ACTH revisited: effective treatment for acute crystal induced synovitis in patients with multiple medical problems

To determine the effectiveness of adrenocorticotropic hormone (ACTH) for acute gouty arthritis and pseudogout in a population of patients with multiple coexisting medical problems.

We retrospectively reviewed our experience with parenteral ACTH 40 or 80 units intravenous, intramuscular, or subcutaneous tid with tapering in the treatment of 38 patients. Thirty-three patients had documented acute gout and 5 patients had documented acute pseudogout. A total of 43 episodes of acute crystal induced synovitis were treated. The indications for using ACTH included congestive heart failure, chronic renal insufficiency, gastrointestinal bleeding, or no response to NSAID:

All episodes of pseudogout resolved in an average of 4.2 days. Of the episodes of acute gout, 97% resolved in an average of 5.5 days. Although mild hypokalemia, hyperglycemia, fluid retention and rebound arthritis occurred as adverse effects, none was severe and all were easily controlled.

ACTH is a safe and effective treatment for acute gout and pseudogout, especially in patients with multiple medical problems.