ACTH revisited: effective treatment for acute crystal induced synovitis in patients with multiple medical problems

J Rheumatol. 1994 Apr;21(4):696-9.


Objective: To determine the effectiveness of adrenocorticotropic hormone (ACTH) for acute gouty arthritis and pseudogout in a population of patients with multiple coexisting medical problems.

Methods: We retrospectively reviewed our experience with parenteral ACTH 40 or 80 units intravenous, intramuscular, or subcutaneous tid with tapering in the treatment of 38 patients. Thirty-three patients had documented acute gout and 5 patients had documented acute pseudogout. A total of 43 episodes of acute crystal induced synovitis were treated. The indications for using ACTH included congestive heart failure, chronic renal insufficiency, gastrointestinal bleeding, or no response to NSAID:

Results: All episodes of pseudogout resolved in an average of 4.2 days. Of the episodes of acute gout, 97% resolved in an average of 5.5 days. Although mild hypokalemia, hyperglycemia, fluid retention and rebound arthritis occurred as adverse effects, none was severe and all were easily controlled.

Conclusion: ACTH is a safe and effective treatment for acute gout and pseudogout, especially in patients with multiple medical problems.

Publication types

  • Clinical Trial

MeSH terms

  • Adrenocorticotropic Hormone / adverse effects
  • Adrenocorticotropic Hormone / therapeutic use*
  • Aged
  • Aged, 80 and over
  • Arthritis, Gouty / complications
  • Arthritis, Gouty / drug therapy*
  • Chondrocalcinosis / complications
  • Chondrocalcinosis / drug therapy*
  • Female
  • Gastrointestinal Hemorrhage / complications
  • Gastrointestinal Hemorrhage / drug therapy
  • Heart Failure / complications
  • Heart Failure / drug therapy
  • Humans
  • Hypokalemia / chemically induced
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / drug therapy
  • Male
  • Recurrence
  • Retrospective Studies
  • Synovitis / drug therapy*


  • Adrenocorticotropic Hormone