Department of Rheumatology, Patras University Hospital, University of Patras Medical School, Patras, Greece.
Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41 110, Larissa, Greece.
Rheumatol Int. 2020 Dec;40(12):1941-1947. doi: 10.1007/s00296-020-04659-5. Epub 2020 Jul 26.
Treatment of acute gout consists of non-steroidal anti-inflammatory drugs (NSAIDs), colchicine and steroids. However, the typical patient with gout has multiple comorbidities such as cardiovascular disease, hypertension, renal dysfunction or diabetes/metabolic syndrome that represent contraindications to these therapeutic options. The aim of this study is to review the available evidence regarding the use of ACTH as an alternative therapeutic option for acute gout and explore potential mechanisms of action. We performed an electronic search (MEDLINE, Scopus and Web of Science) using the keywords ACTH or adrenocorticotropic hormone combined with gout or crystal-induced arthritis. ACTH appears suitable for patients with many comorbidities due to its good safety profile. Clinical evidence shows that ACTH is at least as effective as classic agents. The mechanism of action of ACTH in gout is not entirely known. Robust experimental evidence points to the direction that ACTH does not act solely by triggering the release of endogenous steroids but also appears to downregulate inflammatory responses by activating melanocortin receptors on innate immune cells, such as macrophages. Moreover, indirect evidence indicates that ACTH may have an IL-1 antagonistic effect. We propose that ACTH may be an alternative therapeutic option for gout in patients with multiple comorbidities. Large-scale studies assessing the efficacy and safety of ACTH compared to classic therapeutic options are needed.
治疗急性痛风包括非甾体抗炎药（NSAIDs）、秋水仙碱和类固醇。然而，典型的痛风患者有多种合并症，如心血管疾病、高血压、肾功能不全或糖尿病/代谢综合征，这些都代表了这些治疗选择的禁忌症。本研究旨在回顾关于使用 ACTH 作为急性痛风的替代治疗选择的现有证据，并探讨潜在的作用机制。我们使用 ACTH 或促肾上腺皮质激素与痛风或晶体诱导性关节炎相结合的关键词进行了电子搜索（MEDLINE、Scopus 和 Web of Science）。ACTH 由于其良好的安全性，似乎适合患有多种合并症的患者。临床证据表明，ACTH 至少与经典药物一样有效。ACTH 在痛风中的作用机制尚不完全清楚。强有力的实验证据表明，ACTH 不仅通过触发内源性类固醇的释放起作用，而且似乎通过激活先天免疫细胞（如巨噬细胞）上的黑素皮质素受体来下调炎症反应。此外，间接证据表明 ACTH 可能具有 IL-1 拮抗作用。我们提出，ACTH 可能是患有多种合并症的痛风患者的另一种治疗选择。需要进行大规模研究来评估 ACTH 与经典治疗选择相比的疗效和安全性。
