Efficacy of anakinra for various types of crystal-induced arthritis in complex hospitalized patients: a case series and review of the literature.
BACKGROUND
There are few data on anakinra use after failure of conventional medications for crystal-induced peripheral arthritis and/or crowned dens syndrome among complex hospitalized patients.


METHODS
We retrospectively analyzed the outcome of six patients affected with subacute crystal-induced arthritis who had received anakinra in second or third line therapy, including three patients with crowned dens syndrome and three others with gouty arthritis. Patients' comorbidities, reasons for anakinra use and associated drugs, and outcomes were recorded.


RESULTS
All patients presented with elevated inflammatory syndrome, systemic symptoms with poly/oligoarthritis. Except for absolute contraindications, all patients were previously treated with full or decreased dose of NSAID, colchicine, and/or glucocorticoids, with unsatisfactory response. All three gouty patients exhibited complete responses in all acute involvements under anakinra within 3 to 5 days, including one of them who needed the reintroduction of colchicine treatment that was previously unsuccessful. Crowned dens syndrome patients, including two with pseudogout and one with subacute hydroxyapatite deposition disease, needed 9 to 11 days to achieve complete response. Tolerance to anakinra was good.


CONCLUSIONS
In case series of complex hospitalized patients, anakinra showed good activity in crowned dens syndrome and associated crystal-induced peripheral arthritis, with longer treatment duration than in gouty arthritis.
Department of Internal Medicine, CHU de Caen, Université de Caen, Basse Normandie, avenue de la Côte de Nacre, Caen, France ; Department of Haematology, Hôpital Necker-Enfants Malades, 149 rue de Sevres, 75015 Paris, France.
A
A
Aouba
Department of Internal Medicine, CHU de Caen, Université de Caen, Basse Normandie, avenue de la Côte de Nacre, Caen, France.
S
S
Deshayes
Department of Haematology, Hôpital Necker-Enfants Malades, 149 rue de Sevres, 75015 Paris, France.
L
L
Frenzel
Department of Pharmacy, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92141 Clamart Cedex, France.
A
A
Decottignies
Department of Pharmacy, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92141 Clamart Cedex, France.
C
C
Pressiat
Department of Internal Medicine, CHU de Caen, Université de Caen, Basse Normandie, avenue de la Côte de Nacre, Caen, France.
B
B
Bienvenu
Department of Internal Medicine, CHU de Caen, Université de Caen, Basse Normandie, avenue de la Côte de Nacre, Caen, France.
F
F
Boue
Department Haematology, CHU de Caen, Université de Caen, Basse Normandie, avenue de la Côte de Nacre, Caen, France.
G
G
Damaj
Department of Haematology, Hôpital Necker-Enfants Malades, 149 rue de Sevres, 75015 Paris, France.
O
O
Hermine
Department of Internal Medicine, Hôpital Tenon, Université Paris 6 Pierre et Marie Curie, DHU I2B, 4 rue de la Chine, 75020 Paris, France.
S
S
Georgin-Lavialle
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001168:Arthritis / Q000188:drug therapy*; D015210:Arthritis, Gouty / Q000188:drug therapy*; D002097:C-Reactive Protein / Q000378:metabolism; D003078:Colchicine / Q000627:therapeutic use; D015897:Comorbidity; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D007249:Inflammation / Q000188:drug therapy; D053590:Interleukin 1 Receptor Antagonist Protein / Q000627:therapeutic use*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D005938:Glucocorticoids; D053590:Interleukin 1 Receptor Antagonist Protein; D002097:C-Reactive Protein; D003078:Colchicine