ACTH as a treatment for acute crystal-induced arthritis: update on clinical evidence and mechanisms of action.

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:

We performed a systematic electronic search (Medline and ScienceDirect) using the keywords gout, treatment, ACTH, adrenocorticotropic hormone, and pseudogout. We identified 5 studies assessing the efficacy of ACTH in acute crystal-induced arthritis.

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.

• 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)
• Copyright: © 2013 Published by Elsevier Inc.

Chemical References

• Adrenocorticotropic Hormone

Topics

• Adrenocorticotropic Hormone (therapeutic use)
• Arthritis, Gouty (drug therapy)
• Chondrocalcinosis (drug therapy)
• Gout (drug therapy)
• Humans
• Treatment Outcome