Overview of contraindications to and potential adverse effects of medications commonly used to treat crystalline arthropathy

Medication	Contraindications	Potential adverse effects
Intraarticular glucocorticoids^*	Concern for concurrent septic joint Known allergy or intolerance	Bleeding or damage to tissue near the procedure site Iatrogenic septic arthritis Local post-injection flare Facial flushing May cause transient systemic adverse effects (eg, hyperglycemia)
Systemic glucocorticoids^¶	Brittle diabetes mellitus Recent surgery with unhealed wound Concern for concurrent infection Known allergy or intolerance	Gastritis Fluid retention and weight gain Hypertension Hyperglycemia Immunosuppression Insomnia
NSAIDs^Δ	Chronic kidney disease (especially with an eGFR <60 mL/min/1.73 m²) Hyperkalemia Duodenal or gastric ulcer Poorly controlled hypertension Moderate to severe or uncompensated heart failure Cirrhosis Unmodifiable drug interaction (eg, anticoagulation) Known allergy or intolerance	Gastritis and gastrointestinal bleeding^◊ Nephritis Increased risk of cardiovascular events (eg, myocardial infarction, stroke)
Colchicine	Combined kidney and hepatic impairment Kidney or hepatic impairment with concurrent or very recent use of certain medications^§ Known allergy or intolerance	Gastrointestinal symptoms (eg, diarrhea, abdominal pain, nausea, vomiting) Rarely, more severe toxicities (eg, blood cytopenias, rhabdomyolysis, myopathy, peripheral neuropathy, liver failure)
Anti-interleukin 1 (IL-1) therapy (eg, anakinra, canakinumab)^¥	Concern for concurrent infection Known allergy or intolerance	Immunosuppression Injection site reactions Hepatitis Neutropenia

To be used with UpToDate content on treatment of gout, calcium pyrophosphate crystal deposition disease (CPPD), and adverse effects of glucocorticoids and NSAIDs.

eGFR: estimated glomerular filtration rate; NSAID: nonsteroidal antiinflammatory drug.

* Refer to UpToDate content on complications of joint aspiration and injection in adults.

¶ Risk of potential adverse effects depends on dosing and duration. Refer to UpToDate content on adverse effects of systemic glucocorticoids.

Δ Refer to UpToDate content on adverse effects of NSAIDs.

◊ Risk factors include expectation of a prolonged treatment course (eg, crystalline arthropathy flare lasting >48 hours), history of peptic ulcer or gastrointestinal bleeding, age >65 years, and concurrent use of aspirin or glucocorticoids. Refer to UpToDate content on primary and secondary prevention of gastroduodenal toxicity in patients taking NSAIDs.

§ Medications include strong inhibitors of cytochrome P450 3A4 and inhibitors of the P-glycoprotein multidrug resistance transporter. Refer to UpToDate content on the treatment of gout flares for examples.

¥ Refer to UpToDate content on overview of biologic agents in the rheumatic diseases.

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خرید پکیج

Overview of contraindications to and potential adverse effects of medications commonly used to treat crystalline arthropathy