those for osteoarthritis without CPPD. 1, 2

• Standard osteoarthritis treatment protocols apply 1
• This includes analgesics, NSAIDs, physical therapy, and consideration of joint replacement for severe destructive disease 1

Evaluation for Associated Metabolic Conditions

If chondrocalcinosis is detected, particularly in patients under 60 years of age, evaluate for and treat associated metabolic conditions including hyperparathyroidism, hemochromatosis, hypomagnesemia, and hypophosphatemia. 1, 2, 3

• These metabolic conditions can promote or cause chondrocalcinosis 3
• Treatment of the underlying metabolic disorder is essential when identified 1, 2
• Magnesium supplementation can be used prophylactically in cases of hypomagnesemia 3