Background Anakinra has shown modest efficacy in rheumatoid arthritis and there is proof of principle for its efficacy in gout. Several case reports have suggested it is effective in pseudogout [1-2].
Methods We report a small study of 3 patients treated with anakinra for pseudogout.
Results Three patients, two men and one woman aged 49, 68 and 68 years, respectively, were treated with subcutaneous anakinra 100mg/day for pseudogout. Diagnosis was based on the association of polyarthralgia and typical X-ray features of pseudogout. In two patients, pseudogout was secondary to haemochromatosis. All three patients had previously received non-steroidal anti-inflammatory drugs and colchicine. Two had been treated unsuccessfully with methotrexate. The first patient did not respond to anakinra (delta DAS +0.3) and treatment was discontinued after 3 months. Anakinra was also stopped in the second patient after 2 months, because of lack of response (delta DAS -0.72) and adverse event. In the last patient, after 3 months of treatment, DAS 28 decreased from 4.83 to 2.31 (delta DAS -2.5) and HAQ from 1.5 to 0.875 and anakinra was continued. Significant side-effects occurred with moderate reaction at the site of injection in two patients and interstitial lung disease in one that could have been due to anakinra.
Conclusions In contrast with previous case-reports, this study showed low efficacy of anakinra in pseudogout. The efficacy of Il-1 blockade treatment in pseudogout needs to be confirmed by randomised controlled studies.
McGonagle D, Tan AL, Madden J, Emery P, McDermott MF. Successful treatment of resistant pseudogout with anakinra. Arthritis Rheum. 2008;58:631-3.
Announ N, Palmer G, Guerne PA, Gabay C. Anakinra is a possible alternative in the treatment and prevention of acute attacks of pseudogout in end-stage renal failure.Joint Bone Spine. 2009;76:424-6.
Disclosure of Interest None Declared