Calcium pyrophosphate dihydrate deposition disease is a common and potentially severe metabolic arthropathy. Early disease (in patients </= 60 years old) requires a search for one of the associated metabolic conditions, particularly hemochromatosis. Treatment is primarily symptomatic (no drug is known to prevent the progression of articular destruction). Nonsteroidal anti-inflammatory drugs and intra-articular or systemic glucocorticoids (in small amounts if use is prolonged) are the most useful treatments. Colchicine can be effective to treat recurring pseudogout, and magnesium can be effective on a preventive basis. Methotrexate showed interesting effectiveness in a small, uncontrolled series, and it can be used in the event of failure of the other treatments.