Calcium Pyrophosphate Deposition Disease Diagnosis & Treatment Gaps Remain

“We know CPPD commonly exists with OA, but there are questions about whether CPPD causes arthritis or worsens OA,” said Dr. Tedeschi. “Before 2020, four large cohort studies produced conflicting results. These were looking at chnondrocalcinosis anywhere in the joint and OA progression as a whole.”

More recently, Wu, et al. found chondrocalcinosis in hyaline cartilage predicted further cartilage loss in the same knee compartment two years later, even without baseline cartilage damage. Dr. Tedeschi stressed that although it pointed toward a causal relationship, it was an observational study so causation could not be shown.³

The Rotterdam Study and Multicenter Osteoarthritis Study (MOST) looked at the association of chondrocalcinosis with incident OA, evaluating more than 6,000 knees. Although the studies themselves showed mixed results, a meta-analysis noted a 77% increase in risk, which was significant.

Treatment Options

Despite CPPD being a common cause of arthritis after age 60, well-researched treatment options are not available.

Dr. Pascart

“What I am going to talk about today is all off label,” said Tristan Pascart, MD, PhD, clinical researcher at Lille Catholic University in Lille, France. “There is certainly an urgent need for guidance in terms of managing CPPD.”

Some studies give us early indications of what may or may not work in these patients. The COLCHICORT trial compared colchicine with prednisone in a short-term equivalence setting.

A group of 112 patients with an average age of 87 were treated the first day with a standard analgesic. One arm was given 1.5 mg colchicine on day one and 1 mg on the second, compared with 30 mg of prednisone on both days. This study showed equivalency to the main end point of visual analog scale pain on the first day.⁴ Despite that equivalency, a post hoc analysis looked at the need for additional doses of either study medication or interarticular injections. In this instance, colchicine was associated with poorer response on day three.⁵

“The general guidance gives you two options in treating acute flares,” said Dr. Pascart. “From this trial in most cases, it is better to favor prednisone.”

Longer term options include blocking crystal formation or dissolving the crystals. Multiple studies looking at probenecid and magnesium supplementation have not shown efficacy in dissolving the crystals.

“That leaves us with blocking inflammation,” said Dr. Pascart. “The trials we do have are both very old. A crossover pilot study of hydrochloricone showed a reduction in recurrent flares. We are still waiting 30 years for the conformational study that never came.”