Acute CPP Crystal Arthritis Across Multiple Joints — What to Do When First-Line Therapy Has Not Resolved the Flare

Clinical Scenario

This protocol addresses acute calcium pyrophosphate (CPP) crystal arthritis when more than two joints are affected, or when the involved small joints are not suitable for intra-articular glucocorticoid injection — situations that require systemic anti-inflammatory therapy.

First-Line Treatment Insufficient

When systemic agents — including NSAIDs, oral colchicine, or corticosteroids (oral or intramuscular) — have been trialled and the acute flare has not resolved within 7–14 days, escalation to a further treatment step is indicated. This protocol describes that next step.

Next-Step Approach (Partial Overview)

In refractory acute CPP crystal arthritis, an IL-1 receptor antagonist administered by subcutaneous injection may be used. The full regimen, including administration schedule and clinical decision criteria, is available in the structured protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.3389/fmed.2024.1327715

Systemic anti-inflammatory agents such as NSAIDs, colchicine, and glucocorticoids are indicated when more than two joints are involved or small joints are not suitable for intra-articular glucocorticoid injection.
In patients with refractory acute CPP, arthritis may be treated with anakinra.
Anakinra is an IL-1 receptor antagonist (IL-1Ra) that is administered as a daily 100 mg subcutaneous injection.
Typically, a 3-day regimen has been used to treat acute attacks.

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