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Adrenocorticotropic hormone: an effective “natural” biologic therapy for acute gout?

Rheumatology International volume 40, pages 1941–1947 (2020)Cite this article

Abstract

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.

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Funding

This study was not funded by any source.

Author information

Authors and Affiliations

  1. Department of Rheumatology, Patras University Hospital, University of Patras Medical School, Patras, Greece

    Dimitrios Daoussis & Andrew P. Andonopoulos

  2. Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41 110, Larissa, Greece

    Dimitrios P. Bogdanos & Lazaros Sakkas

  3. 4th Department of Internal Medicine Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Theodoros Dimitroulas

Authors
  1. Dimitrios Daoussis
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  2. Dimitrios P. Bogdanos
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  3. Theodoros Dimitroulas
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  4. Lazaros Sakkas
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  5. Andrew P. Andonopoulos
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Contributions

DD conceived the idea and designed the study, performed the literature search, analyzed data and drafted the manuscript. DB, TD and LS assisted in study design and critically revised the manuscript. AA coordinated the study and assisted in data analysis and manuscript drafting.

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Correspondence to Dimitrios Daoussis.

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DD has received speaking fees and honorarium for participation in the advisory board from Mallinckrodt. All other authors declare no conflict of interest.

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This is a review article. This article does not contain any studies with human participants or animals performed by any of the authors.

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Cite this article

Daoussis, D., Bogdanos, D.P., Dimitroulas, T. et al. Adrenocorticotropic hormone: an effective “natural” biologic therapy for acute gout?. Rheumatol Int 40, 1941–1947 (2020). https://doi.org/10.1007/s00296-020-04659-5

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  • DOI: https://doi.org/10.1007/s00296-020-04659-5

Keywords

  • Gout
  • Treatment
  • Adrenocorticotropic hormone
  • Comorbidities

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