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Clin Med Insights Arthritis Musculoskelet Disord. 2019 Dec 09;12:1179544119890853. doi: 10.1177/1179544119890853. eCollection 2019.

Patients Prescribed Anakinra for Acute Gout Have Baseline Increased Burden of Hyperuricemia, Tophi, and Comorbidities, and Ultimate All-Cause Mortality.

Clinical medicine insights. Arthritis and musculoskeletal disorders

Ena Sharma, Brian Pedersen, Robert Terkeltaub


  1. Department of Medicine, San Diego Veterans Affairs Healthcare System, San Diego, CA, USA.
  2. Division of Rheumatology, Allergy & Immunology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA.

PMID: 31839715 PMCID: PMC6902385 DOI: 10.1177/1179544119890853


OBJECTIVE: The interleukin-1 (IL-1) receptor antagonist anakinra is an effective, off-label option in acute gout flares, when conventional therapy options are narrowed. We performed a retrospective, randomized, case-controlled study to gain clinical insight on baseline factors for gout patients most likely to receive anakinra, and ultimate mortality of those who received anakinra.

METHODS: Of 1451 gout patients seen between January 2003 and January 2015 in a Veterans Affairs (VA) rheumatology group practice, under stringent managed care principles, 13 (100% male), who received anakinra at least once for flares, were compared with 1:4 age- and sex-matched gout controls. Each patient's first rheumatology encounter was studied by factor analysis for variables associated with later anakinra.

RESULTS: At baseline, patients that received anakinra had higher urate burden (palpable tophi [10/13] vs controls [16/52],

CONCLUSIONS: At baseline rheumatology gout encounter, higher urate, palpable tophi, statin prescription, and East Asian descent were associated with later anakinra use for flares. Mortality was more closely associated to the presence of comorbidities at baseline rheumatology visit than to anakinra prescription.

© The Author(s) 2019.

Keywords: Gout; arthritis; cytokines; hyperuricemia; mortality

Conflict of interest statement

Declaration of conflicting interests:The author(s) declared following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr R.T. has served a


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