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EULAR recommendations for calcium pyrophosphate deposition. Part II: Management
  1. W Zhang1,
  2. M Doherty1,
  3. E Pascual2,
  4. V Barskova3,
  5. P-A Guerne4,
  6. T L Jansen5,
  7. B F Leeb6,
  8. F Perez-Ruiz7,
  9. J Pimentao8,
  10. L Punzi9,
  11. P Richette10,
  12. F Sivera11,
  13. T Uhlig12,
  14. I Watt13,
  15. T Bardin10
  1. 1Academic Rheumatology, University of Nottingham, Nottingham, UK
  2. 2Sección de Rheumatologia, Hospital General Universitario de Alicante, Alicante, Spain
  3. 3Crystal Arthritis Department, State Institute of Rheumatology, Moscow, Russia
  4. 4Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland
  5. 5University Medical Centre Nijmegen St Radboud, Department of Rheumatology, Nijmegen, The Netherlands
  6. 62nd Department of Medicine, Centre for Rheumatology Lower Austria, Stockerau, Austria
  7. 7Sección de Rheumatologia, Hospital de Cruces, Baracaldo, Spain
  8. 8Department of Rheumatology, Egas Moniz Hospital, Lisbon, Portugal
  9. 9Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy
  10. 10University Paris 7, Fédération de Rhumatologie, Hôpital Lariboisière, Paris, France
  11. 11Department of Rheumatology, Hospital General de Alicante, Alicante, Spain
  12. 12Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  13. 13Department of Radiology. Leiden University Medical Centre, Leiden, The Netherlands
  1. Correspondence to Dr Weiya Zhang, Academic Rheumatology, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham NG5 1PB, UK; weiya.zhang{at}


Objectives To develop evidence-based recommendations for management of calcium pyrophosphate deposition (CPPD).

Methods A multidisciplinary guideline development group of 15 experts, representing 10 European countries, generated key propositions for management of CPPD using a Delphi consensus approach. For each recommendation research evidence was searched systematically. Whenever possible, the effect size and number needed to treat for efficacy and RR or OR for side effects were calculated for individual treatment modalities. Strength of recommendation was assessed by the European League Against Rheumatism visual analogue scale.

Results Nine key recommendations were generated, including topics for general management, treatment of acute attacks, prophylaxis against recurrent acute attacks and management of chronic symptoms. It was recommended that optimal treatment requires both non-pharmacological and pharmacological treatments. For acute CPP crystal arthritis, cool packs, temporary rest and joint aspiration combined with steroid injection are often sufficient. For prophylaxis or chronic inflammatory arthritis with CPPD, oral non-steroidal anti-inflammatory drugs with gastroprotective treatment and/or low-dose colchicine 0.5–1.0 mg daily may be used. Other recommendations included parenteral or oral corticosteroid for acute CPP arthritis in those unresponsive or unsuited to other measures, and low-dose corticosteroid, methotrexate or hydroxychloroquine for chronic inflammatory arthritis with CPPD. Asymptomatic CPPD requires no treatment. Strength of recommendations varies from 79% to 95%.

Conclusion Nine key recommendations for management of CPP crystal associated arthritis were developed using both research evidence and expert consensus. Strength of recommendations was provided to assist the application of these recommendations.

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  • Funding Financial support was received from the European League Against Rheumatism.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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