Efficacy of anakinra in gouty arthritis: a retrospective study of 40 cases
Arthritis Research & Therapy 2013, 15:R123 doi:10.1186/ar4303Published: 17 September 2013
Gout is a common arthritis that occurs particularly in patients who frequently have associated comorbidities that limit the use of conventional therapies. The main mechanism of crystal-induced inflammation is interleukin-1 production by activation of the inflammasome. We aimed to evaluate the efficacy and tolerance of anakinra in gouty patients.
We conducted a multicentric retrospective review of patients receiving anakinra for gouty arthritis. We reviewed the response to treatment, adverse events and relapses.
We examined data for 40 gouty patients (32 males, mean age 60.0 +/- 13.9 years) receiving anakinra. Mean disease duration was 8.7 +/- 8.7 years. All patients showed contraindications to and/or failure of at least 2 conventional therapies. Most (36; 90%) demonstrated good response to anakinra. Median pain on a 100-mm visual analog scale was rapidly decreased (73.5 [70.0-80.0] to 25.0 [20.0-32.5] mm, P <0.0001), as was median C-reactive protein (CRP) level (130.5 [55.8-238.8] to 16.0 [5.0-29.5] mg/l, P <0.0001). After a median follow-up of 7.0 [2.0-13.0] months, relapse occurred in 13 patients after a median delay of 15.0 [10.0-70.0] days. Seven infectious events, mainly with long-term use of anakinra were noted.
Anakinra may be efficient in gouty arthritis, is relatively well tolerated with short-term use, and could be a relevant option in managing gouty arthritis when conventional therapies are ineffective or contraindicated. Its long-term use could be limited by infectious complications.