Expert Perspective: Treatment of Patients With Calcium Pyrophosphate Deposition Disease: Where Do We Begin and Where Are We Going?

Calcium pyrophosphate deposition (CPPD) disease is a common crystalline arthritis in older adults with substantial unmet treatment needs, limited clinical trial evidence, and no currently approved disease-modifying therapy. This review proposes a practical treatment approach that begins with confirming the presence of CPPD disease, determining whether current symptoms are attributable to CPPD disease, and selecting therapy according to CPPD disease manifestation and clinical context. For acute CPP crystal arthritis, current options include short-course systemic glucocorticoids, colchicine, intra-articular glucocorticoids, and anakinra; for chronic CPP crystal arthritis or recurrent acute flares, current approaches include colchicine, hydroxychloroquine, methotrexate, IL-1 inhibition, and IL-6 inhibition. The article summarizes data from randomized trials and open-label studies, highlights ongoing clinical trials of colchicine, tocilizumab, and baricitinib, and discusses potential future avenues including true disease-modifying approaches targeting CPP crystal formation or dissolution.