Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland; University College Dublin, Ireland.
Best Pract Res Clin Rheumatol. 2021 Dec;35(4):101720. doi: 10.1016/j.berh.2021.101720. Epub 2021 Oct 28.
In contrast to gout, no disease-modifying therapies currently exist that reduce articular crystal deposition of calcium pyrophosphate crystals (CPPs). Treatment is aimed at ameliorating the inflammatory response and reducing the frequency and severity of clinical symptoms due to CPP deposition (CPPD). Despite being one of the most common forms of inflammatory arthritis, CPPD remains under-studied and evidence-based treatment guidelines remain lacking. Commonly used treatments for clinical manifestations of CPPD (non-steroidal anti-inflammatory drugs [NSAIDs], colchicine and corticosteroids [CSs]) are extrapolated from use in gout. Anakinra and tocilizumab can be used in refractory cases. Though no current crystal-targeted treatments exist, studies suggest that nucleoside analogues and phosphocitrate can attenuate calcification of human cartilage ex-vivo. Hindering research, is the lack of a well-defined description of CPPD. However, international working groups have convened to establish classification criteria and validated outcome domains for CPPD. This should help facilitate the setting up of large multicentre studies, with well-defined cohorts, which can evaluate suitable therapies, providing high levels of evidence to guide clinicians. Here, we summarise and discuss the currently available anti-inflammatory treatment options for CPPD and discuss potential future crystal-targeted approaches.
与痛风相反，目前尚无能够减少焦磷酸钙晶体（CPP）关节结晶沉积的疾病修正治疗方法。治疗的目的是改善炎症反应，减少由于 CPP 沉积（CPPD）引起的临床症状的频率和严重程度。尽管 CPPD 是最常见的炎症性关节炎形式之一，但对其研究仍不足，缺乏基于证据的治疗指南。常用于 CPPD 临床表现的治疗方法（非甾体抗炎药 [NSAIDs]、秋水仙碱和皮质类固醇 [CSs]）是从痛风治疗中推断出来的。对于难治性病例，可以使用阿那白滞素和托珠单抗。虽然目前尚无针对晶体的治疗方法，但研究表明，核苷类似物和膦酸盐可以体外抑制人软骨的钙化。由于缺乏对 CPPD 的明确描述，阻碍了研究的开展。然而，国际工作组已经召集起来，为 CPPD 建立分类标准和验证的结局领域。这应该有助于建立具有明确队列的大型多中心研究，评估合适的治疗方法，提供高水平的证据来指导临床医生。在这里，我们总结和讨论了目前 CPPD 的抗炎治疗选择，并讨论了潜在的未来针对晶体的方法。
