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While the efficacy and safety of interleukin 1 (IL-1) inhibitors (e.g., anakinra) in the acute management of gout and pseudogout has been repeatedly shown, the cost efficacy of such biologic therapy has rendered it impractical for most. A new retrospective study has shown that IL-1 inhibitors may be effective and appropriate for some medically complex, hospitalized patients with acute gout or calcium pyrophosphate crystal arthritis.
This single center study included 100 inpatients (115 episodes of arthritis) treated for crystal-associated arthritis with anakinra between 2014 and 2017. Most (82%) were male, with an average age of 60 years and had many expected comorbidities included renal disease (45%) and organ transplantation (14%). Nearly 25-30% had perioperative arthritis or concurrent infection.
Responses to anakinra yielded a partial or complete response within 4 days in 75% of patients with 75% of these responding within one day of anakinra administration. Anakinra was otherwise well tolerated.
Anakinra appears to be an effective treatment option for complex, inpatients (e.g., perioperative or immunosuppressed patients) who are refractory to or unable to receive usual therapies for acute crystal-associated arthritis in the hospital.