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Open Access Highly Accessed Research article

A pilot study of IL-1 inhibition by anakinra in acute gout

Alexander So1*, Thibaut De Smedt2, Sylvie Revaz1 and Jürg Tschopp3

Author Affiliations

1 Service of Rhumatologie, Department of Medicine, Centre Hospitalier Universtaire Vaudois and University of Lausanne, 1011 Lausanne, Switzerland

2 Apoxis SA, Avenue de Sévelin 18-20, 1004 Lausanne, Switzerland

3 Institute of Biochemistry, University of Lausanne, chemin de Boveresses 155, 1066 Epalinges, Switzerland

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Arthritis Research & Therapy 2007, 9:R28  doi:10.1186/ar2143

Published: 12 March 2007

Abstract

Monosodium urate crystals stimulate monocytes and macrophages to release IL-1β through the NALP3 component of the inflammasome. The effectiveness of IL-1 inhibition in hereditary autoinflammatory syndromes with mutations in the NALP3 protein suggested that IL-1 inhibition might also be effective in relieving the inflammatory manifestations of acute gout. The effectiveness of IL-1 inhibition was first evaluated in a mouse model of monosodium urate crystal-induced inflammation. IL-1 inhibition prevented peritoneal neutrophil accumulation but TNF blockade had no effect. Based on these findings, we performed a pilot, open-labeled study (trial registration number ISRCTN10862635) in 10 patients with gout who could not tolerate or had failed standard antiinflammatory therapies. All patients received 100 mg anakinra daily for 3 days. All 10 patients with acute gout responded rapidly to anakinra. No adverse effects were observed. IL-1 blockade appears to be an effective therapy for acute gouty arthritis. The clinical findings need to be confirmed in a controlled study.