Table 1.

Management strategies in the treatment of pseudogout.

Strategy	Treatment	Comments
Treating associated metabolic conditions	Decreasing iron overload, treating hypothyroidism	No hard evidence that this improves CPPD-related arthropathy
	Magnesium supplementation	Only indicated in hypomagnesemic states. Otherwise evidence is largely anecdotal
Conventional anti-inflammatory medications	NSAIDs	Symptomatic relief but may be relatively contraindicated in the older population
	Corticosteroids	Excellent symptomatic relief with intra-articular injections. Some evidence for short courses of oral/intramuscular steroids for polyarticular flares
	Colchicine	Acts upstream of the inflammasome and has an emerging role as a prophylactic agent
Anticrystal therapy	Probenecid	Good theoretical rationale but evidence lacking
	Phosphocitrate	Strong evidence from animal studies but no safety or efficacy data in humans
Targeting the inflammasome	Methotrexate	Emerging role in the prevention of recurrent attacks
	Inhibition of IL-1 pathway (anakinra, canakinumab, IL-1 Trap)	May become key agents for refractory polyarticular disease
	Anti-TNFα drugs	Poor efficacy in auto-inflammatory conditions and therefore unlikely to be successful in pseudogout

CPPD, calcium pyrophosphate dehydrate; IL-1, interleukin 1; NSAID, nonsteriodal anti-inflammatory drug; TNFα, tumour necrosis factor α.