Therapy with canakinumab for gout

A significant part of patients with gout has contraindications to taking nonsteroidal anti-inflammatory drugs, colchicine and glucocorticoids. Such therapy is often ineffective, particularly in patients with the severe tophaceous gout what hampers treatment of acute arthritis attack assuming the need for other methods of therapy. During the last years several medications have been introduced the mechanism of anti-inflammatory action of which is associated with inhibition of interleukin 1 (IL1) playing a key role in the development of acute gouty arthritis. To date, the most well-studied and the only registered drug for relief of acute arthritis attack is canakinumab, recommended for use in situations where other therapy options are unacceptable. Despite these limitations, the use of IL1 inhibitors, in particular canakinumab, seems promising due to the high efficiency of the drug, the ability to use it in patients with comorbid diseases, as well as a favorable effect on the risk of cardiovascular disease.

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Principles of gout management

10.1093/med/9780199668847.003.0044 ◽

2016 ◽

Author(s):

Pascal Richette

Keyword(s):

Xanthine Oxidase ◽

Interleukin 1 ◽

Serum Urate ◽

Oxidase Inhibitor ◽

Tophaceous Gout ◽

Xanthine Oxidase Inhibitor ◽

Xanthine Oxidase Inhibitors ◽

Inflammatory Drugs ◽

Anti Inflammatory ◽

General Goals

The general goals of gout therapy are to manage acute flares and to prevent recurrences and prevent or reverse the complications of urate deposition by lowering urate levels. The choice of drug should be made on the basis of the patient’s co-morbidities, other medications, and side effect profile. Treatment of flares can be achieved with non-steroidal anti-inflammatory drugs, colchicine, or corticosteroids (systemic or intra-articular). Interleukin-1 blockers could become an alternative in patients contraindicated for traditional anti-inflammatory agents. Lowering of urate levels below monosodium urate (MSU) saturation point with both a non-pharmacological and pharmacological approach allows to dissolve MSU crystals and to cure gout. Serum urate (SUA) levels should be maintained below 6 mg/dL (360 μ‎mol/L) or below 5 mg/dL (300 μ‎mol/L) in patients with severe gout to facilitate faster dissolution of crystals. Urate-lowering therapy (ULT) should be initiated close to the first diagnosis of gout. Allopurinol and febuxostat are the most widely used xanthine oxidase inhibitors to lower SUA levels. If the SUA target cannot be reached by these agents, uricosurics are indicated, either alone or in combination with a xanthine oxidase inhibitor. In patients with severe tophaceous gout in whom the SUA target cannot be reached with any other available drug, pegloticase is indicated. Since ULT initiation may trigger acute attacks of gout, prophylaxis with an anti-inflammatory agent is recommended, mostly with low-dose colchicine. Of note, patient education, appropriate lifestyle advice, and treatment of comorbidities are also important parts of the management of patients with gout.

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Comparison of the natural history of untreated acute gouty arthritis vs acute gouty arthritis treated with non-steroidal-anti-inflammatory drugs [letter]

British Journal of Clinical Pharmacology ◽

10.1111/j.1365-2125.1988.tb03412.x ◽

1988 ◽

Vol 26 (4) ◽

pp. 488-489 ◽

Cited By ~ 15

Author(s):

MH Arnold ◽

SJ Preston ◽

WW Buchanan

Keyword(s):

Natural History ◽

Gouty Arthritis ◽

Acute Gouty Arthritis ◽

History Of ◽

Inflammatory Drugs ◽

Anti Inflammatory

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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

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2011-200908 ◽

2012 ◽

Vol 71 (11) ◽

pp. 1839-1848 ◽

Cited By ~ 204

Author(s):

Naomi Schlesinger ◽

Rieke E Alten ◽

Thomas Bardin ◽

H Ralph Schumacher ◽

Mark Bloch ◽

...

Keyword(s):

Visual Analogue Scale ◽

Adverse Events ◽

Analogue Scale ◽

Treatment Options ◽

Gouty Arthritis ◽

Visual Analogue Scale Pain ◽

Double Blind ◽

Acute Gouty Arthritis ◽

Inflammatory Drugs ◽

Anti Inflammatory

ObjectivesGouty arthritis patients for whom non-steroidal anti-inflammatory drugs and colchicine are inappropriate have limited treatment options. Canakinumab, an anti-interleukin-1β monoclonal antibody, may be an option for such patients. The authors assessed the efficacy/safety of one dose of canakinumab 150 mg (n=230) or triamcinolone acetonide (TA) 40 mg (n=226) at baseline and upon a new flare in frequently flaring patients contraindicated for, intolerant of, or unresponsive to non-steroidal anti-inflammatory drugs and/or colchicine. Core study co-primary endpoints were pain intensity 72 h postdose (0–100 mm visual analogue scale and time to first new flare.MethodsTwo 12-week randomised, multicentre, active-controlled, double-blind, parallel-group core studies with double-blind 12-week extensions (response in acute flare and in prevention of episodes of re-flare in gout (β-RELIEVED and β-RELIEVED-II)).Results82.6% patients had comorbidities. Mean 72-h visual analogue scale pain score was lower with canakinumab (25.0 mm vs 35.7 mm; difference, −10.7 mm; 95% CI −15.4 to −6.0; p<0.0001), with significantly less physician-assessed tenderness and swelling (ORs=2.16 and 2.74; both p≤0.01) versus TA. Canakinumab significantly delayed time to first new flare, reduced the risk of new flares by 62% versus TA (HR: 0.38; 95% CI 0.26 to 0.57) in the core studies and by 56% (HR: 0.44; 95% CI 0.32 to 0.60; both p≤0.0001) over the entire 24-week period, and decreased median C-reactive protein levels (p≤0.0001 at 72 h and 7 days). Over the 24-week period, adverse events were reported in 66.2% (canakinumab) and 52.8% (TA) and serious adverse events were reported in 8.0% (canakinumab) and 3.5% (TA) of patients. Adverse events reported more frequently with canakinumab included infections, low neutrophil count and low platelet count.ConclusionCanakinumab provided significant pain and inflammation relief and reduced the risk of new flares in these patients with acute gouty arthritis.

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Anti-inflammatory activity of curcumin-loaded tetrahedral framework nucleic acids on acute gouty arthritis

Bioactive Materials ◽

10.1016/j.bioactmat.2021.06.003 ◽

2021 ◽

Author(s):

Mei Zhang ◽

Xiaolin Zhang ◽

Taoran Tian ◽

Qi Zhang ◽

Yuting Wen ◽

...

Keyword(s):

Nucleic Acids ◽

Gouty Arthritis ◽

Inflammatory Activity ◽

Tetrahedral Framework ◽

Acute Gouty Arthritis ◽

Anti Inflammatory

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Ozone Therapy Alleviates Monosodium Urate Induced Acute Gouty Arthritis in Rats Through Inhibition of NLRP3 Inflammasome

Current Drug Therapy ◽

10.2174/1574885516666210719092523 ◽

2021 ◽

Vol 16 ◽

Author(s):

Doaa M. Abdullah ◽

Soad L. Kabil

Keyword(s):

Gouty Arthritis ◽

Antioxidant Defense System ◽

Albino Rats ◽

Monosodium Urate ◽

Ozone Therapy ◽

Reference Drug ◽

Acute Gouty Arthritis ◽

Beneficial Effects ◽

Anti Inflammatory ◽

Domain 3

Background: Gout is a metabolic disease strictly related to hyperuricemia. The associated intense inflammation and pain are triggered by the deposited monosodium urate crystals (MSU) in joints. The principal therapeutic strategies of gout involve the control of hyperuricemia and anti-inflammatory medications. Objectives: This study aimed to investigate the possible beneficial effects of ozone therapy, a well-known antioxidant, and an immunomodulation, on gouty arthritis and the underlying mechanisms. Methods : Acute gouty arthritis was induced in male albino rats via MSU crystals intra-articular injection in the ankle joint. The gouty arthritic rats received pre-treatment with ozone, colchicine (as a reference drug), or combination. Results : The obtained results of ozone therapy showed obvious reduction in the degree of ankle edematous swelling, pro-inflammatory cytokines, lipid peroxidation, the nucleotide binding oligomerization domain like receptor containing pyrin domain 3 (NLRP3), procaspase-1, caspase-1, interleukin-1β synovial tissue levels with enhancement of antioxidant defense system. Additionally, ozone therapy significantly attenuated the histological derangements in gouty arthritic rats. Conclusion : This study suggests that ozone is able to treat gouty arthritis and reducing synovial injury through an anti-inflammatory effect as well as antioxidant activity.

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Hyperuricemia and Gout – Ins and Out

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v15i2.50845 ◽

2020 ◽

Vol 15 (2) ◽

pp. 227-234

Author(s):

Md Abdur Razzak ◽

Quazi Audry Arafat Rahman ◽

Fahtiha Nasreen

Keyword(s):

Gouty Arthritis ◽

Polarized Light ◽

Acute Gout ◽

Women Patients ◽

Monosodium Urate ◽

Tophaceous Gout ◽

First Metatarsal ◽

Birefringent Crystals ◽

Inflammatory Drugs ◽

Urate Crystals

Gout is a condition characterized by the deposition of monosodium urate crystals in the joints or soft tissue. The four phases of gout include asymptomatic hyperuricemia, acute gouty arthritis, intercritical gout and chronic tophaceous gout. The peak incidence occurs in patients 30 to 50 years old, and the condition is much more common in men than in women. Patients with asymptomatic hyperuricemia do not require treatment, but efforts should be made to lower their urate levels by encouraging them to make changes in diet or lifestyle. Acute gout most commonly affects the first metatarsal joint of the foot, but other joints are also commonly involved. Definitive diagnosis requires joint aspiration with demonstration of birefringent crystals in the synovial fluid under a polarized light microscope. Treatment includes nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, corticosteroids and analgesics. In patients without complications, NSAID therapy is preferred. JAFMC Bangladesh. Vol 15, No 2 (December) 2019: 227-234

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Peripheral Tramadol in Dentistry: A New Use for an Old Drug

Odovtos - International Journal of Dental Sciences ◽

10.15517/ijds.v0i0.23490 ◽

2016 ◽

Vol 18 (2) ◽

pp. 10

Author(s):

Daniel Chavarría DDS, MSc, PhD ◽

Amaury Pozos DDS, MSc, PhD

Keyword(s):

Adverse Effects ◽

Opioid Receptors ◽

Analgesic Effect ◽

Health Sciences ◽

Analgesic Drug ◽

Orofacial Region ◽

Inflammatory Drugs ◽

Anti Inflammatory ◽

New Perspective ◽

Inflammatory Action

Tramadol is a well known central acting analgesic drug, used in a wide variety of treatments within health sciences; including dentistry. Due to its lack of anti-inflammatory action and some adverse effects related mainly to opioid receptors agonism, it is not use as a routine alternative; keeping mainly for patients allergic to non-steroideal anti-inflammatory drugs or as an adjuvant to manage severe odontogenic pain. Since new available evidence supports the possible analgesic effect of this drug when is applied locally in different sites, recent reports have been done to explore the same effect in the orofacial region, especially to improve the local management of odontogenic pain. This new perspective article summarize some of the current efforts develop to explore the peripheral Tramadol in dentistry; “a new use for an old drug”.

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