Treatment of calcium pyrophosphate crystal deposition (CPPD) disease
- Michael A Becker, MD
Michael A Becker, MD
- Section Editor — Crystal Diseases
- Professor Emeritus of Medicine
- University of Chicago Pritzker School of Medicine
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".)
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 , 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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- GENERAL APPROACH
- ACUTE CPP CRYSTAL ARTHRITIS ('ACUTE PSEUDOGOUT')
- Initial treatment/one or two joints
- Initial treatment/more than two joints
- - NSAIDs
- - Colchicine
- - Unable to use oral NSAIDs and colchicine
- Resistant disease
- Prophylaxis for acute CPP crystal arthritis
- CHRONIC CPP CRYSTAL INFLAMMATORY ARTHRITIS ('PSEUDO-RHEUMATOID ARTHRITIS')
- OTHER CHRONIC PRESENTATIONS
- Chronic and progressive calcium pyrophosphate crystal deposition (CPPD)
- Joint degeneration ('OA with CPPD')
- Severe joint degeneration/Pseudo-neuropathic joint disease
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS