Activation of the NLRP3 inflammasome triggered by depostion of monosodium urate cristals has a key role in initiation of acute gouty arthritis. Caspase 1, which is recruited by the activated inflammasome, induces maturation and secretion of interleukin (IL)-1β, the potent proinflammatory cytokine, that elicits acute inflammatory response. Canakinumab is a fully human anti-IL-1β monoclonal antibody that binds with high affinity to human IL-1β and blocks its interaction with IL-1 receptors. In two phase 3 studies and their extensions, a single dose of canakinumab was consistently superior to triamcinolone acetonide in patients with an acute flare of gout and provided rapid and effective pain relief and prolonged suppression of flares and inflammation. Canakinumab should be considered as a treatment option for patients with acute gouty arthritis who have contraindications for, intolerant of, or unresponsive to NSAIDs and/or colchicine.
Acute gouty arthritis, interleukin-1 β , canakinumab.