Thursday, 25 Apr 2019

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Anakinra for Acute Crystal-Induced Arthritis

A retrospective analysis of hospitalized patients who also had a gout and pseudogout attack shows that injections of anakinra (interleukin-1 receptor antagonist) were highly effective and safe in nearly three-quarters of patients.  

Through a medical records search they found 100 patients and 115 episodes between 2014-2017 who were treated with anakinra for crystal arthritis. 

This population was medically complex, 82% male, average age 60 years, 45% with renal disease (45%), CHF in 43%, 14% with organ transplantation, 22% on anticoagulants and the mean serum creatinine was 1.9 mg/dl. Concurrent infection was present in one-third of the episodes.

Ninety-three of the patients had gout (22 were crystal-proven) and 7 patients had CPPD (5 were crystal-proven). The mean uric acid level during the attacks was 8.6 mg/dl. 

Within 4 days of starting anakinra 84 episodes (73%) had partial or complete response and nearly half (66 episodes) had partial or complete response within one day of anakinra administration.

Anakinra was not dosed in a standard fashion. Variably used it was given as a single dose in 24 episodes; 100mg daily for two doses was given for  13 episodes; 100mg daily for three doses was given for 52 episodes; and 100mg daily for more than three doses was given for eight episodes.

These findings suggest the potential efficacy and safety of of anadata also support the use of this biologic agent in individuals with infections, as well as perioperative individuals and immunosuppressed transplant recipients.

The author has no conflicts of interest to disclose related to this subject

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