Elsevier

Joint Bone Spine

Volume 76, Issue 4, July 2009, Pages 424-426
Joint Bone Spine

Case report
Anakinra is a possible alternative in the treatment and prevention of acute attacks of pseudogout in end-stage renal failure

https://doi.org/10.1016/j.jbspin.2009.01.001Get rights and content

Abstract

We describe the case of a 71-year-old man with recurrent pseudogout attacks affecting multiple joints. He had end-stage renal failure that contra-indicated the use of non-steroidal anti-inflammatory drugs and was resistant to therapy with glucocorticoids. Based on the recent findings that interleukin (IL)-1β is involved in crystal-induced inflammation, the patient received anakinra, a specific IL-1 inhibitor, in order to treat an acute attack of pseudogout. In addition, anakinra was administered as preventive therapy 3 days per week after each hemodialysis session. Under this treatment, he did not present any severe episode of arthritis after a follow-up of 8 months. This observation suggests that anakinra is efficacious and safe for the prevention of crystal-induced arthritis in patients with severe renal failure.

Section snippets

Case report

We describe the case of a 71-year-old man on hemodialysis for end-stage renal failure secondary to hypertensive and diabetic nephropathy. For 18 months, he had a history of several painful acute episodes of arthritis with severe disability leading to several hospitalizations. In addition, he also complained of pain in both wrists and ankles and the left hip. During the latest episode of acute arthritis, C-reactive protein (CRP) levels were elevated at 72 mg/L (normal <10), serum calcium was 2.43 

Discussion

Chondrocalcinosis can cause severe acute attacks of inflammatory arthritis, as well as various forms of chronic arthropathies [7]. Treatments of acute attacks are very similar to those used in gout. However, as opposed to gout, there is no specific long-term therapy for the prevention of acute attacks and of chronic CPPD-associated arthropathies. Thus, the management of chondrocalcinosis is primarily based on symptomatic therapies such as NSAIDs, glucocorticoids (local or systemic), and

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