What is the diagnosis and treatment for Chondrocalcinosis (Calcium Pyrophosphate Deposition Disease)?

From the Guidelines

Diagnosis and Treatment of Chondrocalcinosis (Calcium Pyrophosphate Deposition Disease)

Chondrocalcinosis, also known as Calcium Pyrophosphate Deposition Disease (CPPD), is diagnosed based on clinical presentation and radiographic findings, and its treatment should be individualized according to patient characteristics, risk factors, and comorbidities 1.

Key Points in Diagnosis and Treatment:

• Asymptomatic Chondrocalcinosis: Does not require any treatment and is usually an age-related feature in the normal population 1.
• Acute CPP Crystal Arthritis: Optimal and safe treatment comprises application of ice or cool packs, temporary rest, joint aspiration, and intra-articular injection of long-acting glucocorticosteroids (GCS) 1.
• Systemic Treatments for Acute CPP Crystal Arthritis: Include oral non-steroidal anti-inflammatory drugs (NSAIDs) with gastroprotective treatment if indicated, and low-dose oral colchicine (0.5 mg up to 3–4 times a day) 1.
• Prophylaxis against Frequent Recurrent Acute CPP Crystal Arthritis: Can be achieved with low-dose oral colchicine (0.5–1 mg daily) or low-dose oral NSAID (with gastroprotective treatment if indicated) 1.
• Chronic CPP Crystal Inflammatory Arthritis: Pharmacological options in order of preference are oral NSAID (plus gastroprotective treatment if indicated) and/or colchicine (0.5–1.0 mg daily), low-dose corticosteroid, methotrexate, and hydroxychloroquine 1.
• Management of OA with CPPD: Should follow the same treatment objectives as for OA, including education, reducing joint pain and stiffness, maintaining and improving joint mobility, and improving health-related quality of life 1.

Important Considerations:

• Treatment should be tailored according to clinical features, general risk factors, and the presence of predisposing metabolic disorders 1.
• Associated conditions such as hyperparathyroidism, haemochromatosis, or hypomagnesaemia should be treated if detected 1.
• No treatment modifies CPP crystal formation or dissolution, and no treatment is required for asymptomatic chondrocalcinosis 1.

From the Research

Diagnosis of Chondrocalcinosis

• Definitive diagnosis of chondrocalcinosis is allowed by identification of calcium pyrophosphate (CPP) crystals in synovial fluid 2
• X-Rays are the most frequent imaging used to detect chondrocalcinosis in daily practice 2
• Chondrocalcinosis can be visualised on plain radiograph as deposition of calcium pyrophosphate crystals within cartilage or fibrocartilage 3

Clinical Features of Chondrocalcinosis

• Clinical features of chondrocalcinosis are various, with two common presentations being acute synovitis (pseudogout) and chronic arthritis 3
• Chondrocalcinosis can lead to a severe disability, especially in the chronic arthritis form 3
• Sporadic form of the disease is by far the most frequent, with aging being the main risk factor for the occurrence of sporadic chondrocalcinosis 3

Treatment of Chondrocalcinosis

• Treatment of CPP arthritis includes application of ice, rest, joint aspiration and intra-articular injection of corticosteroids 2
• Oral NSAIDs can be used cautiously, in particular in the elderly 2
• Prophylaxis against frequent recurrent acute CPP crystal arthritis can be achieved with low-dose oral colchicine 2
• No etiological treatment for chondrocalcinosis exists at the present time, with therapy limited to the administration of nonsteroidal antiinflammatory drugs and physiotherapy 4

Associated Metabolic Disorders

• Hereditary hemochromatosis, hyperparathyroidism, and hypomagnesemia are metabolic disorders that predispose to secondary chondrocalcinosis 3, 5
• Primary metabolic disorders or familial predisposition should be considered if chondrocalcinosis occurs in patients younger than 60 years 2, 3