title: ACTH as first line treatment for acute gout in 181 hospitalized patients.
abstract: OBJECTIVE
  We aimed at assessing the efficacy and safety of adrenocorticotropic hormone (ACTH) for the treatment of acute gout in hospitalized patients.
  
  
  METHODS
  We retrospectively reviewed our inpatient consultation records and identified 181 cases of gout where ACTH was used as first line treatment. The hospital medical records of these patients were fully reviewed. A total of 181 patients were treated with 1mg of synthetic ACTH intramuscularly.
  
  
  RESULTS
  A response was seen in 77.90% of patients and was evident the day following ACTH injection. The majority of non-responders (87.50%) were treated once more with ACTH the day following the first injection; 82.85% of these patients responded. A relatively small percentage of responders suffered a second gouty attack (11.34%) at a median of four days from the initial attack. They were retreated with a single ACTH course and all responded. Blood pressure and potassium levels remained stable 24 and 48 hours following ACTH administration. Diabetic patients showed an increase in fasting glucose levels 24 hours following the injection compared to baseline but this increase was not evident at 48 hours.
  
  
  CONCLUSIONS
  Our data indicate that ACTH is effective and safe for the treatment of gout in hospitalized patients. ACTH is an attractive therapeutic option for hospitalized patients since the use of non-steroidal anti-inflammatory drugs, steroids or colchicine in this patient population may be problematic.
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Patras University Hospital, University of Patras Medical School, 26504 Rion, Patras, Greece. jimdaoussis@hotmail.com
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Daoussis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Antonopoulos
authors.forename: Georgios
authors.initials: G
authors.lastname: Yiannopoulos
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Andonopoulos
mesh_terms: D000208:Acute Disease; D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage* / Q000009:adverse effects*; D000368:Aged; D015210:Arthritis, Gouty / Q000188:drug therapy* / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006073:Gout / Q000188:drug therapy* / Q000453:epidemiology; D006728:Hormones / Q000008:administration & dosage / Q000009:adverse effects; D006760:Hospitalization; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D006728:Hormones; D000324:Adrenocorticotropic Hormone