Revised: April 23, 2013
Accepted: June 1, 2013
Published online: July 12, 2013
Treatment of acute gout is not always an easy task since patients usually have multiple comorbidities that preclude the use of nonsteroidal anti-inflammatory drugs and colchicine, the most widely used therapeutic tools. Adrenocorticotropic hormone (ACTH) has long been used in the treatment of acute gout and several studies have shown that it is highly effective and exhibits an excellent safety profile. ACTH belongs to a family of proteins called melanocortins; these molecules have strong anti-inflammatory properties and serve as natural inhibitors of inflammatory responses. We have recently reported that treatment of acute gout with 100 IU of synthetic ACTH is highly effective and associates with negligible side effects. It is note worthy that ACTH did not associate with significant “steroid related” side effects such as hypertension, hyperglycemia and hypokalemia. ACTH appears as a powerful and easy to use therapeutic tool for patients with multiple comorbidities. We believe that the role of ACTH as a treatment for acute gout should be reappraised, especially in light of new experimental data indicating that ACTH has pleiotropic anti-inflammatory properties and is not just a hormone that stimulates the release of steroids.
Core tip: The treatment of acute gout in patients with multiple comorbodities is problematic. Adrenocorticotropic hormone (ACTH) is an effective, safe and easy to use therapeutic tool for these patients. ACTH is probably the most attractive choice. Evidence suggests that it is safe and does not seem to associate with immunussupperssion; moreover ACTH is a low cost drug at least in Europe.