Which medications in the drug class Anti-Inflammatory Agents are used in the treatment of Calcium Pyrophosphate Deposition (CPPD) Disease?

Answer

Anti-Inflammatory Agents

If given orally or, rarely, intravenously, these agents can be used to treat acute pseudogout. Toxicity is significant; therefore, other therapies should be considered first. Low-dose colchicine may be useful for long-term prophylaxis of pseudogout attacks.

Colchicine

Colchicine inhibits microtubules and, as a result, may inhibit neutrophil chemotaxis and phagocytosis. It also may inhibit prostaglandin generation.

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Zamora EA, Naik R. Calcium Pyrophosphate Deposition Disease. 2023 Jan. [Medline]. [Full Text].
[Guideline] Zhang W, Doherty M, Bardin T, Barskova V, Guerne PA, et al. European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann Rheum Dis. 2011 Apr. 70(4):563-70. [Medline].
Cowley S, McCarthy G. Diagnosis and Treatment of Calcium Pyrophosphate Deposition (CPPD) Disease: A Review. Open Access Rheumatol. 2023. 15:33-41. [Medline]. [Full Text].
Beutler A, Rothfuss S, Clayburne G. Calcium pyrophosphate dihydrate crystal deposition in synovium. Relationship to collagen fibers and chondrometaplasia. Arthritis Rheum. 1993 May. 36(5):704-15. [Medline].
Tsui FW. Genetics and Mechanisms of Crystal Deposition in Calcium Pyrophosphate Deposition Disease. Curr Rheumatol Rep. 2011 Dec 24. [Medline].
Pritzker KP, Cheng PT, Renlund RC. Calcium pyrophosphate crystal deposition in hyaline cartilage. Ultrastructural analysis and implications for pathogenesis. J Rheumatol. 1988. 15(5):828-35. [Medline].
Ryan LM, Wortmann RL, Karas B. Pyrophosphohydrolase activity and inorganic pyrophosphate content of cultured human skin fibroblasts. Elevated levels in some patients with calcium pyrophosphate dihydrate deposition disease. J Clin Invest. 1986 May. 77(5):1689-93. [Medline].
Zaka R, Williams CJ. Genetics of chondrocalcinosis. Osteoarthritis Cartilage. 2005 Sep. 13(9):745-50. [Medline].
Doherty M, Hamilton E, Henderson J. Familial chondrocalcinosis due to calcium pyrophosphate dihydrate crystal deposition in English families. Br J Rheumatol. 1991 Feb. 30(1):10-5. [Medline].
Williams CJ. The role of ANKH in pathologic mineralization of cartilage. Curr Opin Rheumatol. 2016 Mar. 28(2):145-51. [Medline].
Ramos YF, Bos SD, van der Breggen R, Kloppenburg M, Ye K, Lameijer EW, et al. A gain of function mutation in TNFRSF11B encoding osteoprotegerin causes osteoarthritis with chondrocalcinosis. Ann Rheum Dis. 2014 Apr 17. [Medline].
Patel T, Ryan L, Dubois M, Carrera G, Baynes K, Mannem R, et al. The prevalence of chondrocalcinosis of the symphysis pubis on CT scan and correlation with calcium pyrophosphate dihydrate crystal deposition disease. Clin Rheumatol. 2016 Mar. 35(3):771-3. [Medline].
Kleiber Balderrama C, Rosenthal AK, Lans D, Singh JA, Bartels CM. Calcium Pyrophosphate Deposition Disease and Associated Medical Comorbidities: A National Cross-Sectional Study of US Veterans. Arthritis Care Res (Hoboken). 2017 Sep. 69 (9):1400-1406. [Medline]. [Full Text].
McCarty DJ. Calcium pyrophosphate dihydrate crystal deposition disease--1975. Arthritis Rheum. 1976 May-Jun. 19 Suppl 3:275-85. [Medline].
Paalanen K, Rannio K, Rannio T, Asikainen J, Hannonen P, Sokka T. Prevalence of calcium pyrophosphate deposition disease in a cohort of patients diagnosed with seronegative rheumatoid arthritis. Clin Exp Rheumatol. 2020 Jan-Feb. 38 (1):99-106. [Medline]. [Full Text].
Duran Tİ, Özgen M. Two cases of calcium pyrophosphate deposition disease (CPPD) presented with spondylodiscitis. Eur J Rheumatol. 2020 Apr. 7 (2):84-87. [Medline].
Kudoh K, Kudoh T, Tsuru K, Miyamoto Y. A case of tophaceous pseudogout of the temporomandibular joint extending to the base of the skull. Int J Oral Maxillofac Surg. 2017 Mar. 46 (3):355-359. [Medline].
Park HJ, Chung HW, Oh TS, Lee JS, Song JS, Park YK. Tumoral pseudogout of the proximal interphalangeal joint of a finger: a case report and literature review. Skeletal Radiol. 2016 Jul. 45 (7):1007-12. [Medline].
Watanabe K, Yamazaki Y, Sugawara M. Tuberculosis of the Wrist Accompanied with Calcium Pyrophosphate: A Case Report. Intern Med. 2017 Oct 11. [Medline].
Bell DJ, Gaillard F, et al. Crowned dens syndrome. Radiopaedia. Available at https://radiopaedia.org/articles/crowned-dens-syndrome?lang=us. August 15, 2022; Accessed: April 5, 2023.
Haikal A, Everist BM, Jetanalin P, Maz M. Cervical CT-Dependent Diagnosis of Crowned Dens Syndrome in Calcium Pyrophosphate Dihydrate Crystal Deposition Disease. Am J Med. 2020 Feb. 133 (2):e32-e37. [Medline].
Wold A, Petscavage-Thomas J, Walker EA. Non-union rate of type II and III odontoid fractures in CPPD versus a control population. Skeletal Radiol. 2018 Nov. 47 (11):1499-1504. [Medline].
Zabotti A, Della Siega P, Picco L, Quartuccio L, Bassetti M, De Vita S. Gitelman syndrome disclosed by calcium pyrophosphate deposition disease: early diagnosis by ultrasonographic study. Reumatismo. 2016 Jun 23. 68(1):53-5. [Medline].
Ryan LM. Calcium pyrophosphate dihydrate crystal deposition. Weyand CM, Wortman R, Klippel JH, eds. Primer on Rheumatic Diseases. 11th ed. Atlanta, Ga: Arthritis Foundation; 1997. 226-9.
Tedeschi SK, Becce F, Pascart T, Guermazi A, Budzik JF, Dalbeth N, et al. Imaging Features of Calcium Pyrophosphate Deposition Disease: Consensus Definitions From an International Multidisciplinary Working Group. Arthritis Care Res (Hoboken). 2023 Apr. 75 (4):825-834. [Medline].
Mitton-Fitzgerald E, Gohr CM, Williams CM, Rosenthal AK. Identification of Common Pathogenic Pathways Involved in Hemochromatosis Arthritis and Calcium Pyrophosphate Deposition Disease: a Review. Curr Rheumatol Rep. 2022 Feb. 24 (2):40-45. [Medline].
Radu L, Groppa L, Vudu L. MUSCULOSKELETAL IMPAIRMENT IN PRYMARY HYPOTHYROIDISM. Rev Med Chir Soc Med Nat Iasi. 2016 Apr-Jun. 120 (2):244-51. [Medline].
Zeng C, Wei J, Terkeltaub R, Yang T, Choi HK, Wang YL, et al. Dose-response relationship between lower serum magnesium level and higher prevalence of knee chondrocalcinosis. Arthritis Res Ther. 2017 Oct 24. 19 (1):236. [Medline].
Boumans D, Hettema ME, Vonkeman HE, Maatman RG, van de Laar MA. The added value of synovial fluid centrifugation for monosodium urate and calcium pyrophosphate crystal detection. Clin Rheumatol. 2017 Jul. 36 (7):1599-1605. [Medline].
Niessink T, Otto C, Janssen M, Jansen TL. Calcium carbonates are novel positive birefringent crystals in synovial fluid. Clin Rheumatol. 2023 Feb. 42 (2):635-636. [Medline]. [Full Text].
Jacques T, Michelin P, Badr S, Nasuto M, Lefebvre G, Larkman N, et al. Conventional Radiology in Crystal Arthritis: Gout, Calcium Pyrophosphate Deposition, and Basic Calcium Phosphate Crystals. Radiol Clin North Am. 2017 Sep. 55 (5):967-984. [Medline].
Saffar P. Chondrocalcinosis of the wrist. J Hand Surg [Br]. 2004 Oct. 29(5):486-93. [Medline].
Ellabban AS, Kamel SR, Omar HA, El-Sherif AM, Abdel-Magied RA. Ultrasonographic diagnosis of articular chondrocalcinosis. Rheumatol Int. 2011 Dec 23. [Medline].
Gutierrez M, Di Geso L, Salaffi F, Carotti M, Girolimetti R, De Angelis R, et al. Ultrasound detection of cartilage calcification at knee level in calcium pyrophosphate deposition disease. Arthritis Care Res (Hoboken). 2014 Jan. 66(1):69-73. [Medline].
Filippou G, Adinolfi A, Iagnocco A, Filippucci E, Cimmino MA, Bertoldi I, et al. Ultrasound in the diagnosis of calcium pyrophosphate dihydrate deposition disease. A systematic literature review and a meta-analysis. Osteoarthritis Cartilage. 2016 Jun. 24(6):973-81. [Medline].
Expert Panel on Musculoskeletal Imaging:., Jacobson JA, Roberts CC, Bencardino JT, Appel M, Arnold E, et al. ACR Appropriateness Criteria^® Chronic Extremity Joint Pain-Suspected Inflammatory Arthritis. J Am Coll Radiol. 2017 May. 14 (5S):S81-S89. [Medline].
Forien M, Combier A, Gardette A, Palazzo E, Dieudé P, Ottaviani S. Comparison of ultrasonography and radiography of the wrist for diagnosis of calcium pyrophosphate deposition. Joint Bone Spine. 2017 Sep 28. [Medline].
Filippou G, Adinolfi A, Cimmino MA, Scirè CA, Carta S, Lorenzini S, et al. Diagnostic accuracy of ultrasound, conventional radiography and synovial fluid analysis in the diagnosis of calcium pyrophosphate dihydrate crystal deposition disease. Clin Exp Rheumatol. 2016 Mar-Apr. 34 (2):254-60. [Medline].
Cipolletta E, Smerilli G, Mirza RM, Matteo AD, Carotti M, Salaffi F, et al. Sonographic assessment of calcium pyrophosphate deposition disease at wrist. A focus on the dorsal scapho-lunate ligament. Joint Bone Spine. 2020 May 10. [Medline].
Filippou G, Filippucci E, Mandl P, Abhishek A. A critical review of the available evidence on the diagnosis and clinical features of CPPD: do we really need imaging?. Clin Rheumatol. 2020 Nov 24. [Medline].
Magarelli N, Amelia R, Melillo N, Nasuto M, Cantatore F, Guglielmi G. Imaging of chondrocalcinosis: calcium pyrophosphate dihydrate (CPPD) crystal deposition disease -- imaging of common sites of involvement. Clin Exp Rheumatol. 2012 Jan-Feb. 30 (1):118-25. [Medline].
Parperis K, Papachristodoulou E, Kakoullis L, Rosenthal AK. Management of calcium pyrophosphate crystal deposition disease: A systematic review. Semin Arthritis Rheum. 2021 Feb. 51 (1):84-94. [Medline].
Andrés M, Sivera F, Pascual E. Therapy for CPPD: Options and Evidence. Curr Rheumatol Rep. 2018 Apr 19. 20 (6):31. [Medline].
Abhishek A, Doherty M. Update on calcium pyrophosphate deposition. Clin Exp Rheumatol. 2016 Jul-Aug. 34 (4 Suppl 98):32-8. [Medline].
Iqbal SM, Qadir S, Aslam HM, Qadir MA. Updated Treatment for Calcium Pyrophosphate Deposition Disease: An Insight. Cureus. 2019 Jan 7. 11 (1):e3840. [Medline].
Meng Z, Baker DG, Branigan P, et al. Hydroxychloroquine inhibits matrix metalloprotease activity in experimental calcium pyrophosphate dihydrate (CPPD) crystal induced inflammation in the rat subcutaneous air pouch. Inflammopharmacology. 2000. 8:113-121. [Full Text].
Ea HK, Liote F. Calcium pyrophosphate dihydrate and basic calcium phosphate crystal-induced arthropathies: update on pathogenesis, clinical features, and therapy. Curr Rheumatol Rep. 2004 Jun. 6(3):221-7. [Medline].
Announ N, Palmer G, Guerne PA, Gabay C. Anakinra is a possible alternative in the treatment and prevention of acute attacks of pseudogout in end-stage renal failure. Joint Bone Spine. 2009 Jul. 76(4):424-6. [Medline].
Ottaviani S, Brunier L, Sibilia J, Maurier F, Ardizzone M, Wendling D, et al. Efficacy of anakinra in calcium pyrophosphate crystal-induced arthritis: a report of 16 cases and review of the literature. Joint Bone Spine. 2013 Mar. 80(2):178-82. [Medline].
Moltó A, Ea HK, Richette P, Bardin T, Lioté F. Efficacy of anakinra for refractory acute calcium pyrophosphate crystal arthritis. Joint Bone Spine. 2012 Dec. 79(6):621-3. [Medline].
Cipolletta E, Di Matteo A, Scanu A, Isidori M, Di Battista J, Punzi L, et al. Biologics in the treatment of calcium pyrophosphate deposition disease: a systematic literature review. Clin Exp Rheumatol. 2020 Apr 28. [Medline].
Andrés M, Sivera F, Pascual E. Therapy for CPPD: Options and Evidence. Curr Rheumatol Rep. 2018 Apr 19. 20 (6):31. [Medline].
Latourte A, Ea HK, Frazier A, Blanchard A, Lioté F, Marotte H, et al. Tocilizumab in symptomatic calcium pyrophosphate deposition disease: a pilot study. Ann Rheum Dis. 2020 Aug. 79 (8):1126-1128. [Medline].

Media Gallery

Calcium pyrophosphate deposition disease. Radiograph of the knee showing chondrocalcinosis involving the meniscal cartilage, as well as evidence of osteoarthritis.
Calcium pyrophosphate deposition disease. Radiograph of the wrist and hand showing chondrocalcinosis of the articular disc of the wrist and atypical osteoarthritis involving the metacarpophalangeal joints in a patient with underlying hemochromatosis.
Calcium pyrophosphate deposition disease. Appearance of calcium pyrophosphate dihydrate crystals obtained from the knee of a patient with pseudogout. The crystals are rhomboid-shaped with weakly positive birefringence, as seen by compensated polarized microscopy. The black arrow indicates the direction of the compensator.
Calcium pyrophosphate deposition disease. High-powered view of calcium pyrophosphate dihydrate crystals with compensated polarized microscopy. The black arrow indicates the direction of the compensator. Crystals parallel to the compensator are blue, while those perpendicular to the compensator are yellow.
Calcium pyrophosphate deposition disease. High-powered view of calcium pyrophosphate dihydrate crystals with compensated polarized microscopy. The crystals parallel to the compensator were blue, while those perpendicular to the compensator were yellow. However, the crystals have been rotated 90%, resulting in a color change in both of them. The direction of the compensator was not changed and is indicated by the black arrow.
Calcium pyrophosphate deposition disease. Ultrasonography of the wrist demonstrates chondrocalcinosis.
Intraoperative photographs demonstrate extensive precipitate deposition of the calcium pyrophosphate crystals in the articular cartilage, meniscus, and synovium of a knee. Left images depict femoral and tibial surfaces. Right images depict anterior cruciate ligament.
Intraoperative photographs demonstrate extensive precipitate deposition of the calcium pyrophosphate crystals in the articular cartilage, meniscus, and synovium of a knee. Upper left image depicts anterior horn medial meniscus. Lower left image depicts undersurface of meniscus. Upper right image depicts medial femoral condyle. Lower right image depicts synovium.
Calcium pyrophosphate deposition disease. Ultrasound scan of the triangular fibrocartilage complex (TFCC) of the wrist shows thin hyperechoic bands parallel to the surface of the hyaline cartilage. Other findings include a punctate pattern consisting of several hyperechoic spots and homogeneous hyperechoic nodular or oval deposits in the articular surface.

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Author

Constantine K Saadeh, MD President, Allergy ARTS, LLP; Principal Investigator, Amarillo Center for Clinical Research, Ltd

Constantine K Saadeh, MD is a member of the following medical societies: American Academy of Allergy, Asthma and Immunology, American College of Rheumatology, American Medical Association, Southern Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Nicole Davey-Ranasinghe, MD Rheumatologist, Allergy ARTS, LLP, Amarillo Center for Clinical Research, Ltd

Nicole Davey-Ranasinghe, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

Acknowledgements

Neil J Barkin, MD, FAAOS Consulting Surgeon, Capitol Orthopaedics & Rehabilitation, LLC

Neil J Barkin, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Lawrence H Brent, MD Associate Professor of Medicine, Jefferson Medical College of Thomas Jefferson University; Chair, Program Director, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center

Lawrence H Brent, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Physicians, and American College of Rheumatology

Disclosure: Abbott Honoraria Speaking and teaching; Centocor Consulting fee Consulting; Genentech Grant/research funds Other; HGS/GSK Honoraria Speaking and teaching; Omnicare Consulting fee Consulting; Pfizer Honoraria Speaking and teaching; Roche Speaking and teaching; Savient Honoraria Speaking and teaching; UCB Honoraria Speaking and teaching

Paul E Di Cesare, MD, FACS Professor, Department of Orthopedic Sugery, University of California, Davis, School of Medicine

Paul E Di Cesare, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, and Sigma Xi

Disclosure: Stryker Consulting fee Consulting; Smith & Nephew Consulting fee Consulting

Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society

Disclosure: Nothing to disclose.

Jegan Krishnan, MBBS, FRACS, PhD Professor, Chair, Department of Orthopedic Surgery, Flinders University of South Australia; Senior Clinical Director of Orthopedic Surgery, Repatriation General Hospital; Private Practice, Orthopaedics SA, Flinders Private Hospital

Jegan Krishnan, MBBS, FRACS, PhD, is a member of the following medical societies: Australian Medical Association, Australian Orthopaedic Association, and Royal Australasian College of Surgeons

Disclosure: Nothing to disclose.

Kristine M Lohr, MD, MS Professor, Department of Internal Medicine, Center for the Advancement of Women's Health and Division of Rheumatology, Director, Rheumatology Training Program, University of Kentucky College of Medicine

Kristine M Lohr, MD, MS is a member of the following medical societies: American College of Physicians and American College of Rheumatology

Disclosure: Nothing to disclose.

Jan Malacara, PA-C Consulting Staff, Allergy ARTS, LLP

Disclosure: Nothing to disclose.

Dinesh Patel, MD, FACS Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Anne Tesar, PA-C Physician Assistant, Capitol Orthopaedics and Rehabilitation, LLC

Anne Tesar, PA-C is a member of the following medical societies: American Academy of Physician Assistants

Disclosure: Nothing to disclose.

Acknowledgments

The authors wish to thank Shannon Shaw and Michael Gaylor for their hard work in helping to prepare this article.

Which medications in the drug class Anti-Inflammatory Agents are used in the treatment of Calcium Pyrophosphate Deposition (CPPD) Disease?

Anti-Inflammatory Agents

Colchicine

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