Anakinra rapidly resolves symptoms in complex cases of gout: Journal of Rheumatology 

USA: Anakinra (Kineret) is an effective and well-tolerated therapy for medically complex, hospitalized patients with acute gout and pseudogout, a recent study published in the Journal of Rheumatology has found.

The researchers observed a rapid response to Anakinra, an interleukin 1 receptor antagonist, with 75% of episodes significantly improving or completely resolving within 4 days of the first dose.

"To our knowledge, this is the largest observational study of anakinra use in the inpatient setting for the acute treatment of crystal-associated arthritis," wrote the authors.

A gout is a form of arthritis caused by a buildup of uric acid crystals around the joints. The condition is characterized by sudden, severe attacks of pain, swelling, redness, and tenderness in the joints, often the joint at the base of the big toe. It affects 2.4% of adults and typically affects the older population.

Pseudogout, also known as calcium pyrophosphate dihydrate crystal deposition disease, is a form of arthritis caused by the deposition of calcium pyrophosphate dihydrate crystal in the joint and surrounding tissues. Its symptoms are similar to gout. Pseudogout causes sudden attacks of joint pain, swelling, and warmth.

Acute gout and pseudogout usually are managed with colchicine, nonsteroidal anti-inflammatory drugs, steroids, or joint injections. These standard therapies, however, are often avoided in patients with comorbid conditions such as chronic kidney disease, heart failure, diabetes, or hypertension.

The interleukin 1–receptor antagonist anakinra (Kineret) sometimes is used off-label in patients with acute crystal disease who cannot be managed with traditional therapy, although access is restricted because of its expense.

This retrospective U.S. study led by Jean W. Liew, University of Washington, Seattle, Washington, USA, aimed to assess the efficacy and safety of anakinra in medically complex, hospitalized patients with acute gout and calcium pyrophosphate crystal arthritis.

The study involved 100 medically complex hospitalized patients (mean age, 60,82% male) with acute gout or pseudogout. Response to anakinra treatment was determined from a review of provider documentation, as well as recorded pain scores on a numeric scale.

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Key findings of the study include:

• Renal disease was present in 45% of patients; 14% had prior organ transplants.


• Twenty-nine episodes of arthritis occurred in the perioperative setting.


• Concurrent infection was present in 34 episodes.


• Eighty-six episodes of arthritis had a partial or complete response to anakinra within 4 days of treatment initiation; 66 episodes had a partial or complete response within 1 day of anakinra administration.


• Anakinra was well tolerated.

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"We observed a rapid response to anakinra, with 75% of episodes significantly improving or completely resolving within 4 days of the first dose. Our data also support the use of this biologic agent in individuals with infections, as well as perioperative individuals and immunosuppressed transplant recipients," concluded the authors.

The study, "Use of Anakinra in Hospitalized Patients with Crystal-associated Arthritis," is published in The Journal of Rheumatology.

DOI: https://doi.org/10.3899/jrheum.181018

Journal Information: The Journal of Rheumatology