Management of calcium pyrophosphate crystal deposition disease: A systematic review |
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| Institution: | 1. Department of Medicine, Division of Rheumatology, University of Arizona College of Medicine, Phoenix, Arizona, USA;2. Department of Internal Medicine, Division of Rheumatology, University of Cyprus Medical School, Nicosia, Cyprus;3. Department of Internal Medicine, University of Cyprus Medical School, Nicosia, Cyprus;4. Department of Respiratory Medicine, University of Patras General Hospital, Patras, Greece;5. Department of Medicine, Division of Rheumatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA;1. Hospital for Special Surgery, Department of Medicine, Division of Rheumatology, 535 East 70th Street, New York, NY 10021, United States;2. Weill Cornell Medicine, Department of Healthcare Policy and Research, 402 East 67th Street, New York, NY 10065, United States;3. Weill Cornell Medicine, Department of Medicine, Division of General Internal Medicine, 420 East 70th Street, 3rd Floor, New York, NY 10065, United States;4. Weill Cornell Medicine, Department of Medicine, Division of Cardiology, 520 East 70th Street, New York, NY 10021, United States;1. Division of General Internal Medicine and Primary Care, Brigham and Women''s Hospital, Boston, MA, United States;2. Harvard Medical School, Boston, MA, United States;3. Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, United States;4. Clinical Epidemiology Program, Mongan Institute, Massachusetts General Hospital, Boston, MA, United States |
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| Abstract: | ObjectiveCalcium pyrophosphate crystal deposition disease (CPPD) is a common cause of acute and chronic arthritis, especially in the elderly population. There is a paucity of data regarding the management of CPPD disease, which is currently based on expert opinion and evidence derived from the treatment of gout. We conducted a systematic literature review in order to identify the available treatment options for CPPD, and describe their efficacy and safety.Material and methodsOnline databases were searched from inception to May of 2020 using the search terms: (CPPD Title/Abstract] OR CPDD Title/Abstract] OR calcium pyrophosphate Title/Abstract] OR chondrocalcinosis Title/Abstract]) AND (treatment Title/Abstract] OR management Title/Abstract] OR therapy Title/Abstract]). Articles evaluating the use of specific treatment agents for CPPD were eligible for inclusion. Case reports were excluded.ResultsA total of 22 eligible studies and 403 unique patients were selected. We identified only 3 randomized, double-blind, controlled trials (RCTs) evaluating the use of methotrexate, hydroxychloroquine, and magnesium carbonate in CPPD, and these therapeutic options, with the exception of methotrexate, have shown efficacy and reduction of pain intensity. Further, 10 case series and 9 cohort studies were included. Intramuscular and intra-articular glucocorticoids, ACTH, as well as the biologic agents anakinra and tocilizumab appear to be efficacious in CPPD. Intra-articular injections of glycosaminoglycan polysulphate, hyaluronic acid and yttrium, as well as synovial membrane destruction by laser irradiation were associated with symptomatic improvement. Due to significant study heterogenicity, direct comparison between studies was not possible.ConclusionThere are a limited number of studies evaluating the treatment of CPPD. High quality evidence is rather limited, while commonly administered agents such as NSAIDs, colchicine and corticosteroids have not been evaluated by RCTs. The need for high quality evidence supporting specific treatment modalities is urgent for this common yet neglected form of arthritis. |
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