What treatments are there for calcium crystal diseases?
Attacks of acute CPP crystal arthritis or acute calcific tendinitis will usually settle on their own without any treatment. However, because the attacks are so painful and distressing, treatment is usually required to relieve pain, reduce inflammation and speed up recovery.
Your doctor may prescribe non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen or diclofenac, which can help to ease the pain of an acute attack. For the intense pain of an acute attack, these will need to be prescribed at a high dose.
NSAIDs can cause digestive problems (stomach upsets, indigestion or damage to the lining of the stomach), so in most cases they’ll be given along with a drug called a proton pump inhibitor (PPI), which will help to protect your stomach. NSAIDs also carry an increased risk of heart attack or stroke. Although the increased risk is small, your doctor will be cautious about prescribing NSAIDs if there are other factors that may increase your overall risk – for example, smoking, circulation problems, high blood pressure, high cholesterol or diabetes.
Another treatment that's sometime used is colchicine. This drug is also used to treat acute gout and works by reducing the interaction between the crystals and your immune system. The usual dose is 0.5 mg 2–4 times a day, which is usually very effective and well tolerated. The most common side-effect is loose bowel motions, but higher doses can cause more severe diarrhoea.
Joint aspiration and injection
Your doctor may use a needle and syringe to take fluid out of your joint. This is called aspiration, and it can very quickly reduce the high pressure in your joint which is causing the extreme pain. This is a quick, simple procedure that usually brings fast relief. Usually, once the fluid has been drawn out your doctor will inject a small volume (1–2 ml) of a long-acting steroid into your joint through the same needle. This helps to reduce inflammation in the lining of your joint and prevent the build-up of more fluid.
This process can also help if acute calcific tendinitis has caused a large build-up of fluid in the subacromial bursa or subdeltoid bursa.