Acute CPPD Without NSAIDs — SCE Rheumatology MCQ

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EasyCrystal ArthropathyAcute CPPD Without NSAIDsSCE Rheumatology

A 72-year-old woman has an acute monoarticular flare of CPP crystal arthritis affecting the knee. Septic arthritis has been excluded. NSAIDs and colchicine are contraindicated. Which treatment is most appropriate?

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Correct answer: D — Intra-articular glucocorticoid injection

The correct answer is D. For an acute monoarticular CPP crystal arthritis flare, aspiration followed by intra-articular glucocorticoid injection is an appropriate treatment once septic arthritis has been excluded. It is particularly useful when NSAIDs and colchicine are contraindicated. A short course of oral glucocorticoid is an alternative if injection is unsuitable or several joints are affected. Supportive measures such as rest and cool packs may be added but do not preclude anti-inflammatory treatment. Probenecid, allopurinol and febuxostat alter urate handling and are treatments for gout; they neither remove calcium pyrophosphate crystals nor treat an acute CPP flare.

Reference: Zhang W et al. EULAR recommendations for calcium pyrophosphate deposition. Part II: management. Ann Rheum Dis. 2011;70:571–575. https://pubmed.ncbi.nlm.nih.gov/21257614/