Gout (monosodium urate deposition) and calcium pyrophosphate deposition (CPPD) disease cause acute, episodic arthritis and chronic joint damage. Management aims to control inflammation, reduce flares, and — for gout — lower serum urate to dissolve crystal burden.
Gout: urate-lowering therapy
Xanthine oxidase inhibitors remain first-line: allopurinol and febuxostat are both effective at lowering serum urate (febuxostat somewhat more potent per the original comparative trials), though febuxostat carries cardiovascular-risk considerations in some populations. The key expansion is at the refractory/tophaceous end. The uricase pegloticase rapidly clears urate but was long limited by anti-drug antibodies; the MIRROR trial showed that co-administering methotrexate markedly improves response and reduces those antibodies, and the FDA expanded pegloticase's label accordingly — now the standard way to use it. Newer uricase approaches such as SEL-212 (pegadricase paired with a tolerogenic nanoparticle to suppress anti-drug antibodies) have completed Phase 3 trials, and a pipeline of oral URAT1 inhibitors (dotinurad, verinurad, AR882) and next-generation xanthine oxidase inhibitors (tigulixostat) is advancing.
Gout: anti-inflammatory therapy
For flares and prophylaxis, NSAIDs, colchicine, and corticosteroids remain mainstays (a liquid colchicine formulation now aids dosing in renal or hepatic impairment). Canakinumab, an IL-1β inhibitor, is effective for acute and refractory gout when standard options are contraindicated, at the cost of infection risk. Diet, hydration, and weight management remain useful adjuncts.
CPPD disease
CPPD lacks any therapy that removes the crystals, so management is symptom-driven. Acute flares are treated with NSAIDs, colchicine, or corticosteroids (including intra-articular injection for mono/oligoarticular attacks once infection is excluded). Chronic disease may need low-dose colchicine, low-dose steroids, hydroxychloroquine, or methotrexate, and anakinra is useful for refractory acute attacks or chronic CPPD in patients with contraindications to standard therapy. The 2023 EULAR imaging recommendations and the 2023 ACR/EULAR classification criteria have improved diagnosis (ultrasound double-contour sign in gout; chondrocalcinosis in CPPD).
| Condition / phase | Therapies | Comments |
|---|---|---|
| Gout — urate-lowering | Allopurinol, febuxostat; pegloticase (+ methotrexate) for refractory | URAT1 inhibitors and SEL-212 emerging |
| Gout — flare | NSAIDs, colchicine, steroids; canakinumab | Canakinumab for refractory/contraindicated |
| CPPD — acute | NSAIDs, colchicine, steroids (incl. intra-articular) | Exclude septic joint |
| CPPD — chronic/refractory | Colchicine, hydroxychloroquine, methotrexate, anakinra | No crystal-eliminating therapy exists |
Further reading: febuxostat vs allopurinol (Becker et al., NEJM 2005); MIRROR pegloticase-methotrexate and SEL-212 DISSOLVE program; canakinumab in gout (Schlesinger et al.); anakinra in CPPD; 2023 EULAR crystal-arthropathy imaging recommendations.