Background/Purpose: Anakinra is an IL-1 blocking medication used off label to relieve acute inflammation from gout and pseudogout. The efficacy and safety of this treatment in the inpatient setting have not been well evaluated.

Methods: Patients with crystal-induced arthritis who were hospitalized at Oregon Health & Science University (OHSU) Hospital and the VA Portland Health Care System (VA) since 2008 were included. Patient characteristics, comorbidities, medications prior to anakinra use, reason for anakinra use, number of doses of anakinra (one dose was 100 mg subcutaneous injection), adverse events, and response to treatment were analyzed. A response to treatment was defined as a pain score improvement of 2 on a 0-10 pain scale, functional improvement such as ability to bear weight on affected limb when unable to initially, or a documented clinical response such as “great improvement.” For pain improvement, a student’s t test was used to calculate significance.

Results: A total of 79 gout patients were identified who had 101 flares. There were 11 patients with pseudogout who had 14 flares. Three patients had both processes on joint aspiration. The average patient age was 64 (61 at OHSU, 69 at the VA), with an average of 3.9 joints flaring. At both OHSU and the VA around half of all patients had comorbidities such as diabetes, congestive heart failure, and chronic kidney disease that affected the choice of their crystal induced arthritis treatment. At OHSU each patient received an average of 4.6 doses of anakinra, while at the VA the average number of doses of anakinra was 3.3. All of the patients except two had a response to anakinra. Ninety percent of the patients responded within 2 days after initiation of anakinra at both hospitals when evaluating function, pain, and/or clinical response. Anakinra was well tolerated. No adverse reactions to anakinra were reported.

Conclusion: Anakinra is an effective and safe medication for the use of gout and pseudogout in hospitalized patients in the academic and VA settings who have acute crystal induced arthritis, particularly in those who have comorbidities that would limit the use of other acute gout medications.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/utility-of-anakinra-in-acute-crystalline-diseases-a-retrospective-study-comparing-a-university-hospital-with-veterans-affairs-medical-center/