Background/Purpose:

Medically complex individuals may have contraindications to standard therapies for acute arthritis secondary to gout or calcium pyrophosphate disease (CPPD). Observational studies have demonstrated the rapid efficacy of the IL-1 receptor antagonist, anakinra, on acute arthritis attacks. In this retrospective observational study, we demonstrate the efficacy and safety of anakinra in medically complex, hospitalized patients with acute gout and CPPD arthritis.

Methods:

Adult patients treated with anakinra during their admissions from 2014-2017 at two hospitals were identified for inclusion. Charts were reviewed for demographics, comorbidities, serum uric acid level, joint involvement, prior treatment, anakinra dosing, response, and adverse effects, concurrent infections, and surgical interventions. Response to anakinra treatment was determined from review of provider documentation, as well as recorded pain scores on a numeric scale.

Results:

We identified 100 individuals accounting for 115 episodes of arthritis. This population was 82% male, with an average age of 60 years. Comorbidities included renal disease (45%) and history of organ transplantation (14%). Twenty-six episodes of arthritis occurred in the perioperative setting. Concurrent infection was present in 29 episodes.

Joint involvement was monoarticular in 43 episodes, oligoarticular in 56, and polyarticular in 15; one episode presented as a systemic inflammatory response alone. The most commonly involved joints were the knee, ankle, wrist, first metatarsal-phalangeal joint, elbow, and fingers.

Eighty-four episodes of arthritis had partial or complete response to anakinra within four days of treatment initiation; 66 episodes had partial or complete response within one day of anakinra administration. There was only a partial response in seven episodes and no response in six. There was insufficient information to determine the response in 14 episodes.

Side effects included three instances of leukopenia.

Conclusion:

This is the largest observational study of anakinra use in the inpatient setting for the acute treatment of gout or CPPD arthritis. We demonstrated a rapid response to anakinra, with 75% of episodes significantly improving or completely resolving within four days of the first dose. Overall, anakinra was well tolerated. This data supports the use of this biologic agent even in individuals with infections, as well as perioperative individuals, and immunosuppressed transplant recipients

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/use-of-anakinra-in-hospitalized-patients-with-acute-crystalline-arthritis/