New recommendations from the European League Against Rheumatism (EULAR) suggest 9 areas where doctors can manage calcium pyrophosphate disease, researchers reported here at the 2010 Annual Meeting of EULAR.
"The 9 key recommendations for management of calcium pyrophosphate crystal-associated arthritis were developed using both research evidence and expert consensus," said Thomas Bardin, MD, Hôpital Lariboisiére, Paris, France, who presented the findings of the 15-member expert panel during an oral presentation here on June 18.
The recommendations are as follows:
· Optimal treatment of calcium pyrophosphate disease requires both nonpharmacologic and pharmacological modalities and should be tailored to presentation, general factors such as age and comorbidities, and the presence of a predisposing disorder.
· For acute calcium pyrophosphate crystal arthritis, optimal and safe treatment comprises application of ice or cool packs, temporary rest, joint aspiration, and intra-articular injection of long-acting glucocorticosteroid. For many patients these alone may be sufficient.
· Both oral non-steroidal anti-inflammatory drugs (NSAIDs) -- with gastro protection therapy if indicated -- and low-dose colchicine (0.5 mg up to 4 times a day) are effective symptomatic treatment for acute calcium pyrophosphate crystal arthritis, although their use is limited by toxicity and comorbidities, especially in the elderly.
· A short tapering course of oral glucocorticosteroid or parenteral glucocorticosteroid of adrenocorticotropic hormone may be effective for acute calcium pyrophosphate crystal arthritis that is not amenable to intra-articular glucocorticosteroid injection and are alternatives to colchicine and/or NSAIDs.
· Prophylaxis against frequent recurrent acute calcium pyrophosphate crystal arthritis can be achieved with low-dose colchicines or low-dose oral NSAIDs.
· The management objectives and treatment options for osteoarthritis patients with calcium pyrophosphate disease are the same as those without calcium pyrophosphate disease.
· For chronic calcium pyrophosphate crystal inflammatory arthritis, pharmacological options to consider are oral NSAIDs, colchicines, low-dose corticosteroid, methotrexate, and hydroxychloroquine.
· If detected, associated conditions such as hyperparathyroidism, haemochromatosis, or hypomagnesaemia should be managed as appropriate.
· Currently no treatment is known to modify calcium pyrophosphate crystal formulation or dissolution and no treatment is recommended for asymptomatic calcium pyrophosphate crystal disease.
source: docguide
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