Management of treatment resistant inflammation of acute on chronic tophaceous gout with anakinra

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Abstract
We report a 74-year-old man with acute on chronic tophaceous gout in whom conventional treatments failed but who responded to treatment with the interleukin-1 receptor antagonist, anakinra. The patient presented in February 2004 with a severe flare of gout. Multiple joints were swollen, including the right fifth proximal interphalangeal (PIP), the left fourth PIP, and the first metatarsophalangeal (MTP) joints bilaterally. Apart from chronic tophaceous gout, he also had a history of membranous glomerulonephritis (for which he was on prednisolone 5 mg/day), hypertension, and ischaemic heart disease. Allopurinol had previously induced a severe anaphylactic reaction and his renal impairment was exacerbated by non-steroidal anti-inflammatory drugs. On examination, the …
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