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Interleukin-1 receptor antagonist (anakinra) treatment in patients with systemic-onset juvenile idiopathic arthritis or adult onset Still disease: preliminary experience in France

T Lequerré¹, P Quartier², D Rosellini², F Alaoui³, M De Bandt⁴, O Mejjad¹, I Kone-Paut⁵, M Michel⁶, E Dernis⁷, M Khellaf⁶, N Limal⁸, C Job-Deslandre⁹, B Fautrel¹⁰, X Le Loët¹, J Sibilia³, on behalf of the Société Francophone pour la Rhumatologie et les Maladies Inflammatoires en Pédiatrie (SOFREMIP) and the Club Rhumatismes et Inflammation (CRI)

¹ Rheumatology Department, Rouen University Hospital & Inserm 905, Rouen, France
² Paediatric Immuno-Haematology and Rheumatology Department, Necker-Enfants Malades Hospital, Paris, France
³ Rheumatology Department, CHU Strasbourg, Strasbourg, France
⁴ Rheumatology Department, Hôpital Robert Ballanger, Aulnay sous Bois, France
⁵ Paediatric Department, Bicêtre Hospital, Le Kremlin-Bicêtre, France
⁶ Department of Internal Medicine, Hôpital Henri Mondor, Créteil, France
⁷ Rheumatology Department, Hôpital Le Mans, Le Mans, France
⁸ Department of Internal Medicine, Hôpital Pitié Salpétrière, France
⁹ Rheumatology A Department, Cochin Hospital, Paris, France
¹⁰ Rheumatology Department, Hôpital Pitié-Salpétrière, Paris, France

T Lequerré, Rheumatology Department, Rouen University Hospital & Inserm 905, 76031 Rouen, France; thierry.lequerre{at}univ-rouen.fr. Pierre Quartier, Unité d’Immunologie-Hématologie et Rhumatologie pédiatrique, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75015 Paris, France; quartier{at}necker.fr

Background: Anakinra treatment has been reported to be effective in some patients with systemic-onset juvenile idiopathic arthritis (SoJIA) or adult-onset Still disease (AoSD).

Objectives: To assess the efficacy and the safety of anakinra treatment in SoJIA and AoSD.

Methods: SoJIA and AoSD patients were treated with anakinra (1–2 mg/kg/day in children, 100 mg/day in adults); we analysed its effect on fever, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, numbers of swollen and tender joints, the assessment of disease activity (by physician and parent/patient) and pain (by parent/patient), and American College of Rheumatology (ACR) pediatric core set criteria for JIA activity.

Results: A total of 35 patients were included, 20 with SoJIA and 15 with AoSD. Their mean age (range) at the onset of treatment was 12.4 (3–23) and 38.1 (22–62) years, respectively; disease duration was 7.0 (1–16) and 7.8 (2–27) years, respectively. Active arthritis was present in all cases but one. Of the 20 SoJIA patients, 5 achieved ACR 50% improvement in symptoms (ACR50) response criteria at 6 months. Steroid dose had been decreased by 15% to 78% in 10 cases. A total of 11 of the 15 AoSD patients achieved at least a 50% improvement for all disease markers (mean follow-up: 17.5 (11–27) months). Steroids had been stopped in two cases and the dose was decreased by 45% to 95% in 12 patients. Two patients stopped anakinra due to severe skin reaction, and two patients due to infection: one visceral leishmaniasis and one varicella.

Conclusion: Anakinra was effective in most AoSD patients, but less than half SoJIA patients achieved a marked and sustained improvement.

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Anakinra treatment for systemic juvenile idiopathic arthritis and adult onset Still disease

Patricia Woo
Ann Rheum Dis 2008 67: 281-282. [Extract] [Full Text] [PDF]

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