From the Division of Rheumatology, Department of Medicine, University of Washington, Seattle, Washington, USA.
J.W. Liew, MD, Division of Rheumatology, Department of Medicine, University of Washington; G.C. Gardner, MD, Division of Rheumatology, Department of Medicine, University of Washington.
J Rheumatol. 2019 Oct;46(10):1345-1349. doi: 10.3899/jrheum.181018. Epub 2019 Jan 15.
In this retrospective observational study, we assess the efficacy and safety of the interleukin 1 receptor antagonist anakinra in medically complex, hospitalized patients with acute gout and calcium pyrophosphate crystal arthritis.
Adult inpatients treated with anakinra from 2014 to 2017 were identified for inclusion. Charts were reviewed for demographics, comorbidities, laboratory data, pain scores, joint involvement, prior treatment, dosing and response to anakinra, concurrent infections, and surgical interventions. Response to anakinra treatment was determined from review of provider documentation, as well as recorded pain scores on a numeric scale.
We identified 100 individuals accounting for 115 episodes of arthritis. This population was 82% male, with an average age of 60 years. Comorbidities included renal disease (45%) and history of organ transplantation (14%). Twenty-nine episodes of arthritis occurred in the perioperative setting. Concurrent infection was present in 34 episodes. Eighty-six episodes of arthritis had partial or complete response to anakinra within 4 days of treatment initiation; 66 episodes had partial or complete response within 1 day of anakinra administration. Anakinra was well tolerated.
To our knowledge, this is the largest observational study of anakinra use in the inpatient setting for the acute treatment of crystal-associated arthritis. We observed a rapid response to anakinra, with 75% of episodes significantly improving or completely resolving within 4 days of the first dose. Our data also support the use of this biologic agent in individuals with infections, as well as perioperative individuals and immunosuppressed transplant recipients.
在这项回顾性观察研究中，我们评估了白细胞介素 1 受体拮抗剂阿那白滞素在患有急性痛风和焦磷酸钙晶体关节炎的复杂住院患者中的疗效和安全性。
纳入了 2014 年至 2017 年接受阿那白滞素治疗的成年住院患者。对病历进行了回顾，以了解患者的人口统计学、合并症、实验室数据、疼痛评分、关节受累情况、既往治疗、阿那白滞素的剂量和反应、同时存在的感染以及手术干预情况。根据医生的记录和数字评分记录的疼痛评分，来确定对阿那白滞素治疗的反应。
我们确定了 100 名患者，共 115 例关节炎发作。该人群中 82%为男性，平均年龄为 60 岁。合并症包括肾脏疾病（45%）和器官移植史（14%）。29 例关节炎发作发生在围手术期。同时存在 34 例感染。86 例关节炎在开始治疗后 4 天内出现部分或完全缓解；66 例关节炎在阿那白滞素给药后 1 天内出现部分或完全缓解。阿那白滞素耐受良好。
据我们所知，这是最大规模的阿那白滞素在住院患者中用于治疗急性晶体相关性关节炎的观察性研究。我们观察到阿那白滞素快速起效，75%的发作在首次给药后 4 天内显著改善或完全缓解。我们的数据还支持在感染患者、围手术期患者和免疫抑制移植受者中使用这种生物制剂。
