Background Gout is a common arthritis that occurs particularly in subjects who have frequently associated comorbidities. These comorbid conditions could limit the use of conventional therapies (e.g. colchicine, non-steroidal anti-inflammatory drugs and/or corticosteroids).
Objectives The aim of the herein study was to evaluate the efficacy and tolerance of anakinra in patients with urate crystal-induced arthritis.
Methods We performed a multicentric retrospective chart review of patients who received anakinra for gouty arthritis. Demographic information, comorbidities, co-medication, treatment outcomes, adverse event and subsequent flares were recorded. The change of pain (VAS 0-100 mm) and CRP levels were evaluated at baseline and after 3 days of SC injections of anakinra (100 mg). The outcome of anakinra treatment was categorized as: good response (> 50% of improvement of VAS pain and CRP level), partial response (20 to 50% of improvement), or no response.
Results A total of 36 patients (29 males, mean age: 60.4 ± 13.4 years) who were treated by anakinra for gouty arthritis were included. The mean disease duration was 9.3 ± 9.0 years. All patients had contraindication and/or failure to at least two conventional therapies. The majority (33 [91.7%]) of patients demonstrated a good response to anakinra therapy. IL-1 blockade led to a strong and rapid decrease of VAS pain (72.5 [70.0-80.0] to 20.0 [20.0-30.0] mm, P <0.0001) and CRP level (130.5 [62.3-239.5] to 18.0 [5.0-29.5] mg/l, P <0.0001). After a median follow-up of 7.5 [2.0-12.3] months, a relapse occurred in 12 (33.3%) patients with a median delay to relapse of 22.5 [13.8-97.5] days. Relapse occurred more frequently in patients without prevention of acute flare (P=0.014). None patient under anakinra for long-term use relapsed. Seven infections were noted and no case of neutropenia was observed.
Conclusions Our results confirm that anakinra is efficient in gouty arthritis, relatively well tolerated and could be a relevant alternative in the management of gouty arthritis, particularly in patients for whom conventional therapies are ineffective or contra-indicated.
Disclosure of Interest None Declared