Abstract
Calcium pyrophosphate deposition disease (CPPD) is a prevalent cause of inflammatory arthritis in older adults, often complicated by comorbidities that limit standard anti-inflammatory therapies. Despite its burden, evidence for biologic treatments remains limited. Four patients with CPPD, 3 with chronic polyarthritis, and 1 with overlapping gout are presented. All patients were treated with tocilizumab (TCZ) after failure or intolerance to colchicine, non-steroidal anti-inflammatory drugs, or corticosteroids. All patients experienced partial clinical improvement, with reduced inflammation markers and modest reductions in flare frequency or severity. However, corticosteroid dependence persisted in most cases, and the improvement assessment was mostly subjective. Tocilizumab was well tolerated without serious adverse events. Recent reports suggest a potential role for IL-6 blockade in CPPD, yet efficacy remains variable. Comparative studies with Interleukin (IL)-1 inhibitors and emerging data from observational cohorts and pilot trials support further investigation. In conclusion, TCZ may offer clinical benefit in refractory CPPD, while there is a true need for validation in controlled prospective studies.