Thursday, July 5, 2012

Anakinra and Pseudogout (calcium pyrophosphate crystal arthritis) at the EULAR 2012

As the IL-1Ra-Receptor antagonist anakinra hasn’t been a success story in rheumatoid arthritis, the producer has been looking for alternative targets. Calcium pyrophosphate crystal arthritis is one of these targets. I doubt that calcium pyrophosphate crystal arthritis really is an issue. Most patients do fine on NSAIDs, colchicine, oral and/or local corticosteroids. No wonder the study has only n=16.

S. Ottaviani and colleagues looked at the efficacy of anakinra in calcium pyrophosphate crystal arthritis. It is a multi center retrospective study with five centers involved. Only 16 patients were enrolled in the study. Not all patients had a CPP crystal demonstration in synovial fluid, but only X-ray evidence. Anakinra has been effective, but one patient suffered from pyocyanic pneumonitis.

S. Ottaviani1, L. Brunier1, J. Sibilia2, F. Maurier3, K. Dawidowicz1, E. Palazzo1, G. Hayem1, M. Ardizzone4, D. Wendling5, O. Meyer1, P. Dieudé1. 1Rheumatology, Hôpital Bichat, Paris; 2Rheumatology, CHU Strasbourg-Hautepierre, Strabourg; 3Internal Medicine, CH Metz, Metz; 4Rheumatology, CH Mulhouse, Mulhouse; 5Rheumatology, Hôpital Jean Minjoz, Besançon, France
Conclusions: Anakinra is an effective and relatively well-tolerated treatment of refractory CPP arthritis and should be an alternative in individuals having non-response or contra-indication to conventional therapies.

Maybe there will be the one patients with a decade, where I could imagine prescribing anakinra, but still it would be off-label.

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