Table 2

LOE and SOR: order according to topic (general, acute attacks, prophylaxis and chronic CPPD management)

NoPropositionLOESOR (95% CI)
1Optimal 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 disorderIV93 (85 to 100)
2For 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 sufficientIIa–IV95 (92 to 98)
3Both 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 patientIb–IIb79 (66 to 91)
4A 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 NSAIDIIb–III87 (76 to 97)
5Prophylaxis 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–IV81 (70 to 92)
6The management objectives and treatment options for patients with OA and CPPD are the same as those for OA without CPPDIa84 (74 to 94)
7For 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 hydroxychloroquineIb–IV79 (67 to 91)
8If detected, associated conditions such as hyperparathyroidism, haemochromatosis or hypomagnesaemia should be treatedIb89 (81 to 98)
9Currently, no treatment modifies CPP crystal formation or dissolution and no treatment is required for asymptomatic CCIV90 (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).