Specialist Management of CPPD Arthropathy
Rheumatologists are the primary specialists who manage CPPD arthropathy, though general practitioners, orthopedic surgeons, and specialists in physical medicine and rehabilitation also commonly treat this condition. 1
Primary Specialists Involved
Rheumatologists serve as the primary specialists for CPPD management, particularly for complex cases involving chronic inflammatory arthritis, recurrent acute attacks, or when systemic immunosuppressive therapy is being considered 1
General practitioners commonly manage CPPD in routine clinical practice, especially for straightforward acute attacks and asymptomatic chondrocalcinosis 1
Orthopedic surgeons are involved in CPPD management, particularly when structural joint damage requires surgical intervention or when diagnostic arthroscopy is needed 1, 2
Physical medicine and rehabilitation specialists and sports medicine physicians play a role in managing functional impairment and chronic symptoms associated with CPPD 1
When to Refer to Rheumatology
Chronic inflammatory arthritis with CPPD requiring disease-modifying therapy such as methotrexate (5-10 mg/week) or hydroxychloroquine should prompt rheumatology referral 1, 3
Recurrent acute attacks requiring prophylactic therapy with low-dose colchicine (0.5-1.0 mg daily) benefit from rheumatology expertise 1, 3
Polyarticular disease that is difficult to manage with simple measures warrants specialist evaluation 3
Suspected underlying metabolic conditions such as primary hyperparathyroidism (3-fold increased odds with CPPD), hemochromatosis, hypomagnesemia, or hypophosphatasia require rheumatology assessment 4, 3
Refractory disease unresponsive to first-line treatments (NSAIDs, colchicine, corticosteroids) should be referred for consideration of biologic agents like anakinra or tocilizumab 5
Role of Other Specialists
Radiologists need awareness of CPPD imaging guidelines to recommend appropriate imaging techniques (conventional radiography, ultrasound, DECT) for diagnosis and monitoring, though they do not directly treat patients 1
Endocrinologists should be consulted when screening reveals primary hyperparathyroidism or other metabolic disorders associated with CPPD 4, 3
Nephrologists may be involved when vascular calcification suggests CKD-mineral bone disorder or when renal impairment complicates medication choices 3
Clinical Context for Specialist Selection
The 2024 EULAR imaging recommendations explicitly state that these guidelines "will allow clinicians, not only rheumatologists, but also orthopaedic surgeons, and commonly general practitioners, who deal with CiAs to guide the decision-making process in daily clinical practice" 1. This reflects the reality that CPPD predominantly affects older patients with multiple comorbidities who may present to various specialists depending on the clinical scenario 1, 6.