ACTH vs steroids for the treatment of acute gout in hospitalized patients: a randomized, open label, comparative study

Daoussis, Dimitrios; Kordas, Panagiotis; Varelas, George; Michalaki, Marina; Onoufriou, A.; Mamali, Irene; Iliopoulos, George; Μελισσαρόπουλος, Κωνσταντίνος; Ntelis, Konstantinos; Velissaris, Dimitrios; Tzimas, Giannis; Georgiou, Panagiotis; Vamvakopoulou, Sofia; Paliogianni, Fotini; Andonopoulos, Andrew P.; Georgopoulos, Neoklis A.

doi:10.1007/s00296-022-05128-x

Cited by 3 publications

(4 citation statements)

References 35 publications

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“…Интересно, что одним из первых препаратов, которые доказали свою эффективность при симптоматическом лечении подагры, был АКТГ, причем еще до внедрения в рутинную клиническую практику ГК [14]. Более того, опубликованы данные, что однократная инъекция АКТГ для купирования острого приступа подагрического артрита не уступает в эффективности таковой для ГК [15]. Но если до последнего десятилетия применение ГК при подагре ограничивалось, как правило, их рутинным использованием для купирования острых приступов артрита, то в последние годы они, наряду с колхицином и НПВП, назначаются длительно в низких дозах с целью профилактики приступов [16], что снижает не только их частоту, но и интенсивность, тем самым «стирая» характерные для подагры симптомы артрита (сильнейшая боль, ограничение функции, гиперемия и гипертермия и т.д.)…”

Section: Discussionunclassified

The course of gout in a patient with Cushing’s disease after successful surgical treatment

Dzeranova

Елисеев²,

Golounina

et al. 2023

Obes. metabol.

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Endogenous hypercortisolism is a severe endocrine disease characterized by prolonged exposure to excessive amounts of glucocorticoid hormones, accompanied by a wide range of symptoms and complications, including immunosuppression. Timely surgical treatment in most cases allows to save the patient’s life, significantly improve its quality. However, restoration of the normal concentration of glucocorticoid hormones can become a trigger factor in the development or exacerbation of autoimmune and auto-inflammatory diseases. We present a clinical case of atypical gout in a patient with hypercortisolism and a progressive increase in symptoms of the disease after successful surgical treatment for Cushing’s disease and achieving stable remission. The issues of diagnosis and treatment of this group of autoinflammatory diseases are highlighted, the leading clinical and radiological symptoms are considered, the differential diagnosis of microcrystalline (metabolic) arthritis is presented. Despite the widespread, the diagnosis and treatment of this group of diseases still cause difficulties for specialists. A competent choice of drug therapy allows to fully control diseases considered in the article, including when they are combined, and thereby improve the quality of life of the patient.

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Section: Discussionunclassified

The course of gout in a patient with Cushing’s disease after successful surgical treatment

Dzeranova

Елисеев²,

Golounina

et al. 2023

Obes. metabol.

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“…Several studies have demonstrated that treatment with ACTH is efficacious in the management of gout flares [105][106][107][108]. Although this was largely presumed to be due to the role of ACTH in stimulating production of glucocorticoids, studies in rats demonstrated that a dose of ACTH which had no effect on circulating corticosterone levels was still able to suppress MSU crystal-induced inflammation, indicating that ACTH can exert antiinflammatory effects independently of corticosteroids [104].…”

Section: Acth Mshs the Nlrp3 Inflammasome And Goutmentioning

confidence: 99%

Circadian Rhythms in NLRP3 Inflammasome Regulation: Possible Implications for the Nighttime Risk of Gout Flares

Poulsen,

Dalbeth

2024

GUCDD

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Gout flares more frequently start late at night or in the early morning compared to during the day. The reasons for this are unknown. Activation of the NLRP3 inflammasome in monocytes/macrophages is central to initiation of gout flares. Here, we review the mechanisms by which circadian clocks control the NLRP3 inflammasome and the implications of this for the nighttime pattern of gout flares. Several hormones involved in inflammation regulation, e.g., glucocorticoids, melatonin and melanocortins, are under circadian control, with both circulating hormone levels as well as the expression of their receptors on target tissues showing time-of day differences. In addition, the NLRP3 inflammasome is also under the control of the macrophage circadian clock, leading to time-of-day differences in expression of NLRP3 inflammasome components and susceptibility to inflammasome-activating stimuli. MSU crystal exposure leads to altered expression of circadian clock components in macrophages, leading to time-of-day-specific loss of repression of NLRP3 inflammasome activity. Taken together, there is clear evidence that circadian clocks regulate the NLRP3 inflammasome and that this regulation may be compromised by MSU crystal exposure in gout. Circadian control of the inflammasome may be one of the factors contributing to nighttime susceptibility to gout flares.

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“…77.9% responded well with no serious side effects related to ACTH treatment. We then went further to compare ACTH with betamethasone intramuscular injection use for acute gout events in 38 patients hospitalized for whatever reason [86]. This is the first prospective study regarding the use of ACTH in gout.…”

Section: Acth and Goutmentioning

confidence: 99%

“…Nguyen et al [16], Sharon et al [17] and Nelson et al [18] eye uveitis Bryan et al [20] eye optic neuritis Wirta et al [21] eye keratitis Anesi et al [22] eye retinal vasculitis Cusick et al [38], Kaplan et al [39], [40], Hunter et al [41] nervous system multiple sclerosis Chugani et al [44], Knupp et al [45], O'Callaghan et al [47], Yin et al [50] pediatrics infantile spasms Gills et al [55], Fleischmann et al [57] musculoskeletal rheumatoid arthritis Furie et al [66,67], Askanase et al [68,69] musculoskeletal sle Aggarwal et al [74] musculoskeletal inflammatory myopathy Baughman et al [75], Chopra et al [76], Rahaghi et al [77] musculoskeletal sarcoidosis Daoussis et al [85], [86], Xu et al [91] musculoskeletal gout…”

Section: Diseasementioning

confidence: 99%

Fda-Approved Indications of Adrenocorticotropic Hormone (Acth) as a Drug: Does It Have a Place in Disease Management Today?

Iliopoulos

Daoussis

2023

CAJMHE

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ACTH is a pituitary hormone important for proper function of adrenal glands, cortisol production as well as human physiology in general. It is involved in the pathogenesis of several endocrine disorders like Cushing syndrome and can be a useful diagnostic tool for diseases like primary adrenal insufficiency. Although popular as a hormone in endocrine system physiology and testing, ACTH has been used as a drug since the 1950s. Except for steroid-releasing properties, its mechanism of action involves a steroid-independent anti-inflammatory and possible immune-modulatory effect. Pharmaceutic ACTH has a wide range of indications approved by FDA and usually comes in the form of subcutaneous injections. In this narrative review, we accumulated what we considered as important data from reviews, cases and trials involving the most basic FDA-approved ACTH indications. A special emphasis was given on rheumatologic indications of ACTH. More large data studies need to be performed to assess ACTH usefulness, efficacy, safety and cost-effectiveness as a drug.

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ACTH vs steroids for the treatment of acute gout in hospitalized patients: a randomized, open label, comparative study

Cited by 3 publications

References 35 publications

The course of gout in a patient with Cushing’s disease after successful surgical treatment

The course of gout in a patient with Cushing’s disease after successful surgical treatment

Circadian Rhythms in NLRP3 Inflammasome Regulation: Possible Implications for the Nighttime Risk of Gout Flares

Fda-Approved Indications of Adrenocorticotropic Hormone (Acth) as a Drug: Does It Have a Place in Disease Management Today?

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