Efficacy of anakinra for refractory acute calcium pyrophosphate crystal arthritis
Efficacy of anakinra for refractory acute calcium pyrophosphate crystal arthritis
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DOI：
10.1016/j.jbspin.2012.01.010
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发表时间：
2012-12-01
期刊：
影响因子：
4.2
通讯作者：
Liote, Frederic
中科院分区：
文献类型：
--
作者：
Molto, Anna;Ea, Hang-Korng;Liote, Frederic
由焦磷酸钙（CPP）和尿酸盐晶体沉积诱导的急性滑膜炎涉及白细胞介素-1 β的产生和激活。阻断白细胞介素-1 β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-1 β抗体）对痛风发作的疗效已有充分的记录，但仅在两份CPP晶体诱导的急性关节炎的单一病例报告中报告。在这里，我们报告了5例（4名男性，平均年龄71 +/- 27）CPP晶体诱导的炎性关节炎难治性和/或不耐受常规药物治疗，并有效地治疗阿那白滞素。通过鉴定滑液中的晶体，证实了CPP晶体诱导性关节炎的诊断。CPP晶体诱导的少关节炎（n = 4）和多关节炎（n = 1）是传统治疗，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）难治性。排除潜伏感染后，皮下注射阿那白滞素100 mg/天，持续3天。4例患者在治疗后平均3天显示出快速的临床和生物学反应。阿那白滞素提供了良好的关节疼痛缓解（基线0- 100 mm视觉模拟量表评分60 +/-17 mm，结果10 +/-10 mm）和降低血清C反应蛋白水平（58 +/- 43至5 +/- 2 mg/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。阿那白滞素对急性CPP晶体沉积所致的难治性关节炎的小系列患者有效且安全。(C)2012年法国rhumatologie协会。出版社：Elsevier Masson SAS All rights reserved.
Acute synovitis induced by deposition of calcium pyrophosphate (CPP) and monosodium urate crystals involves interleukin-1 beta production and activation. The efficacy of blocking interleukin-1 beta activity (with an interleukin-1 receptor antagonist [anakinra] or interleukin-1 beta 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 nonsteroidal anti-inflammatory drugs, colchicine and steroids (systemic administration or intra-articular injection). After latent infection was ruled out, anakinra, 100 mg/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 +/- 2 mg/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. (C) 2012 Societe francaise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.