Abstract | BACKGROUND:
ACTH, a member of the melanocortin group of proteins, has long been used in the treatment of gout and is considered as an alternative therapeutic option, especially in difficult-to-treat patients. METHODS: RESULTS: In the studies for acute gout, a total of 266 patients have been treated with ACTH; treatment was highly efficacious with a response rate of 77.9-100%. Only few side effects, such as hyperglycemia, hypokalemia, and edema, were reported, all of which were mild. The available evidence for acute CPP crystal arthritis is limited. A total of 19 patients have been assessed in retrospective studies; the response rate was 90-100%, whereas no significant side effects were recorded. The mechanism of action of ACTH in acute crystal-induced arthritis is not entirely known but seems to extend beyond stimulation of steroid release from the adrenal glands; ACTH is able to stimulate melanocortin receptors on macrophages and downregulate gouty inflammation. CONCLUSIONS: Data suggests that ACTH is effective in acute crystal-induced arthritis and may be a first-line therapy in patients with multiple medical problems. We propose that further evaluation of ACTH should be performed, with a large-scale, randomized controlled study focusing on safety issues in patients with multiple comorbidities.
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Authors | Dimitrios Daoussis, Ioannis Antonopoulos, Andrew P Andonopoulos |
Journal | Seminars in arthritis and rheumatism
(Semin Arthritis Rheum)
Vol. 43
Issue 5
Pg. 648-53
(Apr 2014)
ISSN: 1532-866X [Electronic] United States |
PMID | 24762710
(Publication Type: Journal Article, Review)
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Copyright | © 2013 Published by Elsevier Inc. |
Chemical References |
- Adrenocorticotropic Hormone
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Topics |
- Adrenocorticotropic Hormone
(therapeutic use)
- Arthritis, Gouty
(drug therapy)
- Chondrocalcinosis
(drug therapy)
- Gout
(drug therapy)
- Humans
- Treatment Outcome
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