Clinical Rheumatology

, Volume 38, Issue 2, pp 425–430 | Cite as

Efficacy and tolerance of anakinra in acute calcium pyrophosphate crystal arthritis: a retrospective study of 33 cases

  • Marion Thomas
  • Marine ForienEmail author
  • Elisabeth Palazzo
  • Philippe Dieudé
  • Sébastien Ottaviani
Original Article


Calcium pyrophosphate (CPP) deposition is a frequent joint disease with increased prevalence in older people in whom treatment of acute CPP arthritis with conventional therapies such as colchicine or non-steroidal anti-inflammatory drugs could be contraindicated or not used at an optimal dose. As recommended in gout, anakinra might represent an alternative treatment for arthritis. We aimed to analyze the efficacy and safety of anakinra in acute CPP arthritis in a large reported series. We retrospectively included all patients receiving anakinra for acute CPP arthritis between January 2011 and 2017. The following data were collected before and 4 days after the first anakinra injection: swollen joint count (SJC), tender joint count (TJC), pain score on a visual analog scale (VAS, 0–100 mm), and C-reactive protein (CRP) level. A good response was defined according the evaluation of the physician. We included 33 patients (24 women; mean age 79.2 ± 12.8 years). The number of good responders was 27 (81.8%). At day 4, patients showed decreased mean VAS pain score (from 64.8 ± 26.5 to 21.2 ± 19.7 mm, p < 0.0001), TJC (5.8 ± 5.0 to 1.0 ± 1.0, p < 0.0001), SJC (3.9 ± 2.7 to 0.9 ± 1.0, p < 0.0001), and CRP level (116.1 ± 71.6 to 26.0 ± 23.1 mg/l, p < 0.0001). Anakinra was well tolerated, without skin complications. Only one patient had pneumonitis that was resolved with oral antibacterial agents. Anakinra could be a relevant alternative for managing acute CPP arthritis when conventional therapies are ineffective or contraindicated.


Acute arthritis Anakinra Calcium pyrophosphate dehydrate Treatment 



We thank Laura Smales (BioMedEditing) for copyediting.

Compliance with ethical standards

The Institutional Review Board (No. 12-011) of Paris North Hospitals approved this study. Written informed consent was obtained from all participants in agreement with French bioethics laws.




  1. 1.
    Richette P, Bardin T, Doherty M (2009) An update on the epidemiology of calcium pyrophosphate dihydrate crystal deposition disease. Rheumatology (Oxford) 48:711–715CrossRefGoogle Scholar
  2. 2.
    Neame RL, Carr AJ, Muir K, Doherty M (2003) UK community prevalence of knee chondrocalcinosis: evidence that correlation with osteoarthritis is through a shared association with osteophyte. Ann Rheum Dis 62:513–518CrossRefGoogle Scholar
  3. 3.
    Zhang W, Doherty M, Bardin T, Barskova V, Guerne P-A, Jansen TL, Leeb BF, Perez-Ruiz F, Pimentao J, Punzi L, Richette P, Sivera F, Uhlig T, Watt I, Pascual E (2011) European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann Rheum Dis 70:563–570CrossRefGoogle Scholar
  4. 4.
    Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castañeda-Sanabria J, Coyfish M, Guillo S, Jansen TL, Janssens H, Lioté F, Mallen C, Nuki G, Perez-Ruiz F, Pimentao J, Punzi L, Pywell T, So A, Tausche AK, Uhlig T, Zavada J, Zhang W, Tubach F, Bardin T (2017) 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 76:29–42CrossRefGoogle Scholar
  5. 5.
    Terkeltaub RA (2009) Colchicine update: 2008. Semin Arthritis Rheum 38:411–419CrossRefGoogle Scholar
  6. 6.
    Martinon F, Pétrilli V, Mayor A, Tardivel A, Tschopp J (2006) Gout-associated uric acid crystals activate the NALP3 inflammasome. Nature 440:237–241CrossRefGoogle Scholar
  7. 7.
    Mitroulis I, Skendros P, Ritis K (2010) Targeting IL-1beta in disease; the expanding role of NLRP3 inflammasome. Eur J Intern Med 21:157–163CrossRefGoogle Scholar
  8. 8.
    Ottaviani S, Moltó A, Ea H-K, Neveu S, Gill G, Brunier L, Palazzo E, Meyer O, Richette P, Bardin T, Allanore Y, Lioté F, Dougados M, Dieudé P (2013) Efficacy of anakinra in gouty arthritis: a retrospective study of 40 cases. Arthritis Res Ther 15:R123CrossRefGoogle Scholar
  9. 9.
    Pascart T, Richette P (2017) Current and future therapies for gout. Expert Opin Pharmacother 18:1201–1211CrossRefGoogle Scholar
  10. 10.
    Sivera F, Wechalekar MD, Andrés M, Buchbinder R, Carmona L (2014) Interleukin-1 inhibitors for acute gout. Cochrane Database Syst Rev 9:CD009993Google Scholar
  11. 11.
    Schlesinger N, Alten RE, Bardin T, Schumacher HR, Bloch M, Gimona A, Krammer G, Murphy V, Richard D, So AK (2012) Canakinumab for acute gouty arthritis in patients with limited treatment options: results from two randomised, multicentre, active-controlled, double-blind trials and their initial extensions. Ann Rheum Dis 71:1839–1848CrossRefGoogle Scholar
  12. 12.
    Couderc M, Mathieu S, Glace B, Soubrier M (2012) Efficacy of anakinra in articular chondrocalcinosis: report of three cases. Joint Bone Spine 79:330–331CrossRefGoogle Scholar
  13. 13.
    Moltó A, Ea H-K, Richette P, Bardin T, Lioté F (2012) Efficacy of anakinra for refractory acute calcium pyrophosphate crystal arthritis. Joint Bone Spine 79:621–623CrossRefGoogle Scholar
  14. 14.
    McGonagle D, Tan AL, Madden J, Emery P, McDermott MF (2008) Successful treatment of resistant pseudogout with anakinra. Arthritis Rheum 58:631–633CrossRefGoogle Scholar
  15. 15.
    Aouba A, Deshayes S, Frenzel L, Decottignies A, Pressiat C, Bienvenu B et al (2015) Efficacy of anakinra for various types of crystal-induced arthritis in complex hospitalized patients: a case series and review of the literature. Mediat Inflamm 2015:792173CrossRefGoogle Scholar
  16. 16.
    Diamantopoulos AP, Brodin C, Hetland H, Haugeberg G (2012) Interleukin 1β blockade improves signs and symptoms of chronic calcium pyrophosphate crystal arthritis resistant to treatment. J Clin Rheumatol 18:310–311CrossRefGoogle Scholar
  17. 17.
    Ottaviani S, Brunier L, Sibilia J, Maurier F, Ardizzone M, Wendling D, Gill G, Palazzo E, Meyer O, Dieudé P (2013) Efficacy of anakinra in calcium pyrophosphate crystal-induced arthritis: a report of 16 cases and review of the literature. Joint Bone Spine 80:178–182CrossRefGoogle Scholar
  18. 18.
    So A, De Smedt T, Revaz S, Tschopp J (2007) A pilot study of IL-1 inhibition by anakinra in acute gout. Arthritis Res Ther 9:R28CrossRefGoogle Scholar
  19. 19.
    Gross O, Yazdi AS, Thomas CJ, Masin M, Heinz LX, Guarda G et al (2012) Inflammasome activators induce interleukin-1α secretion via distinct pathways with differential requirement for the protease function of caspase-1. Immunity 36:388–400CrossRefGoogle Scholar
  20. 20.
    Chen K, Fields T, Mancuso CA, Bass AR, Vasanth L (2010) Anakinra’s efficacy is variable in refractory gout: report of ten cases. Semin Arthritis Rheum 40:210–214CrossRefGoogle Scholar
  21. 21.
    Ghosh P, Cho M, Rawat G, Simkin PA, Gardner GC (2013) Treatment of acute gouty arthritis in complex hospitalized patients with anakinra. Arthritis Care Res 65:1381–1384CrossRefGoogle Scholar
  22. 22.
    Terkeltaub R, Sundy JS, Schumacher HR, Murphy F, Bookbinder S, Biedermann S, Wu R, Mellis S, Radin A (2009) The interleukin 1 inhibitor rilonacept in treatment of chronic gouty arthritis: results of a placebo-controlled, monosequence crossover, non-randomised, single-blind pilot study. Ann Rheum Dis 68:1613–1617CrossRefGoogle Scholar
  23. 23.
    Verhoeven F, Prati C, Godfrin-Valnet M, Guillot X, Wendling D (2013) IL1 blockade in crystal-induced arthritis: impact of disease duration and the inflammatory syndrome. Comments on the article by Couderc M. et al. “Efficacy of anakinra in articular chondrocalcinosis”. Joint Bone Spine 80:115–116CrossRefGoogle Scholar
  24. 24.
    Hung AM, Ellis CD, Shintani A, Booker C, Ikizler TA (2011) IL-1β receptor antagonist reduces inflammation in hemodialysis patients. J Am Soc Nephrol 22:437–442CrossRefGoogle Scholar
  25. 25.
    Thueringer JT, Doll NK, Gertner E (2015) Anakinra for the treatment of acute severe gout in critically ill patients. Semin Arthritis Rheum 45:81–85CrossRefGoogle Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2018

Authors and Affiliations

  • Marion Thomas
    • 1
  • Marine Forien
    • 1
    Email author
  • Elisabeth Palazzo
    • 1
  • Philippe Dieudé
    • 1
  • Sébastien Ottaviani
    • 1
  1. 1.Service de Rhumatologie, Hôpital Bichat, APHPUniversité Paris DiderotParisFrance

Personalised recommendations