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Acute CPPD Disease — RACP Adult Medicine MCQ

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ModerateRheumatologyAcute CPPD DiseaseRACP Adult Medicine

A 60-year-old man presents with acute onset severe pain and swelling of the right knee. He has a history of chondrocalcinosis on previous X-rays. Synovial fluid shows calcium pyrophosphate crystals. He has CKD stage 4, takes apixaban for AF, and is allergic to NSAIDs. What is the most appropriate treatment for the acute flare?

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Correct answer: E — Intra-articular corticosteroid injection

With monoarticular CPPD disease, intra-articular corticosteroid injection is the safest and most effective option when NSAIDs are contraindicated and systemic corticosteroids are best avoided (CKD – fluid retention risk). Aspiration of the joint (for diagnosis) combined with injection provides both diagnostic and therapeutic benefit. Colchicine is an alternative but requires dose reduction in CKD and has interactions with apixaban via P-glycoprotein.

Reference: eTG – 2025 – Rheumatology; EULAR – 2023 – CPPD Management Recommendations