Acute calcium pyrophosphate (CPP) crystal arthritis requires a different management strategy when multiple joints are simultaneously inflamed or when affected small joints cannot safely receive a local injection. In these presentations, systemic anti-inflammatory therapy becomes the indicated path.
This protocol applies to acute CPP crystal arthritis where more than two joints are involved, or where the affected joints are small joints not suitable for intra-articular injection. In either case, local treatment alone is insufficient, and a systemic approach is warranted.
Systemic anti-inflammatory agents are the cornerstone of management in this setting. The structured protocol covers the available agent classes and the criteria that guide selection among them — including relevant contraindications and alternative options for patients who cannot tolerate first-choice agents.
Goal: resolution of acute flare within 7–14 days