Background/Purpose: The management of acute crystal-induced arthritis in the hospital setting may be a difficult clinical problem due to co-morbidities that limit the use of traditional treatment options.  Anakinra, an anti-IL1 receptor antagonist, has been successful in the treatment of acute/chronic gout in 3 published series and 4 case reports totaling 27 patients and 2 case reports of calcium pyrophosphate dihydrate (CPPD) disease.  We have previously reported our experience with 17 medically complex patients (16 gout, 1 CPPD) who had received 24 courses of anakinra which successfully treated their acute arthritis.  The purpose of this study is to add additional case experience in the use of anakinra in this same population.

Methods: We reviewed our consult records over the past 5 years to identify inpatients with acute crystal-induced arthropathy treated with anakinra.  Data extracted from the charts included age, gender, BMI, co-morbidities, uric acid level, 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 (i.e. infection or leukopenia).

Results: Twenty-six patients who had received 40 courses of anakinra were identified.  Eighteen patients had failed colchicine and/or steroids, and an additional 8 patients were felt not to be candidates for traditional therapy due to co-morbid disease.  None of the patients were candidates for NSAID therapy.  In 29 of the 40 episodes, the arthritis was polyarticular.  Foot and ankle joints were most commonly affected (44.5%) followed by hand and wrist (25%), knees (18.5%), shoulders, elbows and tendons (12%).  Following first dose of anakinra, 67.5% of patients demonstrated significant pain improvement within 24 hours and 85% had significant relief by 48 hours.  Complete resolution of signs and symptoms of gout occurred by day 5 in 72.5%. Seven patients received up to 5 courses with no apparent decrement in response. Anakinra was well–tolerated and no adverse outcomes were attributed to the drug.  Only one patient appeared to be refractory to this form of IL-1 inhibition.

Conclusion: Anakinra is an effective and safe alternative treatment for acute gouty arthritis in medically complex patients who fail or cannot undergo more conventional therapy

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-treatment-of-acute-gouty-arthritis-in-complex-hospitalized-patients-with-anakinra/