Pascart Tristan, Richette Pascal, Flipo René-Marc
Department of Rheumatology, Saint-Philibert Hospital, Service de Rhumatologie, Lille Catholic University, rue du Grand But, 59160 Lomme, France ; Department of Rheumatology, Roger Salengro Hospital, Lille 2 University, rue Emile Laine, 59037 Lille Cedex, France.
Federation of Rheumatology, Lariboisiere Hospital, Assistance Publique-Hopitaux de Paris, UFR Medicale, Paris 7 University, 75475 Paris Cedex 10, France.
Arthritis. 2014;2014:375202. doi: 10.1155/2014/375202. Epub 2014 May 8.
This update develops the actual therapeutic options in the management of the joint involvement of calcium pyrophosphate deposition disease (CPPD), basic calcium phosphate (BCP) deposition disease, hemochromatosis (HH), ochronosis, oxalosis, and Wilson's disease. Conventional pharmaceutical treatment provides benefits for most diseases. Anti-interleukine-1 (IL-1) treatment could provide similar results in CPPD than in gout flares. There is only limited evidence about the efficacy of preventive long-term colchicine intake, methotrexate, and hydroxychloroquine in chronic CPPD. Needle aspiration and lavage have satisfactory short and midterm results in BCP. Extracorporeal shockwave therapy has also proved its efficacy for high-doses regimes. Phlebotomy does not seem to have shown real efficacy on joint involvement in HH so far. Iron chelators' effects have not been assessed on joint involvement either, while IL-1 blockade may prove useful. NSAIDs have limited efficacy on joint involvement of oxalosis, while colchicine and steroids have not been assessed either. The use of nitisinone for ochronotic arthropathy is still much debated, but it could provide beneficial effects on joint involvement. The effects of copper chelators have not been assessed either in the joint involvement of Wilson's disease. NSAIDs should be avoided because of the liver affection they may worsen.
本次更新阐述了焦磷酸钙沉积病（CPPD）、碱性磷酸钙（BCP）沉积病、血色素沉着症（HH）、褐黄病、草酸盐沉积症和威尔逊氏病关节受累的实际治疗选择。传统药物治疗对大多数疾病都有疗效。抗白细胞介素-1（IL-1）治疗在CPPD中可能产生与痛风发作时相似的效果。关于预防性长期服用秋水仙碱、甲氨蝶呤和羟氯喹在慢性CPPD中的疗效，仅有有限的证据。针吸和灌洗在BCP中具有令人满意的短期和中期效果。体外冲击波疗法在高剂量方案中也已证明其疗效。放血疗法迄今似乎并未显示出对HH关节受累有实际疗效。铁螯合剂对关节受累的影响也未得到评估，而IL-1阻断可能证明是有用的。非甾体抗炎药（NSAIDs）对草酸盐沉积症关节受累的疗效有限，秋水仙碱和类固醇也未得到评估。对于褐黄病性关节病使用尼替西农仍存在很多争议，但它可能对关节受累产生有益影响。铜螯合剂对威尔逊氏病关节受累的影响也未得到评估。由于可能会加重肝脏损害，应避免使用NSAIDs。
