ACTH revisited: effective treatment for acute crystal induced synovitis in patients with multiple medical problems.
OBJECTIVE
To determine the effectiveness of adrenocorticotropic hormone (ACTH) for acute gouty arthritis and pseudogout in a population of patients with multiple coexisting medical problems.


METHODS
We retrospectively reviewed our experience with parenteral ACTH 40 or 80 units intravenous, intramuscular, or subcutaneous tid with tapering in the treatment of 38 patients. Thirty-three patients had documented acute gout and 5 patients had documented acute pseudogout. A total of 43 episodes of acute crystal induced synovitis were treated. The indications for using ACTH included congestive heart failure, chronic renal insufficiency, gastrointestinal bleeding, or no response to NSAID:


RESULTS
All episodes of pseudogout resolved in an average of 4.2 days. Of the episodes of acute gout, 97% resolved in an average of 5.5 days. Although mild hypokalemia, hyperglycemia, fluid retention and rebound arthritis occurred as adverse effects, none was severe and all were easily controlled.


CONCLUSIONS
ACTH is a safe and effective treatment for acute gout and pseudogout, especially in patients with multiple medical problems.
Department of Medicine, Mt. Sinai School of Medicine, New York, NY 10029.
J
J
Ritter
L D
LD
Kerr
J
J
Valeriano-Marcet
H
H
Spiera
D000324:Adrenocorticotropic Hormone / Q000009:adverse effects / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D015210:Arthritis, Gouty / Q000150:complications / Q000188:drug therapy*; D002805:Chondrocalcinosis / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000188:drug therapy; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy; D006801:Humans; D007008:Hypokalemia / Q000139:chemically induced; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D013585:Synovitis / Q000188:drug therapy*
D000324:Adrenocorticotropic Hormone