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| Patients | Crowned dens syndrome and associated peripheral crystal-induced arthritis | Polyarticular gout |
| Patient 1 | Patient 2 | Patient 3 | Patient 4 | Patient 5 | Patient 6 |
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| Age/gender | 65/F | 88/F | 84/F | 66/M | 71/M | 72/F |
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| Background condition | Pseudogout | Hydroxyapatite deposition disease (HADD) | Pseudogout (associated with HADD iconographic picture) | Gout with tophus | Gout | Gout |
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| Comorbid conditions | Hypothyroidism | Essential arterial hypertension; hypothyroidism | Suspected Horton disease, postsurgical staphylococcal infected ingrown nail | Essential arterial hypertension; severe chronic renal insufficiency | Diabetes; grade 4 neutropenia to colchicine; polycythemia vera treated with hydroxyurea and allopurinol | Obesity; essential arterial hypertension; mild renal insufficiency; MGUS; allergy to allopurinol; prolymphocytic leukemia treated with pentostatin |
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| Diagnosis | Crowned dens syndrome
Pseudorheumatoid arthritis | Crowned dens syndrome
Intra-articular acute HADD | Crowned dens syndrome, temporomandibular and peripheral pseudogout and/or HADD oligoarthritis | Subintrant articular gouty attacks
Gouty nephropathy | Subintrant articular gouty attacks | Persistent articular gouty attacks |
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| Acute joint involvement | Periodontoid structures
Symmetrical large and small joints | Periodontoid structures
Right shoulder
Left wrist | Periodontoid and left temporomandibular joint structures, right shoulder and left wrist | Symmetrical large and small joints | Large and small joints | symmetrical large and small joints |
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| Systemic signs (C reactive protein: CRP N < 5 mg/L) | Fever
Anorexia
Marked inflammatory syndrome (CRP ≥ 90 mg/L over 3 weeks) | Alteration of the general state Fever
Elevated inflammatory syndrome (CRP ≥ 60 mg/L over 5 weeks) | Fever
Alteration of the general state
Diffuse headaches
Marked inflammatory syndrome (CRP ≥ 210 mg/L over six weeks) | Alteration of the general state
Fever
Elevated inflammatory syndrome (CRP ≥ 150 mg/L over four weeks)
Increase in creatininemia | Febricula
Alteration of the general state
Persistent inflammatory syndrome (CRP ≥ 85 mg/L over three weeks) | Febricula
Alteration of the general state
Inflammatory syndrome
(CRP ≥ 65 mg/L over six weeks) |
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| Indications for anakinra | Failure of ketoprofen, then colchicine and associated oral cortisone | Failure of colchicine and combined indomethacin, and oral cortisone | Ongoing staphylococcal soft tissues infection treated with rifampicin and vancomycin leading to avoiding colchicine and high dose steroid drugs | Failure of colchicine and associated oral cortisone | Contraindication to colchicine
Failure of cortisone and indomethacin | Contraindication to allopurinol
Failure of cortisone, indomethacin, and colchicine |
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| Anakinra first treatment | | | | | | |
| Duration | 9 days | 7 days | 11 days | 5 days | 5 days | 3 days |
| Associated drugs | None | None | Oral prednisone increased from 5 to 10 mg/day | None | None | None |
| Response | Complete remission of all acute clinical and biological parameters | Progressive improvement of clinical signs with slight cervical signs and normalization of CRP, allowing for consideration of complete response | Dramatic and complete response on the wrist and temporomandibular joints, progressive complete response on the crowned dens syndrome and the wrist involvement, normalization of CRP levels on the 15th day | Dramatic and complete remission of all acute clinical and biological parameters, and decrease in creatininemia | Rapidand complete remission of all acute clinical and biological parameters | Complete remission of all acute clinical signs, partial remission of biological parameters |
| Relapse or rebound | None, under prophylactic treatment of colchicine | Rebound 48 h after improvement at anakinra withdrawal on the 7th day | None, under prophylactic treatment with colchicine | None, under prophylactic treatment with colchicine and allopurinol | None,under prophylactic treatment with allopurinol | Disease relapse 6 weeks after the initial complete response |
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| Anakinra second treatment | | | | | | |
| Duration |
NA | 11 days, until complete response | NA | NA | NA | 5 days |
| Associated drugs | NA | None | NA | NA | NA | None |
| Response | NA | Dramatic complete remission of all acute clinical and biological parameters | NA | NA | NA | Partial clinical and biological response |
| Relapse | NA | None, with prophylactic treatment with colchicine | NA | NA | NA | NA |
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| Anakinra second treatment reintroduction | | | | | | |
| Duration | NA | NA | NA | NA | NA | 3 days |
| Associated drugs | NA | NA | NA | NA | NA | Colchicine |
| Response | NA | NA | NA | NA | NA | Complete clinical and biologic response, respectively, after 3 and 5 days of the combined treatment, respectively |
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