Chapter

Treatment of calcium pyrophosphate deposition

Abhishek Abhishek and Michael Doherty

in Oxford Textbook of Osteoarthritis and Crystal Arthropathy

Third edition

Published on behalf of Oxford University Press

Published in print October 2016 | ISBN: 9780199668847
Published online November 2016 | e-ISBN: 9780191807176 | DOI: https://dx.doi.org/10.1093/med/9780199668847.003.0052

Series: Oxford Textbooks in Rheumatology

Treatment of calcium pyrophosphate deposition

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The treatment of calcium pyrophosphate crystal deposition (CPPD) is mainly symptomatic. Acute calcium pyrophosphate (CPP) crystal synovitis should be treated with rest, local application of ice packs, joint aspiration, and/or intra-articular corticosteroid injection (once joint sepsis has been excluded). Oral colchicine or prednisolone may be used if joint aspiration and/or injection are not feasible. Anti-inflammatory agents (with proton pump inhibitors) may be used but in general these should be avoided as most patients with acute CPP crystal arthritis are elderly, and at a high risk of gastrointestinal and renal complication of non-steroidal anti-inflammatory drug (NSAIDs). Principles of management of CPPD with osteoarthritis (OA) are identical to those for isolated OA. However, patients may have more inflammatory signs and symptoms and periodic joint aspiration and corticosteroid injection may be required more often than in isolated OA. Oral NSAIDs (with gastro-protection), colchicine, low-dose corticosteroids, hydroxychloroquine, and radiosynovectomy have been suggested as options for the treatment of chronic CPP crystal arthritis. There is growing interest in use of anti-interleukin-1 agents for acute or chronic CPP crystal arthritis but the efficacy of these agents has not been formally studied, and their use should be considered on an individual basis.

Chapter.  3254 words. 

Subjects: Rheumatology

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