Efficacy of anakinra in gouty arthritis: a retrospective study of 40 cases
1 Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, F-75205 Paris, France; AP-HP, Service de Rhumatologie, Hôpital Bichat, 75018 Paris, France
2 Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, F-75205 Paris, France; AP-HP, Service de Rhumatologie, Pôle appareil Locomoteur, Hôpital Lariboisière, F-75475 Paris, France
3 Université René Descartes, Service de Rhumatologie B, Hôpital Cochin, APHP, Paris, France
4 Université René Descartes, Service de Rhumatologie A, Hôpital Cochin, APHP, Paris, France
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 multicenter 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 men; 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 two 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 to 80.0) to 25.0 (20.0 to 32.5) mm, P <0.0001), as was median C-reactive protein (CRP) level (130.5 (55.8 to 238.8) to 16.0 (5.0 to 29.5) mg/l, P <0.0001). After a median follow-up of 7.0 (2.0 to 13.0) months, relapse occurred in 13 patients after a median delay of 15.0 (10.0 to 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.