Efficacy of subcutaneous tocilizumab in a patient with severe gout refractory to anakinra

Dear Editor, Gout is a urate-related disease characterized by joint inflammation and severe pain. Without prompt treatment, it can lead to joint sequelae and severe systemic repercussions. Deposits can be dissolved with urate-lowering therapies such as allopurinol, febuxostat and lesinurad. During the initial months, prophylaxis for attacks (such as colchicine, NSAIDs and CSs) should be added. Nevertheless, some patients continue to develop flares, despite this regimen. In such cases, inflammation can be fought by blocking IL-1 with anakinra [1]. However, not all patients respond equally, and some may be refractory or anakinra dependent [2]. In these cases, IL-6 blockade may be an alternative. We present the case of a patient with difficult-to-treat gout refractory to anakinra who responded well to s.c. tocilizumab. The patient was a 56-year-old male smoker with a background of hypertension, hypertriglyceridaemia, hyperferritinaemia, and early-onset gout with tophi in the feet, knees,...