IL1 inhibition in gout—where are we a decade on?

Excerpt

Our paper on the use of the IL1 inhibitor anakinra in acute gout was published in Arthritis Research and Therapy over 12 years ago [1]. It was a pilot study comprising an extended case series and animal data to validate the concept that IL1 played a pivotal role in the initiation of MSU crystal-induced inflammation. ART was chosen because it does accept and publish proof-of-concept studies rapidly, in comparison with conventional journals. The hypothesis we tested was to assess if IL1 blockade by anakinra, a drug that was already on the market but is licensed only for the treatment of rheumatoid arthritis, would help patients who were unable to receive or had contraindications to conventional drugs used to treat acute gout. The successful result of this uncontrolled study was especially gratifying to Jürg Tschopp (1951–2011), my good friend and colleague who had coined the name inflammasome to describe the newly discovered intracellular “machine” that processed pro-IL1β to mature and secreted IL1β [2]. He showed that a whole range of different triggers was capable of activating the complex, including microcrystals formed by MSU, to initiate inflammation through IL1 (both β and α). …