Current drugs used in the treatment of calcium pyrophosphate deposition disease and their indications
Nonsteroidal anti-inflammatory drugs
In the treatment and prevention of flare-ups
Steroids
Effective during flares, especially in multiple joint involvement. Intramuscular steroids are applied to those who cannot take oral steroids. Intra-articular steroids are used for cases of mono or oligoarticular involvement.
Colchicine
It can be used in combination with NSAIDs in the treatment of flares. It is also effective in the prophylaxis of flares.
Methotrexate
This drug is recommended for situations where conventional medications have failed to control attacks or when their use poses potential risks.
Hydroxychloroquine
It is effective in treating chronic arthropathies associated with CPPD.
Interleukin-1 receptor antagonist (anakinra)
It is preferred in cases where conventional drugs cannot be used or in diseases that cannot be managed with conventional drugs.
Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.
Kwon K, Seok H, Lee J, Kim M, Kim S, Park H, et al. Calcium pyrophosphate dihydrate deposition disease in the temporomandibular joint: diagnosis and treatment.Maxillofac Plast Reconstr Surg. 2018;40:19. [DOI] [PubMed] [PMC]
Zhang W, Doherty M, Bardin T, Barskova V, Guerne P, Jansen TL, et al. European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis.Ann Rheum Dis. 2011;70:563–70. [DOI] [PubMed]
Williams CJ, Rosenthal AK. Pathogenesis of calcium pyrophosphate deposition disease.Best Pract Res Clin Rheumatol. 2021;35:101718. [DOI] [PubMed]
Franchi L, Warner N, Viani K, Nuñez G. Function of Nod-like receptors in microbial recognition and host defense.Immunol Rev. 2009;227:106–28. [DOI] [PubMed] [PMC]
Ham Y, Mack H, Colville D, Harraka P, Savige J. Gitelman syndrome and ectopic calcification in the retina and joints.Clin Kidney J. 2021;14:2023–8. [DOI] [PubMed] [PMC]
Yavorskyy A, Hernandez-Santana A, McCarthy G, McMahon G. Detection of calcium phosphate crystals in the joint fluid of patients with osteoarthritis - analytical approaches and challenges.Analyst. 2008;133:302–18. [DOI] [PubMed] [PMC]
Rosales-Alexander JL, Aznar JB, Magro-Checa C. Calcium pyrophosphate crystal deposition disease: diagnosis and treatment.Open Access Rheumatol. 2014;6:39–47. [DOI] [PubMed] [PMC]
Yates KA, Yoshida K, Xu C, Lyu H, Norvang V, Solomon DH, et al. Acute Calcium Pyrophosphate Crystal Arthritis Flare Rate and Risk Factors for Recurrence.J Rheumatol. 2020;47:1261–6. [DOI] [PubMed] [PMC]
Resnick D, Williams G, Weisman MH, Slaughter L. Rheumatoid arthritis and pseudo-rheumatoid arthritis in calcium pyrophosphate dihydrate crystal deposition disease.Radiology. 1981;140:615–21. [DOI] [PubMed]
Lomax A, Ferrero A, Cullen N, Goldberg A, Singh D. Destructive pseudo-neuroarthropathy associated with calcium pyrophosphate deposition.Foot Ankle Int. 2015;36:383–90. [DOI] [PubMed]
Oka A, Okazaki K, Takeno A, Kumanomido S, Kusunoki R, Sato S, et al. Crowned Dens Syndrome: Report of Three Cases and a Review of the Literature.J Emerg Med. 2015;49:e9–13. [DOI] [PubMed]
Flood R, Stack J, McCarthy G. An Update on the Diagnosis and Management of Calcium Crystal Disease.Curr Rheumatol Rep. 2023;25:145–51. [DOI] [PubMed] [PMC]
Parperis K, Papachristodoulou E, Kakoullis L, Rosenthal AK. Management of calcium pyrophosphate crystal deposition disease: A systematic review.Semin Arthritis Rheum. 2021;51:84–94. [DOI] [PubMed]
Stack J, McCarthy G. Calcium pyrophosphate deposition (CPPD) disease – Treatment options.Best Pract Res Clin Rheumatol. 2021;35:101720. [DOI] [PubMed]
Zhang W, Doherty M, Pascual E, Barskova V, Guerne P, Jansen TL, et al. EULAR recommendations for calcium pyrophosphate deposition. Part II: management.Ann Rheum Dis. 2011;70:571–5. [DOI] [PubMed]
Voulgari PV, Venetsanopoulou AI, Drosos AA. Recent advances in the therapeutic management of calcium pyrophosphate deposition disease.Front Med (Lausanne). 2024;11:1327715. [DOI] [PubMed] [PMC]
Ho KY, Cardosa MS, Chaiamnuay S, Hidayat R, Ho HQT, Kamil O, et al. Practice Advisory on the Appropriate Use of NSAIDs in Primary Care.J Pain Res. 2020;13:1925–39. [DOI] [PubMed] [PMC]
Leung YY, Hui LLY, Kraus VB. Colchicine—Update on mechanisms of action and therapeutic uses.Semin Arthritis Rheum. 2015;45:341–50. [DOI] [PubMed] [PMC]
Spilberg I, McLain D, Simchowitz L, Berney S. Colchicine and pseudogout.Arthritis Rheum. 1980;23:1062–3. [DOI] [PubMed]
Tabatabai MR, Cummings NA. Intravenous colchicine in the treatment of acute pseudogout.Arthritis Rheum. 1980;23:370–4. [DOI] [PubMed]
Nashel DJ. Intravenous administration of colchicine.Arthritis Rheum. 1981;24:1215–6. [DOI] [PubMed]
Abhishek A, Tedeschi SK, Pascart T, Latourte A, Dalbeth N, Neogi T, et al. The 2023 ACR/EULAR classification criteria for calcium pyrophosphate deposition disease.Ann Rheum Dis. 2023;82:1248–57. [DOI] [PubMed] [PMC]
Stack J, Ryan J, McCarthy G. Colchicine: New Insights to an Old Drug.Am J Ther. 2015;22:e151–7. [DOI] [PubMed]
Hodgens A, Sharman T. Corticosteroids.In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. [PubMed]
Roane DW, Harris MD, Carpenter MT, Finger DR, Jarek MJ, Alloway JA, et al. Prospective use of intramuscular triamcinolone acetonide in pseudogout.J Rheumatol. 1997;24:1168–70. [PubMed]
Daoussis D, Antonopoulos I, Yiannopoulos G, Andonopoulos AP. ACTH as first line treatment for acute calcium pyrophosphate crystal arthritis in 14 hospitalized patients.Joint Bone Spine. 2014;81:98–100. [DOI] [PubMed]
Cipolletta E, Matteo AD, Scanu A, Isidori M, Battista JD, Punzi L, et al. Biologics in the treatment of calcium pyrophosphate deposition disease: a systematic literature review.Clin Exp Rheumatol. 2020;38:1001–7. [PubMed]
Altomare A, Corrado A, Maruotti N, Cici D, Cantatore FP. The role of Interleukin-1 receptor antagonist as a treatment option in calcium pyrophosphate crystal deposition disease.Mol Biol Rep. 2021;48:4789–96. [DOI] [PubMed] [PMC]
Andrés M, Sivera F, Pascual E. Therapy for CPPD: Options and Evidence.Curr Rheumatol Rep. 2018;20:31. [DOI] [PubMed]
Desmarais J, Chu C. Utility of Anakinra in Acute Crystalline Diseases: A Retrospective Study Comparing a University Hospital with a Veterans Affairs Medical Center.J Rheumatol. 2019;46:748–50. [DOI] [PubMed]
Dumusc A, Maldonado BP, Benaim C, Zufferey P, Aubry-Rozier B, So A. Anakinra compared to prednisone in the treatment of acute CPPD crystal arthritis: A randomized controlled double-blinded pilot study.Joint Bone Spine. 2021;88:105088. [DOI] [PubMed]
González T, Gantes M. Colchicine and pseudogout.Arthritis Rheum. 1982;25:1509–10. [DOI] [PubMed]
Pascual E, Andrés M, Sivera F. Methotrexate: should it still be considered for chronic calcium pyrophosphate crystal disease?Arthritis Res Ther. 2015;17:89. [DOI] [PubMed] [PMC]
Rothschild B, Yakubov LE. Prospective 6-month, double-blind trial of hydroxychloroquine treatment of CPDD.Compr Ther. 1997;23:327–31. [PubMed]
Chollet-Janin A, Finckh A, Dudler J, Guerne P. Methotrexate as an alternative therapy for chronic calcium pyrophosphate deposition disease: an exploratory analysis.Arthritis Rheum. 2007;56:688–92. [DOI] [PubMed]
Finckh A, Carthy GMM, Madigan A, Linthoudt DV, Weber M, Neto D, et al. Methotrexate in chronic-recurrent calcium pyrophosphate deposition disease: no significant effect in a randomized crossover trial.Arthritis Res Ther. 2014;16:458. [DOI] [PubMed] [PMC]
Josefina M, Ana CJ, Ariel V, Silvio AA. Development of pseudogout during etanercept treatment.J Clin Rheumatol. 2007;13:177. [DOI] [PubMed]
Latourte A, Ea H, Frazier A, Blanchard A, Lioté F, Marotte H, et al. Tocilizumab in symptomatic calcium pyrophosphate deposition disease: a pilot study.Ann Rheum Dis. 2020;79:1126–8. [DOI] [PubMed]
Sarkozi AM, Nemeth-Csoka M, Bartosiewicz G. Effects of glycosaminoglycan polysulphate in the treatment of chondrocalcinosis.Clin Exp Rheumatol. 1988;6:3–8. [PubMed]
Disla E, Infante R, Fahmy A, Karten I, Cuppari GG. Recurrent acute calcium pyrophosphate dihydrate arthritis following intraarticular hyaluronate injection.Arthritis Rheum. 1999;42:1302–3. [DOI] [PubMed]
Luzar MJ, Altawil B. Pseudogout following intraarticular injection of sodium hyaluronate.Arthritis Rheum. 1998;41:939–40. [DOI] [PubMed]
Doherty M, Dieppe PA. Double blind, placebo controlled trial of magnesium carbonate in chronic pyrophosphate arthropathy.Ann Rheum Dis. 1983;42:106–7. [PMC]
Florentin M, Elisaf MS. Proton pump inhibitor-induced hypomagnesemia: A new challenge.World J Nephrol. 2012;1:151–4. [DOI] [PubMed] [PMC]
Doherty M, Dieppe PA. Effect of intra-articular yttrium-90 on chronic pyrophosphate arthropathy of the knee.Lancet. 1981;2:1243–6. [DOI] [PubMed]
Cowley S, McCarthy G. Diagnosis and Treatment of Calcium Pyrophosphate Deposition (CPPD) Disease: A Review.Open Access Rheumatol. 2023;15:33–41. [DOI] [PubMed] [PMC]
Cheung HS, Kurup IV, Sallis JD, Ryan LM. Inhibition of calcium pyrophosphate dihydrate crystal formation in articular cartilage vesicles and cartilage by phosphocitrate.J Biol Chem. 1996;271:28082–5. [DOI] [PubMed]
