Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
The Safety and Efficacy of Anakinra in the Treatment of Acute Gout in Hospitalized Patients.
Cho1, Michael, Ghosh3, Pradipta, Hans4, Gurpreet, Rhiannon2, Julia J., Gardner1, Gregory C., Simkin1, Peter A.
The management of acute gout in the hospital setting can be a difficult clinical problem due to co-morbidities that may limit the use of traditional anti-inflammatory medications. The anti-IL1 receptor antagonist, anakinra, has been successful in the treatment of acute/chronic gout in two published series and 4 case reports totaling 24 patients. The purpose of this study was to review our use of anakinra in acute gout in the hospital setting for efficacy of single and multiple courses of anakinra and to investigate any potential safety concerns.
We reviewed our consult records over the past three years to identify patients with acute gout treated with anakinra while hospital inpatients. Data extracted from the charts included age, gender, BMI, co-morbidities, uric acid level, results of arthrocentesis, number of anakinra courses, joint(s) and soft-tissue sites involved, anakinra dosing, time to initial improvement, time to complete resolution of signs and symptoms of inflammation, and any possible side effects in particular infection or leukopenia.
We identified 15 patients with acute gout who had received 22 courses of anakinra. The group consisted of 13 males and 2 females, mean age of 53 years (range 3272 yrs). The major co-morbidities, often in combination, were CKD in 10 patients, DM in 5, CHF in 5, post-solid organ transplant in 2, acute leukemia in 2, and systemic infection in 1. Seven patients had tophaceous disease. The mean BMI was 34.9 (range 22.857.8).
Reasons for choosing anakinra were failure of prophylactic low dose colchicine and therapeutic steroids (oral, IV or IA) to reduce pain and inflammation in 14 courses of anakinra and co-morbid disease limitations in 8. Dosing of anakinra was generally 100 mg subcutaneously daily for 3 days. In 18 of the 22 courses, joint involvement was pauci-polyarticular. Ten patients received 1 course of anakinra and 5 patients had 24 courses during different hospital stays. In 19/22 anakinra courses, patients reported pain improvement (often dramatic) in 1 day or less. In 3/22 courses pain improvement was noted by day 2. In 9/22 courses patients had complete resolution in 5 or less days, 11/22 in 610 days, and in 1/22 it took >10 days for the gouty attack to completely resolve. There was no decrement in response to multiple courses separated by time. There were no cases of anakinra-associated leukopenia but one patient developed a post-operative wound infection 5 days after starting an anakinra course.
Anakinra is an effective therapy for acute gout in hospitalized patients with multiple co-morbidities. It was successful in 14 courses where the patients had no apparent response to steroids. It also appears to be effective in multiple courses in the same patient. Dosing strategies, length of therapy, and positioning of anakinra therapy in this setting are areas that will continue to be investigated. The post-operative wound infection is of concern but of uncertain significance. Use of anakinra in the post-operative period should be considered with caution.
To cite this abstract, please use the following information:
Cho, Michael, Ghosh, Pradipta, Hans, Gurpreet, Rhiannon, Julia J., Gardner, Gregory C., Simkin, Peter A.; The Safety and Efficacy of Anakinra in the Treatment of Acute Gout in Hospitalized Patients. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :163