How is acute CPP crystal arthritis treated?
The principles for treating acute pseudogout are the same as those for treating acute gout, although the disease is not as well studied.
Treatment of acute CPP crystal arthritis
| Treatment | Comments | Disadvantages |
|---|---|---|
| Nonpharmacologic/aspiration | Ice packs, rest, and thorough aspiration of the affected joint may halt the attack | Usually insufficient for clinical relief Not feasible for polyarticular attacks |
| NSAIDs a | Prescribed at full antiinflammatory doses Consider prescribing with a proton pump inhibitor given affected patient population | Caution in elderly and patients with comorbid conditions: renal insufficiency, heart disease, peptic ulcer disease, etc. |
| Intraarticular steroids Long-acting preparations: e.g., 40 mg triamcinolone hexacetonide for large joints (knee), 10–20 mg for smaller joints (wrist) | Good option if avoiding NSAIDs Best method to provide prompt, complete relief of the attack with little risk of systemic adverse effects | Challenging in polyarticular attacks |
| Intramuscular steroids a 1 or 2 intramuscular injections of 60 mg triamcinolone acetonide | Useful in hospitalized patients with contraindications to NSAIDs and who decline an intraarticular injection | Systemic corticosteroid effects |
| Oral steroids a 40 mg of oral prednisone daily, which is tapered to zero in 10–14 days | Can be used if above therapy has failed or is contraindicated | Systemic corticosteroid effects |
| Adrenocorticotropic hormone a IV, IM, or SQ | Can be used in patients that do not respond to other therapies and have multiple comorbidities | Not FDA-approved Very expensive |
| Colchicine a Load with 1.2 mg followed by 0.6 mg 1 hour later | Only use if glomerular filtration rate of >50 mL/minute | Significant potential toxicity in the elderly population |
| IL-1 inhibitors a e.g., Anakinra 100 mg subcutaneously daily for 3–5 days | Considered in the rare circumstance of treatment-resistant disease | Not FDA-approved Very expensive |
FDA, Food and Drug Administration; IM, intramuscular; IV, intravenous; NSAIDs, nonsteroidal antiinflammatory drugs; SQ , subcutaneous.
a Polyarticular attacks of pseudogout can also be managed with these therapies.
