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Adrenocorticotropic hormone: an effective "natural" biologic therapy for acute gout?

Dimitrios Daoussis1, Dimitrios P Bogdanos2, Theodoros Dimitroulas3

  • 1Department of Rheumatology, Patras University Hospital, University of Patras Medical School, Patras, Greece. jimdaoussis@hotmail.com.

Rheumatology International
|July 28, 2020
PubMed

Insights

Adrenocorticotropic hormone (ACTH) offers an effective and safe treatment for acute gout, particularly for patients with comorbidities contraindicating traditional therapies like NSAIDs. Further research is needed to confirm its efficacy and safety.

Area of Science:

  • Rheumatology
  • Endocrinology
  • Immunology

Background:

  • Standard acute gout treatments (NSAIDs, colchicine, steroids) are often contraindicated in patients with common comorbidities (cardiovascular disease, hypertension, renal dysfunction, diabetes).
  • There is a need for safer and effective therapeutic alternatives for acute gout in this patient population.

Purpose of the Study:

  • To review existing evidence on the efficacy and safety of adrenocorticotropic hormone (ACTH) for acute gout treatment.
  • To explore the potential mechanisms of action of ACTH in managing gout flares.

Main Methods:

  • Conducted an electronic literature search across MEDLINE, Scopus, and Web of Science.
  • Used keywords including 'ACTH' or 'adrenocorticotropic hormone' combined with 'gout' or 'crystal-induced arthritis'.

Main Results:

  • ACTH demonstrates a favorable safety profile, making it suitable for patients with multiple comorbidities.
  • Clinical evidence suggests ACTH is as effective as conventional gout treatments.
  • Proposed mechanisms include steroid-independent anti-inflammatory effects via melanocortin receptor activation on macrophages and potential IL-1 antagonism.

Conclusions:

  • ACTH presents a promising alternative therapeutic option for acute gout, especially in patients with contraindications to standard therapies.
  • Further large-scale studies are warranted to rigorously assess ACTH's efficacy and safety compared to established treatments.

Keywords:
Adrenocorticotropic hormoneComorbiditiesGoutTreatment

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