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Ann Rheum Dis 65:542-544 doi:10.1136/ard.2005.045245
  • Concise report

Beneficial response to anakinra and thalidomide in Schnitzler’s syndrome

  1. H D de Koning,
  2. E J Bodar,
  3. A Simon,
  4. J C H van der Hilst,
  5. M G Netea,
  6. J W M van der Meer
  1. Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  1. Correspondence to:
    Dr A Simon
    Radboud University Nijmegen Medical Centre, Department of General Internal Medicine, 484, PO Box 9101, 6500 HB Nijmegen, The Netherlands; a.simon{at}aig.umcn.nl
  • Accepted 5 August 2005
  • Published Online First 11 August 2005

Abstract

Background: Schnitzler’s syndrome is an inflammatory disorder characterised by chronic urticarial rash and monoclonal gammopathy, accompanied by periodic fever, arthralgia or arthritis, and bone pain. The cause and treatment are still unknown.

Objective: To assess treatment with thalidomide and an interleukin 1 receptor antagonist, anakinra, in Schnitzler’s syndrome.

Case reports: Three patients with Schnitzler’s syndrome are described, one with IgM gammopathy, two with IgG type. In one patient, thalidomide induced complete remission, but was stopped because of polyneuropathy. Anakinra 100 mg daily in all three patients led to disappearance of fever and skin lesions within 24 hours. After a follow up of 6–18 months, all patients are free of symptoms.

Conclusion: Anakinra proved to be effective in three patients with Schnitzler’s syndrome. This treatment is preferable to thalidomide, which induced a complete remission in one of our patients, as it has fewer side effects.

Footnotes

  • Published Online First 11 August 2005