Patient case (clinical description): A 39-year-old man comes to the emergency department with an acute onset of severe left toe pain.  The toe is red and exhibits swelling. The patient is not febrile, and does not remember any recent trauma. Medical history is not significant except for the similar attacks and the diagnosis of gouty arthritis. His medication history includes Allopurinol to prevent gouty attacks. His father has the same medical condition. However, his older brother who is 41 years old is healthy with no history of gouty arthritis. Physical examination shows a swollen, tender first metatarsophalangeal joint.  Aspiration of the joint showed high leukocyte count, negative Gram stain, and numerous needle-shaped crystals, which is compatible with gouty arthritis.

Patient's own account: I'm a 39-year-old man and got admitted to the ER after an unbearable pain in my left toe. My toe was red and terribly swollen. I was still standing on my feet, not febrile and I don't remember hitting my head or anything. I don't have any special medical history, but I had been diagnosed with gout before. I take Lopurin to prevent my gouty attacks. My dad had the same problem, but my 41-year-old brother is healthy and does not have gouty attacks. The doctor did a physical exam and found that the joints between my toes and the rest of my foot were swollen and tender. The doctor renewed his diagnosis of gouty arthritis.

Clinical trial: Pilot Study Evaluating The Efficacy Of Etanercept In Acute Gout

Eligibility criteria:
Key Inclusion Criteria:

          1. Male or female patients age ≥18 to ≤85 year

          2. History of established gout

          3. Onset of current acute gout attack within 4 days prior to randomization with: presence
             of any warm joint, swollen joint, pain score at rest ≥5 on the 0-10 pain scale,
             patient self-report of acute gout attack

          4. Baseline pain intensity ≥5 on a 0-10 pain scale;

          5. Tender (≥1 on a 0-4-point Likert scale) and swollen (≥1 on a 0-4-point Likert scale)
             index joint;

          6. If on urate-lowering therapy, a stable dose and regimen for at least 2 weeks prior to
             randomization, and expectance to remain on a stable dose and regimen for the duration
             of the double-blind treatment period, and;

          7. Body mass index (BMI) ≤45 kg/m2.

        Exclusion Criteria:

          1. Use of intra-articular or IM corticosteroids within 14 days prior to screening;

          2. Use of an IL-1 inhibitor, TNF inhibitor or other biologic or investigational drug
             within 30 days prior to screening;

          3. History of a drug allergy to either study drug;

          4. Diagnosis or history of:

               1. rheumatoid arthritis (RA);

               2. infectious/septic or other inflammatory arthritis;

               3. alcoholic hepatitis or nonalcoholic steatohepatitis;

               4. immunodeficiency syndromes, including Human Immunodeficiency Virus (HIV)
                  infection;

               5. Stage IIIb, IV, or V chronic kidney disease;

               6. idiopathic thrombocytopenic purpura;

               7. active, severe chronic pulmonary disease (eg, requiring oxygen therapy);

               8. uncontrolled hypertension (≥ 200/105 mmHg);

               9. symptomatic (New York Heart Association Class II, III, or IV) congestive heart
                  failure;

              10. uncontrolled diabetes Type I or II (recent blood glucose > 300 mg/dL);

              11. myocardial infarction, unstable cardiac arrhythmias or unstable symptomatic
                  coronary ischemia, within the past 12 months before randomization;

              12. history of malignancy of any organ system within the past 5 years;

              13. multiple sclerosis or any other demyelinating disease, or;

              14. major chronic inflammatory disease or connective tissue disease other than RA or
                  psoriatic arthritis (PsA), including but not limited to fibromyalgia or systemic
                  lupus erythematosus (with the exception of secondary Sjögrens syndrome, etc.);

          5. Contraindication to IM injection;

          6. Donation or loss of ≥400 milliliters (mL) of blood in the 8 weeks before dosing;

          7. Any live vaccination in the 3 months before the start of the study;

          8. Active infection (including chronic or localized infections) for which antiinfectives
             were indicated within 4 weeks before screening;

          9. Any serious infection, defined as requiring hospitalization or intravenous
             anti-infectives, within 8 weeks before first dose of investigational product;

         10. Prosthetic joint infection within 5 years of screening, or native joint infection
             within 1 year of screening;

         11. Known alcohol addiction or dependency, daily alcohol use, or current substance use or
             abuse;

         12. Positive medical history for hepatitis B or C (subjects with a history of hepatitis B
             vaccination without history of hepatitis B infection are allowed to enroll);

         13. History of active tuberculosis;

         14. Positive test for tuberculosis during screening, defined as positive Purified Protein
             Derivative (PPD) skin test (≥5 mm induration at 48-72 hours after test is placed), or
             positive Quantiferon test;

         15. Pregnant or nursing (lactating) women

         16. Female patients who are physiologically capable of becoming pregnant must use an
             acceptable method of contraception
No condition on gender to be admitted to the trial.
No healthy subjects accepted to join the trial.
Subject must be at least 18 Years old.
Subject must be at most 85 Years

Eligibility (NLI label): Entailment