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Inflammatory sciatica due to spinal tophaceous gout.

Dominique Buenzli1, Alexander So

  • 1Centre Hospitalier Universitaire Vaudois, Medicine, Rue de Bugnon, Lausanne, 1011, Switzerland.

BMJ Case Reports
|June 21, 2011
PubMed
Summary
This summary is machine-generated.

Anakinra effectively treated sciatica in a patient with chronic tophaceous gout, resolving pain and inflammation. This interleukin-1 receptor antagonist offers a novel therapeutic option for complex gout-related neurological complications.

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Area of Science:

  • Rheumatology
  • Neurology
  • Pharmacology

Background:

  • Chronic tophaceous gout can present with severe degenerative changes and neurological symptoms like sciatica.
  • Gout-related inflammation can exacerbate spinal stenosis and nerve root compression.
  • Limited treatment options exist for gout patients with sciatica due to contraindications or intolerance to standard therapies.

Purpose of the Study:

  • To evaluate the efficacy of anakinra in managing acute sciatica in a patient with chronic tophaceous gout.
  • To assess the impact of anakinra on inflammatory markers and clinical symptoms in this specific patient population.

Main Methods:

  • A 73-year-old woman with chronic tophaceous gout and acute sciatica underwent radiological assessment (conventional radiology, CT scan).
  • Inflammatory markers (C-reactive protein, ESR, leucocytosis, thrombocytosis) were monitored.
  • Treatment included local steroid infiltration followed by anakinra (100 mg daily for 3 days, then thrice weekly).

Main Results:

  • Radiology revealed severe degenerative changes and tophaceous deposits in the lumbar spine (L3/4, L4/5).
  • Anakinra treatment led to rapid clinical improvement of sciatica and normalization of acute phase response.
  • Sustained anakinra therapy resulted in total resolution of sciatic pain.

Conclusions:

  • Anakinra demonstrated significant efficacy in treating acute sciatica associated with chronic tophaceous gout.
  • This interleukin-1 receptor antagonist provides a viable therapeutic alternative for gout patients intolerant to conventional treatments.
  • Anakinra effectively targets the inflammatory pathways involved in gouty arthritis, alleviating neurological complications.