Refractory CPPD Treatment — SCE Rheumatology MCQ

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HardCrystal ArthropathyRefractory CPPD TreatmentSCE Rheumatology

A 55-year-old woman with CPPD disease has recurrent attacks affecting her wrists and knees despite Colchicine prophylaxis. She has tried low-dose Methotrexate with limited benefit. What emerging treatment option has shown promise in chronic inflammatory CPPD?

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Correct answer: B — Low-dose IL-1 inhibition (Anakinra)

IL-1 inhibition with Anakinra has shown promise in refractory acute CPPD attacks and chronic inflammatory CPPD disease in case series and small studies. IL-1 is a key cytokine in crystal-induced inflammation. While not yet licensed for CPPD Anakinra represents a rational targeted approach when conventional therapies fail. Its short half-life (4-6 hours) is advantageous for acute flares. Other options tried include Hydroxychloroquine and low-dose Methotrexate though evidence is limited. There remains no disease-modifying treatment that dissolves CPPD crystals.

Reference: Zhang W et al 2011 EULAR CPPD; Announ N et al 2009 Anakinra in CPPD