Efficacy of anakinra for refractory acute calcium pyrophosphate crystal arthritis.
Acute synovitis induced by deposition of calcium pyrophosphate (CPP) and monosodium urate crystals involves interleukin-1β production and activation. The efficacy of blocking interleukin-1β activity (with an interleukin-1 receptor antagonist [anakinra] or interleukin-1β antibody) is well documented for gout attacks but has only been reported in two single-case reports of CPP crystal-induced acute arthritis. Here we report on five cases (four males, mean age 71±27) of CPP crystal-induced inflammatory arthritis refractory and/or intolerant to usual drug therapy and efficiently treated with anakinra. Diagnosis of CPP crystal-induced arthritis was confirmed by identification of crystals in synovial fluid. CPP crystal-induced oligo-arthritis (n=4) and polyarthritis (n=1) were refractory to conventional treatments, including non-steroidal anti-inflammatory drugs, colchicine and steroids (systemic administration or intra-articular injection). After latent infection was ruled out, anakinra, 100mg/day, was administered subcutaneously for 3 days. Four patients showed rapid clinical and biological responses at a mean of 3 days after treatment. Anakinra provided good joint pain relief (baseline 0-100mm visual analog scale score 60±17mm, outcome 10±10mm) and decreased serum C-reactive protein level (58±43 to 5±2mg/L). Anakinra was well tolerated. One injection-site skin reaction was observed but no infection. Anakinra was effective and safe in this small series of patients with refractory arthritis due to acute CPP crystal deposition.
Pôle appareil locomoteur, fédération de rhumatologie, centre Viggo-Petersen, hôpital Lariboisière, AP-HP, 2 rue Ambroise-Paré, Paris, France.
Anna
A
Moltó
Hang-Korng
HK
Ea
Pascal
P
Richette
Thomas
T
Bardin
Frédéric
F
Lioté
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001168:Arthritis / Q000188:drug therapy* / Q000378:metabolism*; D002097:C-Reactive Protein / Q000378:metabolism; D002131:Calcium Pyrophosphate / Q000378:metabolism*; D003460:Crystallization; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D053590:Interleukin 1 Receptor Antagonist Protein / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D010147:Pain Measurement; D017472:Receptors, Interleukin-1 / Q000037:antagonists & inhibitors; D016896:Treatment Outcome
D018501:Antirheumatic Agents; D053590:Interleukin 1 Receptor Antagonist Protein; D017472:Receptors, Interleukin-1; D002097:C-Reactive Protein; D002131:Calcium Pyrophosphate