Pôle appareil locomoteur, fédération de rhumatologie, centre Viggo-Petersen, hôpital Lariboisière, AP-HP, 2 rue Ambroise-Paré, Paris, France.
Joint Bone Spine. 2012 Dec;79(6):621-3. doi: 10.1016/j.jbspin.2012.01.010. Epub 2012 Jun 1.
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.
焦磷酸钙 (CPP) 和单钠尿酸盐晶体沉积引起的急性滑膜炎涉及白细胞介素-1β 的产生和激活。阻断白细胞介素-1β 活性（使用白细胞介素-1 受体拮抗剂[阿那白滞素]或白细胞介素-1β 抗体）对痛风发作的疗效已有充分的文献记载，但仅在两份 CPP 晶体诱导的急性关节炎的个案报告中有所报道。在此，我们报告了五例（男性 4 例，平均年龄 71±27 岁）CPP 晶体诱导的炎症性关节炎患者，这些患者对常规药物治疗无效和/或不耐受，经阿那白滞素治疗后有效。CPP 晶体诱导的关节炎的诊断通过关节滑液中晶体的鉴定得到确认。CPP 晶体诱导的寡关节炎（n=4）和多关节炎（n=1）对常规治疗（包括非甾体抗炎药、秋水仙碱和类固醇[全身给药或关节内注射]）无效。排除潜伏感染后，给予皮下注射阿那白滞素 100mg/天，共 3 天。4 名患者在治疗后平均 3 天内迅速出现临床和生物学反应。阿那白滞素提供了良好的关节疼痛缓解（基线视觉模拟量表评分 0-100mm 为 60±17mm，结果为 10±10mm），并降低了血清 C 反应蛋白水平（58±43 至 5±2mg/L）。阿那白滞素耐受性良好。观察到 1 例注射部位皮肤反应，但无感染。在这项因急性 CPP 晶体沉积导致的难治性关节炎的小系列患者中，阿那白滞素有效且安全。
