LOE and SOR: order according to topic (general, acute attacks, prophylaxis and chronic CPPD management)
| No | Proposition | LOE | SOR (95% CI) |
|---|---|---|---|
| 1 | Optimal treatment of CPPD requires both non-pharmacological and pharmacological modalities and should be tailored according to:Clinical features (isolated CC, acute, chronic CPP crystal inflammatory arthritis, OA with CPPD)General risk factors (age, comorbidities)The presence of a predisposing metabolic disorder | IV | 93 (85 to 100) |
| 2 | For acute CPP crystal arthritis, optimal and safe treatment comprises application of ice or cool packs, temporary rest, joint aspiration and intra-articular injection of long-acting GCS. For many patients these approaches alone may be sufficient | IIa–IV | 95 (92 to 98) |
| 3 | Both oral NSAID (with gastroprotective treatment if indicated) and low-dose oral colchicine (eg, 0.5 mg up to 3–4 times a day with or without an initial dose of 1 mg) are effective systemic treatments for acute CPP crystal arthritis, although their use is often limited by toxicity and comorbidity, especially in the older patient | Ib–IIb | 79 (66 to 91) |
| 4 | A short tapering course of oral GCS, or parenteral GCS or ACTH, may be effective for acute CPP crystal arthritis that is not amenable to intra-articular GCS injection and are alternatives to colchicine and/or NSAID | IIb–III | 87 (76 to 97) |
| 5 | Prophylaxis against frequent recurrent acute CPP crystal arthritis can be achieved with low-dose oral colchicine (eg, 0.5–1 mg daily) or low-dose oral NSAID (with gastroprotective treatment if indicated) | IIb–IV | 81 (70 to 92) |
| 6 | The management objectives and treatment options for patients with OA and CPPD are the same as those for OA without CPPD | Ia | 84 (74 to 94) |
| 7 | For chronic CPP crystal inflammatory arthritis, pharmacological options in order of preference are oral NSAID (plus gastroprotective treatment if indicated) and/or colchicine (0.5–1.0 mg daily), low-dose corticosteroid, methotrexate and hydroxychloroquine | Ib–IV | 79 (67 to 91) |
| 8 | If detected, associated conditions such as hyperparathyroidism, haemochromatosis or hypomagnesaemia should be treated | Ib | 89 (81 to 98) |
| 9 | Currently, no treatment modifies CPP crystal formation or dissolution and no treatment is required for asymptomatic CC | IV | 90 (83 to 97) |
ACTH, adrenocorticotrophic hormone; CC, chondrocalcinosis; CPP, calcium pyrophosphate; CPPD, calcium pyrophosphate deposition; GCS, glucocorticosteroids; LOE, level of evidence (see table 1 for further details); NSAID, non-steroidal anti-inflammatory drugs; OA, osteoarthritis; SOR, strength of recommendation on visual analogue scale (0–100 mm, 0=not recommended at all, 100=fully recommended).