From the Guidelines
Treating calcium pyrophosphate deposition disease (CPPD) requires a multifaceted approach, focusing on managing pain and inflammation during acute attacks and preventing future episodes, as recommended by the EULAR guidelines 1.
Key Recommendations
- For acute flares, NSAIDs like naproxen (500mg twice daily) or ibuprofen (600-800mg three times daily) are first-line treatments, with colchicine (0.6mg once or twice daily) being effective, especially if started early 1.
- For severe pain or when NSAIDs are contraindicated, joint aspiration followed by intra-articular corticosteroid injection (such as methylprednisolone 40-80mg) provides rapid relief 1.
- Systemic corticosteroids like prednisone (30-40mg daily, tapered over 7-10 days) may be needed for polyarticular flares.
- For chronic CPPD, low-dose colchicine (0.6mg daily) or hydroxychloroquine (200mg twice daily) may help prevent attacks, with methotrexate (10-15mg weekly) sometimes used for refractory cases 1.
Non-Pharmacological Approaches
- Joint rest during flares
- Applying ice packs
- Physical therapy to maintain joint function
Underlying Metabolic Conditions
- Treating any underlying metabolic conditions like hyperparathyroidism or hemochromatosis is important, as these can contribute to crystal formation 1.
Conclusion Not Applicable
As per the guidelines, the management strategy will vary according to the clinical presentation, and treatment should be individualized according to patient characteristics, risk factors, and comorbidities 1.
From the Research
Treatment Options for CPPD
The treatment of Calcium Pyrophosphate Deposition Disease (CPPD) is primarily focused on reducing inflammation, alleviating symptoms, and preventing acute flares, as there are no disease-modifying therapies that reduce articular calcification in CPPD 2, 3, 4.
- Non-steroidal anti-inflammatory drugs (NSAIDs): Effective in managing acute CPP arthritis 2, 3.
- Corticosteroids: Used to manage acute CPP arthritis, and can be administered intramuscularly or intra-articularly 2, 3.
- Colchicine: Effective in managing acute CPP arthritis, and can be used prophylactically to prevent recurrent flares 2, 3.
- Anakinra: An interleukin-1 receptor antagonist, can be administered to alleviate acute flares in refractory cases 2, 3, 4.
- Tocilizumab: Can be used in refractory cases of CPPD 2, 3, 4.
- Hydroxychloroquine: May be used to manage chronic CPP inflammatory arthritis, although data on efficacy is limited 2, 3.
- Methotrexate: May be used to manage chronic CPP inflammatory arthritis, although its use is controversial 3, 5.
- Intra-articular injections: Of glycosaminoglycan polysulphate, hyaluronic acid, and yttrium can be associated with symptomatic improvement 3.
- Synovial membrane destruction: By laser irradiation or intra-articular injection of yttrium 90 can decrease pain in some cases 2, 3.
Challenges in Treatment
The management of CPPD remains a challenge due to the lack of randomized controlled trials, making it difficult to establish evidence-based treatment protocols 2, 3, 4. High-quality evidence is limited, and commonly administered agents such as NSAIDs, colchicine, and corticosteroids have not been evaluated by RCTs 3.