So Alexander, De Smedt Thibaut, Revaz Sylvie, Tschopp Jürg
Service of Rhumatologie, Department of Medicine, Centre Hospitalier Universtaire Vaudois and University of Lausanne, 1011 Lausanne, Switzerland.
Arthritis Res Ther. 2007;9(2):R28. doi: 10.1186/ar2143.
Monosodium urate crystals stimulate monocytes and macrophages to release IL-1beta through the NALP3 component of the inflammasome. The effectiveness of IL-1 inhibition in hereditary autoinflammatory syndromes with mutations in the NALP3 protein suggested that IL-1 inhibition might also be effective in relieving the inflammatory manifestations of acute gout. The effectiveness of IL-1 inhibition was first evaluated in a mouse model of monosodium urate crystal-induced inflammation. IL-1 inhibition prevented peritoneal neutrophil accumulation but TNF blockade had no effect. Based on these findings, we performed a pilot, open-labeled study (trial registration number ISRCTN10862635) in 10 patients with gout who could not tolerate or had failed standard antiinflammatory therapies. All patients received 100 mg anakinra daily for 3 days. All 10 patients with acute gout responded rapidly to anakinra. No adverse effects were observed. IL-1 blockade appears to be an effective therapy for acute gouty arthritis. The clinical findings need to be confirmed in a controlled study.
尿酸钠晶体通过炎性小体的NALP3成分刺激单核细胞和巨噬细胞释放IL-1β。在NALP3蛋白发生突变的遗传性自身炎症综合征中，IL-1抑制的有效性表明，IL-1抑制在缓解急性痛风的炎症表现方面可能也有效。首先在尿酸钠晶体诱导的炎症小鼠模型中评估了IL-1抑制的有效性。IL-1抑制可防止腹膜中性粒细胞积聚，但TNF阻断无效。基于这些发现，我们对10例无法耐受标准抗炎疗法或标准抗炎疗法无效的痛风患者进行了一项开放性初步研究（试验注册号ISRCTN10862635）。所有患者每天接受100 mg阿那白滞素，共3天。所有10例急性痛风患者对阿那白滞素均迅速产生反应。未观察到不良反应。IL-1阻断似乎是急性痛风性关节炎的一种有效疗法。这些临床发现需要在对照研究中得到证实。
