Background/Purpose:

Gout is the most common inflammatory arthritis worldwide and many patients with gout are ‘complicated’ by multiple comorbidities including metabolic syndrome, renal disease and congestive heart failure (CHF). Treatment of acute gout can be very challenging sometimes, especially in patients with CHF, including those managed with left ventricular assist devices (LVAD), as there are no guidelines or specific recommendations for the treatment of these patients. Due to concerns of LVAD infection, there is often hesitance to administer systemic corticosteroids, and drugs like NSAIDs are often contraindicated in these patients. Recent data has shown that interleukin (IL)-1 antagonism with anakinra is successful in improving acute gout symptoms in critically ill hospitalized patients with comorbid medical conditions. In this study, we aim to evaluate the efficacy and safety of anakinra for the treatment of acute gouty arthritis in a cohort of hospitalized CHF patients including those with LVAD placement.

Methods:

We conducted a retrospective chart review of all patients who had a diagnosis of CHF and received inpatient anakinra for acute gouty arthritis over a three year period at an academic medical center. Data collected included demographics, use of LVAD, other medication use, and clinical response of gout to treatment. Patient’s records were evaluated for up to a month post anakinra exposure for assessment of gout recurrence and adverse events.

Results:

There were 36 hospitalized gouty patients identified, 6 were monoarticular and 30 polyarticular (26 men; mean age 64 ± 17 years, 10 women; mean age 70 ±13) all of whom carried a CHF diagnosis (median EF 40-45%); 5 patients also had LVAD placement. The mean serum uric acid level was 8.9 (1.9-12.5) and the mean serum creatinine in the non-dialysis patients was 2.1 (0.8-4.8). 2 patients were ESRD and receiving hemodialysis. All patients received anakinra 100mg/d for 3 consecutive days for the management of an acute gouty flare. All patients were also noted to have contraindications to and/or failure of conventional acute gout therapies prior the selection of anakinra. Prior therapies primarily consisted of systemic corticosteroids. Most (35; 97%) patients demonstrated a good response (>50% improvement in pain as charted by the clinician) to anakinra within 3 days, with only one person who failed to demonstrate improvement in gouty arthritis symptoms. During the 1 month post observation period, 3 patients experienced a recurrence of gout flare. There was one death in a non-LVAD patient which was attributed to severe heart failure. There were no infections noted in the charts over a 1 month period of follow up for any patient who received anakinra.

Conclusion:

Anakinra has been shown to be efficacious and safe for the management of acute gouty arthritis, and this study suggests that patients with CHF, including those with LVADs, and acute gout may also be an appropriate candidate population for IL- 1 antagonist therapy. As this was a retrospective chart review, a more accurate assessment of safety and efficacy of anakinra in this group of patients warrants a larger prospective study.

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/efficacy-and-safety-of-anakinra-in-congestive-heart-failure-patients-including-lvad-with-acute-gouty-arthritis-a-retrospective-study-of-36-patients-at-an-academic-medical-center/