著者: 桃原茂樹 医療法人社団博恵会 草薙整形外科リウマチクリニック

監修: 竹下克志 自治医科大学整形外科

  1. European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. https://pubmed.ncbi.nlm.nih.gov/21216817/ .参照日(2022年3月30日)
  1. EULAR recommendations for calcium pyrophosphate deposition. Part II: management. https://pubmed.ncbi.nlm.nih.gov/21257614/ .参照日(2022年3月30日)


  1. 高齢化に伴い偽痛風は増加傾向にあり、早期診断、早期治療が推奨される(推奨度2)
  1. 偽痛風はピロリン酸カルシウム結晶によって引き起こされる関節炎であるが、非ステロイド性抗炎症薬(Non-Steroidal Anti-Inflammatory Drug:NSAID)によく反応する(推奨度2)
  1. NSAIDで効果が見られない場合には、ステロイドを用いる(推奨度2)
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧に
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
著者のCOI(Conflicts of Interest)開示:
桃原茂樹 : 講演料(エーザイ株式会社,アステラス製薬株式会社,アッヴィ合同会社,小野薬品工業株式会社,田辺三菱製薬株式会社,中外製薬株式会社,日本イーライリリー株式会社,ファイザー株式会社),企業などが提供する寄付講座(小野薬品工業株式会社,中外製薬株式会社,ニューベイシブジャパン株式会社)[2022年]
監修:竹下克志 : 講演料(第一三共,イーライリリー,ファイザー,エーザイ,塩野義)[2022年]

  1. 定期レビューを行い、McCartyらの分類、診断基準、EULARのリコメンデーションについて加筆修正を行った。



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Ann K Rosenthal, Lawrence M Ryan
Calcium Pyrophosphate Deposition Disease.
N Engl J Med. 2016 Jun 30;374(26):2575-84. doi: 10.1056/NEJMra1511117.
PMID 27355536
D J McCarty
Calcium pyrophosphate dihydrate crystal deposition disease--1975.
Arthritis Rheum. 1976 May-Jun;19 Suppl 3:275-85.
PMID 181010
W Zhang, M Doherty, T Bardin, V Barskova, P-A Guerne, T L Jansen, B F Leeb, F Perez-Ruiz, J Pimentao, L Punzi, P Richette, F Sivera, T Uhlig, I Watt, E Pascual
European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis.
Ann Rheum Dis. 2011 Apr;70(4):563-70. doi: 10.1136/ard.2010.139105. Epub 2011 Jan 7.
Abstract/Text OBJECTIVES: To agree terminology and to develop recommendations for the diagnosis of calcium pyrophosphate deposition (CPPD).
METHODS: The European League Against Rheumatism (EULAR) CPPD Task Force, comprising 15 experts from 10 countries, agreed the terms and recommendations for diagnosis of CPPD using a Delphi consensus approach. Evidence was systematically reviewed and presented in terms of sensitivity, specificity and positive likelihood ratio (LR) to support diagnosis; ORs were used for association. Strength of recommendation (SOR) was assessed by the EULAR visual analogue scale.
RESULTS: It was agreed that 'CPPD' should be the umbrella term that includes acute calcium pyrophosphate (CPP) crystal arthritis, osteoarthritis (OA) with CPPD and chronic CPP crystal inflammatory arthritis. Chondrocalcinosis (CC) defines cartilage calcification, most commonly due to CPPD and detected by imaging or histological examination. A total of 11 key recommendations were generated on the topics of clinical features, synovial fluid (SF) examination, imaging, comorbidities and risk factors. Definitive diagnosis of CPPD relies on identification of SF CPP crystals. Rapid onset inflammatory symptoms and signs are suggestive but not definitive for acute CPP crystal arthritis. Radiographic CC is not highly sensitive or specific, whereas ultrasonography appears more useful (LR=24.2, 95% CI 3.51 to 168.01) for peripheral joints. Recognised risk factors for CPPD include ageing, OA and metabolic conditions such as primary hyperparathyroidism, haemochromatosis and hypomagnesaemia; familial forms are rare. SORs varied from 53 to 99 (maximum 100).
CONCLUSION: New terms for CPPD were agreed and 11 key recommendations for diagnosis of CPPD were developed using research evidence and expert consensus.

PMID 21216817
W Martel, D K McCarter, M A Solsky, A E Good, W R Hart, E M Braunstein, T M Brady
Further observations on the arthropathy of calcium pyrophosphate crystal deposition disease.
Radiology. 1981 Oct;141(1):1-15. doi: 10.1148/radiology.141.1.6270724.
Abstract/Text The arthropathy of calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is distinctive and may affect lumbar spinal and sacroiliac joints, as well as appendicular joints. Subchondral pseudocysts that are a hallmark of the disease have a variable appearance, but often occur as a typical cluster of subchondral, coalescent lucencies with smudged, sclerotic margins. Structural joint collapse with fragmentation of cartilage and bone may occur and appear to be related, at least in some cases, to antecedent pseudocysts. Characteristic intra-articular osteochondral bodies are often extensive and may affect multiple joints; their pathogenesis is discussed. Articular synovial calcification is common and may be due to calcium hydroxyapatite, as well as CPPD, particularly if advanced degenerative changes are present. Recognition of the radiologic features may be encountered in CPPD crystal deposition disease is important for differential diagnosis.

PMID 6270724
W Zhang, M Doherty, E Pascual, V Barskova, P-A Guerne, T L Jansen, B F Leeb, F Perez-Ruiz, J Pimentao, L Punzi, P Richette, F Sivera, T Uhlig, I Watt, T Bardin
EULAR recommendations for calcium pyrophosphate deposition. Part II: management.
Ann Rheum Dis. 2011 Apr;70(4):571-5. doi: 10.1136/ard.2010.139360. Epub 2011 Jan 20.
Abstract/Text OBJECTIVES: To develop evidence-based recommendations for management of calcium pyrophosphate deposition (CPPD).
METHODS: A multidisciplinary guideline development group of 15 experts, representing 10 European countries, generated key propositions for management of CPPD using a Delphi consensus approach. For each recommendation research evidence was searched systematically. Whenever possible, the effect size and number needed to treat for efficacy and RR or OR for side effects were calculated for individual treatment modalities. Strength of recommendation was assessed by the European League Against Rheumatism visual analogue scale.
RESULTS: Nine key recommendations were generated, including topics for general management, treatment of acute attacks, prophylaxis against recurrent acute attacks and management of chronic symptoms. It was recommended that optimal treatment requires both non-pharmacological and pharmacological treatments. For acute CPP crystal arthritis, cool packs, temporary rest and joint aspiration combined with steroid injection are often sufficient. For prophylaxis or chronic inflammatory arthritis with CPPD, oral non-steroidal anti-inflammatory drugs with gastroprotective treatment and/or low-dose colchicine 0.5-1.0 mg daily may be used. Other recommendations included parenteral or oral corticosteroid for acute CPP arthritis in those unresponsive or unsuited to other measures, and low-dose corticosteroid, methotrexate or hydroxychloroquine for chronic inflammatory arthritis with CPPD. Asymptomatic CPPD requires no treatment. Strength of recommendations varies from 79% to 95%.
CONCLUSION: Nine key recommendations for management of CPP crystal associated arthritis were developed using both research evidence and expert consensus. Strength of recommendations was provided to assist the application of these recommendations.

PMID 21257614









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