ACTH as a treatment for acute crystal-induced arthritis: update on clinical evidence and mechanisms of action.
BACKGROUND
ACTH, a member of the melanocortin group of proteins, has long been used in the treatment of gout and is considered as an alternative therapeutic option, especially in difficult-to-treat patients.


METHODS
We performed a systematic electronic search (Medline and ScienceDirect) using the keywords gout, treatment, ACTH, adrenocorticotropic hormone, and pseudogout. We identified 5 studies assessing the efficacy of ACTH in acute crystal-induced arthritis.


RESULTS
In the studies for acute gout, a total of 266 patients have been treated with ACTH; treatment was highly efficacious with a response rate of 77.9-100%. Only few side effects, such as hyperglycemia, hypokalemia, and edema, were reported, all of which were mild. The available evidence for acute CPP crystal arthritis is limited. A total of 19 patients have been assessed in retrospective studies; the response rate was 90-100%, whereas no significant side effects were recorded. The mechanism of action of ACTH in acute crystal-induced arthritis is not entirely known but seems to extend beyond stimulation of steroid release from the adrenal glands; ACTH is able to stimulate melanocortin receptors on macrophages and downregulate gouty inflammation.


CONCLUSIONS
Data suggests that ACTH is effective in acute crystal-induced arthritis and may be a first-line therapy in patients with multiple medical problems. We propose that further evaluation of ACTH should be performed, with a large-scale, randomized controlled study focusing on safety issues in patients with multiple comorbidities.
Division of Rheumatology, Department of Internal Medicine, Patras University Hospital, University of Patras Medical School, 26504 Rion, Patras, Greece. Electronic address: jimdaoussis@hotmail.com.
Dimitrios
D
Daoussis
Division of Rheumatology, Department of Internal Medicine, Patras University Hospital, University of Patras Medical School, 26504 Rion, Patras, Greece.
Ioannis
I
Antonopoulos
Division of Rheumatology, Department of Internal Medicine, Patras University Hospital, University of Patras Medical School, 26504 Rion, Patras, Greece.
Andrew P
AP
Andonopoulos
D000324:Adrenocorticotropic Hormone / Q000627:therapeutic use*; D015210:Arthritis, Gouty / Q000188:drug therapy*; D002805:Chondrocalcinosis / Q000188:drug therapy*; D006073:Gout / Q000188:drug therapy*; D006801:Humans; D016896:Treatment Outcome
D000324:Adrenocorticotropic Hormone
ACTH; Crystal-induced arthritis; Gout; Pseudogout; Treatment