Management for calcium pyrophosphate crystal arthritis
Finckh, 2014Zhang, Doherty, Bardin, 2011Zhang, Doherty, Pascual, 2011
There is a lack of evidence to guide the optimal management for acute calcium pyrophosphate crystal arthritis; current management recommendations are based on extrapolating the evidence from treatment of acute gout. As patients with acute calcium pyrophosphate crystal arthritis are often older and more likely to have age-related comorbidities (eg chronic kidney disease), intra-articular corticosteroid injection may be the safest treatment option (after excluding septic arthritis). Other treatment options include nonsteroidal anti-inflammatory drugs (NSAIDs), systemic corticosteroids and colchicine.
For rapid symptom relief in acute calcium pyrophosphate crystal arthritis with a corticosteroid, use:
1a local corticosteroid injection at up to 2 affected sites (see Principles of local corticosteroid injection use for musculoskeletal pain for advice on drug choice and example doses)
OR
1prednisolone (or prednisone) 15 to 30 mg orally, daily until symptoms subside (typically 3 to 5 days)1 prednis ol one prednis(ol)one prednis(ol)one
All of the NSAIDs listed below are equally effective and drug choice should be based on patient factors (eg comorbidities)—see Choosing an NSAID for advice on drug choice. For rapid symptom relief in calcium pyrophosphate crystal arthritis with an NSAID, use:
1celecoxib 100 to 200 mg orally, daily in 1 or 2 divided doses, until symptoms subside celecoxib celecoxib celecoxib
OR
1etoricoxib 30 to 60 mg orally, daily until symptoms subside etoricoxib etoricoxib etoricoxib
OR
1ibuprofen immediate-release 200 to 400 mg orally, 3 or 4 times daily until symptoms subside ibuprofen ibuprofen ibuprofen
OR
1indometacin 25 to 50 mg orally, 2 to 4 times daily until symptoms subside indometacin indometacin indometacin
OR
1ketoprofen modified-release 200 mg orally, daily until symptoms subside ketoprofen ketoprofen ketoprofen
OR
1meloxicam 7.5 to 15 mg orally, daily until symptoms subside meloxicam meloxicam meloxicam
OR
1naproxen immediate-release 250 to 500 mg orally, twice daily until symptoms subside naproxen naproxen naproxen
OR
1naproxen modified-release 750 to 1000 mg orally, daily until symptoms subside naproxen naproxen naproxen
OR
1piroxicam 10 to 20 mg orally, daily until symptoms subside piroxicam piroxicam piroxicam
OR
2diclofenac 25 to 50 mg orally, 2 or 3 times daily until symptoms subside. diclofenac diclofenac diclofenac
For rapid symptom relief in calcium pyrophosphate crystal arthritis with colchicine, use:
colchicine 1 mg orally initially, then 0.5 mg 1 hour later, as a single one-day course (total dose is 1.5 mg). In addition, an NSAID (see dosage above) can be used for symptom relief until the flare resolves. colchicine colchicine colchicine
Currently, no treatment has been demonstrated to prevent or slow calcium pyrophosphate crystal deposition, prevent recurrent acute attacks or treat chronic disease. However, treatment options that may be trialled by a specialist include NSAIDs, colchicine and hydroxychloroquineStack, 2021.