A comprehensive review in The Lancet Rheumatology revealed significant advances in understanding calcium pyrophosphate deposition disease, potentially the most common inflammatory arthritis in adults over 60.
The 2023 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria marked a pivotal advancement in calcium pyrophosphate deposition (CPPD) disease identification. Patients meeting sufficient criteria through crowned dens syndrome or CPP crystal presence in synovial fluid were automatically classified as having CPPD disease. A threshold score exceeding 56 points demonstrated high sensitivity and specificity in validation cohorts.
A 2023 open-label COLCHICORT trial of 112 patients found prednisone (30 mg daily) provided the optimal benefit-risk ratio for acute CPP crystal arthritis among the tested treatments. While colchicine (1.5 mg day 1, 1 mg day 2) showed equivalent pain reduction at 24 hours (VAS score change: -36 mm vs -38 mm), it carried a 22% risk of mild diarrhea compared to prednisone's 6% hyperglycemia rate.
For chronic inflammatory CPPD, a 2024 European cohort study of 128 patients demonstrated prolonged low-dose colchicine (0.5-1 mg/day) as first-line therapy, controlling symptoms in 30-50% of cases. The study found tocilizumab persistence exceeded anakinra over two years.
Prevalence data from 2024 ultrasonography studies revealed CPPD in 9.8% of knee hyaline cartilage and 22.4% of fibrocartilage among patients with knee pain. These rates increased to 23.3% and 46.7% in patients over 80 years.
Recent evidence linked CPPD to cardiovascular events and osteoporotic fractures. A small single-center study found elevated cardiovascular event risk within two years of acute CPP-crystal arthritis.
The review highlighted genetic factors, including ANKH gene mutations leading to early-onset disease, and a single nucleotide polymorphism associated with sporadic CPPD in two cohorts.
Diagnostic advances included validated imaging criteria across conventional radiography (92% specific but 54% sensitive), ultrasound (71-87% sensitive, 68-88% specific), CT, and dual-energy CT.
The research identified critical knowledge gaps, including mechanisms of crystal deposition, genetics of sporadic cases, and development of crystal-dissolution therapies. Current treatments focus solely on controlling inflammation, as no treatments can dissolve CPP crystals.
A German tertiary-care center study of 503 patients found chondrocalcinosis prevalence doubled in seronegative versus seropositive rheumatoid arthritis (32.3% vs 16.6%). Notably, 85% of patients with both CPPD disease and rheumatoid arthritis were seronegative.
This comprehensive update underscored CPPD's significance as a complex, systemic condition requiring increased clinical attention and continued research for improved therapeutic options.
The lead author received consulting fees from Avalo Therapeutics while another author declared a research grant from Lilly. All other authors declared no competing interests.
