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Treatment of calcium pyrophosphate crystal deposition (CPPD) disease

Author
Michael A Becker, MD
Section Editor
Nicola Dalbeth, MBChB, MD, FRACP
Deputy Editor
Paul L Romain, MD

INTRODUCTION

Precipitation of crystals of calcium pyrophosphate dihydrate (CPP) in connective tissues may be asymptomatic or may be associated with several clinical syndromes. These disorders, including acute inflammatory, chronic inflammatory, and degenerative arthropathies, as well as radiographic calcification, comprise the spectrum of calcium pyrophosphate crystal deposition (CPPD) disease [1-3].

Treatment of CPPD disease is discussed here. The pathogenesis, etiology, clinical manifestations, and diagnosis of this disorder are discussed separately. (See "Pathogenesis and etiology of calcium pyrophosphate crystal deposition (CPPD) disease" and "Clinical manifestations and diagnosis of calcium pyrophosphate crystal deposition (CPPD) disease".)

TERMINOLOGY

The names traditionally used for the varying clinical manifestations of calcium pyrophosphate dihydrate (CPP) crystal deposition (CPPD) disease include pseudogout, chondrocalcinosis, and pyrophosphate arthropathy. Each of these terms has both useful and problematic features [4,5] (see "Clinical manifestations and diagnosis of calcium pyrophosphate crystal deposition (CPPD) disease", section on 'Terminology'). A European League Against Rheumatism (EULAR) consensus panel rigorously reviewed the literature regarding CPP crystal deposition and proposed changes in nomenclature, summarized levels of evidence regarding diagnosis, and made recommendations for management [6,7]   A commentary has also been published concerning the EULAR committee recommendations, authored by experts from the United States, that generally supports use of the EULAR terminology [4], with calcium pyrophosphate deposition disease (also abbreviated as CPPD disease) as the umbrella term for all instances of CPP crystal occurrence.

In view of its wider acceptance in the literature, we will place primary emphasis on the EULAR task force terminology [6,7] in the discussion below. Nevertheless, despite their limitations, the clinical syndromes and findings implied by the traditional terms are likely to be retained by some clinicians on the basis of their resemblances to common clinical disorders familiar to the clinician. Familiarity with the older nomenclature may, in addition, be useful in instances where literature searches using only the EULAR task force terms overlook citations indexed under the traditional terms. For these reasons, the traditional terms appear in parentheses following the EULAR designation:

Asymptomatic CPPD disease (asymptomatic CPPD)

                  
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Literature review current through: Sep 2017. | This topic last updated: Jul 06, 2017.
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References
Top
  1. McCarty DJ. Calcium pyrophosphate dihydrate crystal deposition disease--1975. Arthritis Rheum 1976; 19 Suppl 3:275.
  2. Rosenthal AK, Ryan LM, McCarty DJ. Calcium pyrophosphate crystal deposition disease, pseudogout, and articular chondrocalcinosis. In: Arthritis and Allied Conditions, 15th, Koopman WJ, Moreland LW (Eds), Lippincott Williams & Wilkins, Philadelphia 2005. p.2373.
  3. Rosenthal AK. Pseudogout: Presentation, natural history, and associated conditions. In: Crystal-Induced Arthropathies: Gout, Pseudogout, and Apatite-Associated Syndromes, Wortmann RL, Schumacher HR Jr, Becker MA, Ryan LM (Eds), Taylor and Francis Group, New York 2006. p.99.
  4. Rosenthal AK, Ryan LM. Crystal arthritis: calcium pyrophosphate deposition-nothing 'pseudo' about it! Nat Rev Rheumatol 2011; 7:257.
  5. Rosenthal AK, Ryan LM. Calcium Pyrophosphate Deposition Disease. N Engl J Med 2016; 374:2575.
  6. Zhang W, Doherty M, Bardin T, et al. European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann Rheum Dis 2011; 70:563.
  7. Zhang W, Doherty M, Pascual E, et al. EULAR recommendations for calcium pyrophosphate deposition. Part II: management. Ann Rheum Dis 2011; 70:571.
  8. Schumacher HR, Berger MF, Li-Yu J, et al. Efficacy and tolerability of celecoxib in the treatment of acute gouty arthritis: a randomized controlled trial. J Rheumatol 2012; 39:1859.
  9. Colcrys (colchicine, USP). US Food and Drug Administration (FDA) approved product information. Revised July 1, 2009. (Available online at www.accessdata.fda.gov/drugsatfda_docs/label/2009/022351lbl.pdf).
  10. Colcrys (colchicine USP) Medication Guide. Revision 02, September 2009. Mutual Pharmaceutical Company, Inc, Philadelphia, PA 19124 USA. (Approved by the US Food and Drug Administration).
  11. Ahern MJ, Reid C, Gordon TP, et al. Does colchicine work? The results of the first controlled study in acute gout. Aust N Z J Med 1987; 17:301.
  12. Bouquié R, Deslandes G, Renaud C, et al. Colchicine-induced rhabdomyolysis in a heart/lung transplant patient with concurrent use of cyclosporin, pravastatin, and azithromycin. J Clin Rheumatol 2011; 17:28.
  13. Janssens HJ, Janssen M, van de Lisdonk EH, et al. Use of oral prednisolone or naproxen for the treatment of gout arthritis: a double-blind, randomised equivalence trial. Lancet 2008; 371:1854.
  14. Man CY, Cheung IT, Cameron PA, Rainer TH. Comparison of oral prednisolone/paracetamol and oral indomethacin/paracetamol combination therapy in the treatment of acute goutlike arthritis: a double-blind, randomized, controlled trial. Ann Emerg Med 2007; 49:670.
  15. Rainer TH, Cheng CH, Janssens HJ, et al. Oral Prednisolone in the Treatment of Acute Gout: A Pragmatic, Multicenter, Double-Blind, Randomized Trial. Ann Intern Med 2016; 164:464.
  16. Alvarellos A, Spilberg I. Colchicine prophylaxis in pseudogout. J Rheumatol 1986; 13:804.
  17. Pascual E, Andrés M, Sivera F. Methotrexate: should it still be considered for chronic calcium pyrophosphate crystal disease? Arthritis Res Ther 2015; 17:89.
  18. Andres M, Sivera F, Pascual E. Methotrexate is an option for patients with refractory calcium pyrophosphate crystal arthritis. J Clin Rheumatol 2012; 18:234.
  19. Chollet-Janin A, Finckh A, Dudler J, Guerne PA. Methotrexate as an alternative therapy for chronic calcium pyrophosphate deposition disease: an exploratory analysis. Arthritis Rheum 2007; 56:688.
  20. Doan TH, Chevalier X, Leparc JM, et al. Premature enthusiasm for the use of methotrexate for refractory chondrocalcinosis: comment on the article by Chollet-Janin et al. Arthritis Rheum 2008; 58:2210.
  21. Finckh A, Mc Carthy GM, Madigan A, et al. Methotrexate in chronic-recurrent calcium pyrophosphate deposition disease: no significant effect in a randomized crossover trial. Arthritis Res Ther 2014; 16:458.
  22. Rosenthal AK, Ryan LM. Probenecid inhibits transforming growth factor-beta 1 induced pyrophosphate elaboration by chondrocytes. J Rheumatol 1994; 21:896.
  23. Ryan LM. The ank gene story. Arthritis Res 2001; 3:77.
  24. Hamilton EB, Bomford AB, Laws JW, Williams R. The natural history of arthritis in idiopathic haemochromatosis: progression of the clinical and radiological features over ten years. Q J Med 1981; 50:321.
  25. Van Geertruyden J, Kinnaert P, Frederic N, et al. Effect of parathyroid surgery on cartilage calcification. World J Surg 1986; 10:111.
  26. Glass JS, Grahame R. Chondrocalcinosis after parathyroidectomy. Ann Rheum Dis 1976; 35:521.
  27. Pritchard MH, Jessop JD. Chondrocalcinosis in primary hyperparathyroidism. Influence of age, metabolic bone disease, and parathyroidectomy. Ann Rheum Dis 1977; 36:146.
  28. Smilde TJ, Haverman JF, Schipper P, et al. Familial hypokalemia/hypomagnesemia and chondrocalcinosis. J Rheumatol 1994; 21:1515.
  29. Doherty M, Dieppe PA. Double blind, placebo controlled trial of magnesium carbonate in chronic pyrophosphate arthropathy. Ann Rheum Dis 1983; 42(Suppl):106.