Calcium Pyrophosphate Disease (CPPD) Treatment Houston, Texas
X-rays often demonstrate calcium deposits in involved joints, particularly the knee and the wrist. These deposits often have the appearance of a thin white rim lining the cartilage. While a swollen and inflamed joint coupled with the finding of soft tissue calcium deposits within the joint suggests the diagnosis, as mentioned above, many people over the age of 65 with no joint symptoms may demonstrate these calcium deposits on x-ray.
Examining a sample of joint fluid is a more accurate way of making a diagnosis. Not only can the diagnosis of CPPD be confirmed, but other possible problems, such as acute joint infection, can be ruled out. A drop of fluid can be examined under a device know as a polarized light microscope for calcium crystals, which can be distinguished from uric acid crystals found in gout by an experienced physician. There are certain obstacles to finding the calcium crystals within the joint fluid sample. The crystals of CPPD are more difficult to see under the microscope than the crystals found in gout. If the fluid is not examined within about 6 hours, the crystals may disappear. Also, the joints may not be as inflamed in certain patients with CPPD, and there may be less fluid to aspirate. To make matters more confusing, a certain number of patients have both gout and CPPD.
Laboratory tests do not help diagnose CPPD, but they do help investigate other diseases that may be associated with this condition. Over-activity of the parathyroid gland, which controls calcium levels in the body, under-activity of the thyroid gland, low magnesium levels, and a disease causing iron overload known as hemochromatosis are all seen in increased frequency in patients with CPPD and should be considered and screened for with blood tests. While identifying these associated diseases is important, treating them does not remove calcium crystal from the joint or reduce joint symptoms. CPPD still must be treated separately.
Non-steroidal anti-inflammatory drugs (NSAIDs) reduce symptoms and joint swelling in most individuals with CPPD and may be sufficient to treat the majority of patients. Ibuprofen (Motrin), naproxen (Naprosyn), and indomethacin (Indocin) are commonly used NSAIDs but increase the risk for damage to the stomach, potentially leading to ulcers in certain patients at risk. This risk is reduced when using COX-2 selective NSAIDs such as celecoxib (Celebrex) or valdecoxib (Bextra) as well as the partially COX-2 selective drug meloxicam (Mobic).
Corticosteroids may be administered in many different forms. Most often, these agents are more appropriately given during an acute flare rather than for chronic inflammatory joint disease due to the side effects of long-term therapy (thinning of the bones, elevation of blood sugar, weight gain, cataracts, etc.). While withdrawing fluid from the joint, injecting steroids directly into the joint often provides prompt relief of swelling and pain. Intravenous infusions or injections into the muscle are rarely required to treat severe flares involving multiple joints. Oral corticosteroids can also be given short-term with few side effects; when given chronically, doses of less than 10 mg/day of prednisone or its equivalent should be used.
Colchicine is usually given orally for acute flares. Intravenous colchicine may be more effective in this setting but has the potential risk of suppressing the bone marrow’s production of blood cells. Low doses of oral colchicine given once to twice daily for those with frequent attacks of joint inflammation may reduce the frequency and/or severity of these episodes. The response seen in patients with chronic ongoing inflammatory arthritis is variable, and diarrhea is a side effect that may limit this approach. None-theless, low cost and relatively few side effects make colchicine an option worth attempting in certain patients with CPPD.
Phosphocitrate is a medication in experimental stages of development that seems to prevent formation of CPPD crystals as well as other less common calcium crystals. Studies have not yet established what role this agent may have in treating CPPD long-term.