Session Information
Date: Monday, October 22, 2018
Title: Metabolic and Crystal Arthropathies – Basic and Clinical Science Poster I
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose:
The management of Acute Crystal-Induced Arthritis (ACIA) relies on NSAIDs, colchicine, and glucocorticoids as conventional therapy. In presence of comorbidities (e.g. renal insufficiency, diabetes mellitus, etc.), conventional treatment may be challenging and may lead to poor hospital outcomes. The IL-1 receptor inhibitor anakinra has effectively treated diseases in which the inflammasome plays a main pathogenic role, including ACIA. We studied inpatients with ACIA receiving anakinra at Albany Medical Center compared to conventional therapy to determine differences in pain scores and length of stay.
Methods:
Single center retrospective chart review of ACIA inpatients between January of 2016 and May 2018 was performed. Data collection included demographics, medications, comorbidities, and Visual Analog Pain Scale (VAS-pain). Response to treatment was defined as a decrease in VAS-pain by more than 2 points on a 0-10 scale at 24, 48, and 72 hours. A 1:2 case-control matched pairing (based on demographics, number of joints affected) were selected as controls from the conventional group. A total of 204 patients meeting ACR/EULAR criteria for ACIA were reviewed. Sixteen patients receiving anakinra for ACIA met selection criteria. Thirty-two patients with conventional treatment were matched with the anakinra group. Repeated measures ANOVA was used to compare each group at each time-point of pain assessment. Tukey-Kramer multiple comparisons test was used for post-hoc comparisons.
Results:
All the patients receiving anakinra had a good response, with statistically significant improvement in pain scores compared to the conventional group (p <0.001). Within the anakinra group, pain was significantly improved at 24 hours (p<0.05) and at 48 hours (p<0.001) compared to baseline. The conventional therapy group had significant improvement at 48 hours compared to baseline (p<0.05) but was not significantly improved at 24 hours (p >0.05). Between groups, pain was not different at baseline or at 24 hours (p >0.05) but was at 48 hours (p<0.001). The average length of stay of patients on anakinra was nearly 2 days shorter in comparison to the conventional group. On average, 3.1 doses (95% CI 2.3 – 3.9) of Anakinra 100mg subcutaneously were required for pain relief. There were no significant adverse events noted.
Conclusion:
Anakinra is an effective treatment for ACIA with faster resolution of symptoms compared to conventional therapy prompting a shortened length of stay. Anakinra may be a safe alternative for patients with contraindications to conventional treatment or who may be at high risk for complications from conventional treatment. Further evaluation of these findings in a prospective study may provide more information regarding a role of anakinra in management of ACIA.
Table 1. Patient Characteristics and Outcomes by Conventional Group versus Anakinra Group.
|
Variable |
Conventional Group(n=32) |
Anakinra Group (n =16) |
|
PATIENT CHARACTERISTICS |
||
|
Age, Mean [95% CI] |
63.9 [60.1 – 67.6] |
69.0 [62.3 – 75.7] |
|
Sex, No. [%] |
||
|
Male |
18 [56%] |
10 [63%] |
|
Female |
14 [43%] |
6 [37%] |
|
Race, No. [%] |
||
|
Caucasian |
16 [50%] |
12 [75%] |
|
African American |
11 [34%] |
2 [13%] |
|
Hispanic |
3 [6%] |
1 [6%] |
|
Unknown |
None |
1 [6%] |
|
Crystal Type, No. [%] |
||
|
Uric Acid |
13 [77%] |
9 [56%] |
|
CPPD |
3 [18% |
1 [6%] |
|
Uric Acid + CPPD |
1 [6%] |
None |
|
Flare Duration, Days [95% CI] |
4.4 [2.9-5.9] |
3.3 [2.2 – 4.5] |
|
Diabetes Mellitus, No. [%] |
14 [44%] |
7 [43%] |
|
CKD Stage 2 or Greater, No. [%] |
10 [31%] |
9 [56%] |
|
Uric Acid, Mean [SD] |
7.2 [2.7] |
6.2 [2.2] |
|
Median No. of Joints [Min – Max] |
2 [1 – 6] |
2 [1 – 5] |
|
Mean ESR [95% CI] |
67.1 [55.8 – 78.4] |
54.1 [36.2 – 71.9] |
|
Mean CRP [95% CI] |
101.1 [71.3 – 131] |
146.6 [114 – 179.2] |
|
Renal Function [95% CI] |
||
|
Blood Urea Nitrogen mg/dL |
28.3 [22.7 – 33.9] |
25.4 [19.1 – 31.8] |
|
Serum Creatinine mg/dL |
1.57 [1.22 – 1.92] |
1.81 [0.97 – 2.65] |
|
Glomerular Filtration Rate mL/min/1.73m2 |
45.3 [40.0 – 50.6] |
45.9 [37.0 – 54.8] |
|
OUTCOMES |
||
|
Mean VAS Pain Score [95% CI] |
||
|
Before Treatment |
7.8 [7.1 – 8.4] |
7.9 [6.9 – 8.9] |
|
24 hours after treatmenta |
7.3 [6.6 – 8.1] |
6.3 [5.3 – 7.4] |
|
48 hours after treatmentb,c |
6.7 [5.7 – 7.8] |
4.0 [2.5 – 5.5] |
|
72 hours after treatment |
6.7 [5.7 – 7.6] |
3.1 [1.3 – 4.9] |
|
Mean Length of Stay, Days [95% CI] |
7.7 [5.6 – 9.8] |
5.5 [4.2 – 6.9] |
|
Median doses of Anakinra [Min – Max] ͩ |
None |
3 [1 – 9] |
|
Mean doses of Anakinra [95% CI] |
None |
3.1 [2.3 – 3.9] |
|
Abbreviations: CI, Confidence Interval; SD, Standard Deviation; Min, Minimum; Max, Maximum; ESR, Erythrocyte Sedimentation Rate; CRP, C-Reactive Protein; No, Number; CKD, Chronic Kidney Disease; VAS, Visual Analog Scale; CPPD, Calcium Pyrophosphate Disease a, Anakinra group has significantly lower pain scores than the conventional group at 24 hours (p<0.05) and at 48 hours (p<0.001) b, Conventional group had significantly improved at 48 hours compared to baseline (p<0.05) but was not significantly improved at 24 hours (p>0.05) c, At 48 hours, pain was significantly less in the anakinra group compared to conventional group (p<0.001) d, Only patients in the anakinra group received it at 100 mg subcutaneously daily. |
||
To cite this abstract in AMA style:
Singh S, Ocon A, Mehta V, Musa S, Peredo R. Anakinra Is More Effective at Reducing Pain from Acute Crystal Induced Arthritis When Compared to Conventional Therapy: A Retrospective Review at a Tertiary Care Center [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/anakinra-is-more-effective-at-reducing-pain-from-acute-crystal-induced-arthritis-when-compared-to-conventional-therapy-a-retrospective-review-at-a-tertiary-care-center/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/anakinra-is-more-effective-at-reducing-pain-from-acute-crystal-induced-arthritis-when-compared-to-conventional-therapy-a-retrospective-review-at-a-tertiary-care-center/