TY - JOUR T1 - Is It Time for Gout Flare Treatment to Move into the 21st Century? JF - The Journal of Rheumatology JO - J Rheumatol SP - 667 LP - 669 DO - 10.3899/jrheum.181249 VL - 46 IS - 7 AU - ROBERT T. KEENAN Y1 - 2019/07/01 UR - http://www.jrheum.org/content/46/7/667.abstract N2 - Advances in science have offered opportunities to develop targeted therapies for multiple disease states. Physicians and patients are becoming accustomed, and even expect, to use targeted therapies, avoiding any “shotgun approaches.” The discovery of biologics has revolutionized the treatment of rheumatological diseases. The benefits have greatly outweighed the risks with biologic therapy, and have subsequently reduced tender and swollen joints, improved quality of life, decreased morbidity, and slowed disease progression in this population as a whole1.But despite our greater understanding of the physiology of the inflammatory process of gout, our approach to treatment has remained antiquated. The approved US Food and Drug Administration (FDA) therapies for gout flares include indomethacin, naproxen, sulindac, corticosteroids, and colchicine2,3,4,5. Nonsteroidal antiinflammatory drugs (NSAID) have been used to treat gout flares since the 1960s, corticosteroids since the 1950s, and documented use of colchicine goes back to 17632,6. The efficacy of all these medications for the treatment of gout flares is well documented, but not all patients respond adequately; and in a population that is likely to have 1 or more comorbid conditions, these FDA-approved medications can carry significant risks and adverse effects7.In this issue of The Journal, Desmarais and Chu evaluate the efficacy and safety of anakinra, a biologic therapy that targets interleukin (IL)-1 receptors, thereby blocking IL-1 activity, a major driver of inflammation in an acute gout flare8. The authors used retrospective data spanning almost 9 years from the Oregon Health & Science University (OHSU) Hospital and the Veteran’s Administration Portland Health Care System (VAPORHCS) to identify hospitalized patients who carried a diagnosis of gout or calcium pyrophosphate (CPP) deposition, who flared, and who had received at least one 100-mg dose of anakinra … Address correspondence to Dr. R.T. Keenan, Duke University School of Medicine, 200 Trent Drive, DUMC 3544, Durham, North Carolina 27710, USA. E-mail: Robert.keenan{at}duke.edu ER -