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Interleukin-1 receptor antagonist (anakinra) treatment in patients with systemic-onset juvenile idiopathic arthritis or adult onset Still’s disease. Preliminary experience in France.
  1. Thierry Lequerré (thierry.lequerre{at}univ-rouen.fr)
  1. Rouen University Hospital&Inserm519, IFR23, France
    1. Pierre Quartier (quartier{at}necker.fr)
    1. Necker-enfants malades Hospital, France
      1. David Rosellini
      1. Necker-enfants malades Hospital, France
        1. Fzohra Alaoui (lasaone2002{at}yahoo.fr)
        1. CHU Strasbourg, France
          1. Michel De Bandt (michel.debandt{at}ch-aulnay.fr)
          1. Hôpital Robert Ballanger, France
            1. Othmane Mejjad (othmane.mejjad{at}chu-rouen.fr)
            1. Rouen University Hospital&Inserm519, IFR23, France
              1. Isabelle Kone-Paut
              1. Bicêtre Hospital, France
                1. Marc Michel (marc.michel{at}hmn.aphp.fr)
                1. Hôpital Henri Mondor, France
                  1. Emmanuelle Dernis (edernis{at}ch-lemans.fr)
                  1. Hôpital Le Mans, France
                    1. Mehdi Khellaf
                    1. Hôpital Henri Mondor, France
                      1. Nicolas Limal (nicolas.limal{at}psl.ap-hop-paris.fr)
                      1. Hôpital Pitié Salpétrière, France
                        1. Chantal Job-Deslandre
                        1. Cochin Hospital, France
                          1. Bruno Fautrel (bruno.fautrel{at}psl.ap-hop-paris.fr)
                          1. Hôpital Pitié Salpétrière, France
                            1. Xavier Le Loët (xavier.le-loet{at}chu-rouen.fr)
                            1. Rouen University Hospital&Inserm519, IFR23, France
                              1. Jean Sibilia (sibilia{at}wanadoo.fr)
                              1. CHU Strasbourg, France

                                Abstract

                                Background: Anakinra treatment has been reported to be effective in some patients with Systemic-onset Juvenile Idiopathic Arthritis (SoJIA) or Adult-onset Still's 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 to 2 mg/kg per day in children, 100 mg/day in adults); we analysed its effect on fever, ESR and CRP levels, numbers of swollen and tender joints, the assessment of disease activity (by physician and parent/patient) and pain (by parent/patient), and ACR pedi core set criteria for JIA activity.

                                Results: Thirty-five 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; their disease duration was 7.0 [1-16] and 7.8 [2-27] years, respectively. Active arthritis was present in all cases but one. Five of the 20 SoJIA patients achieved ACR50 response criteria at 6 months. Steroid dose had been decreased by 15% to 78% in 10 cases. Eleven 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 2 cases and the dose was decreased by 45% to 95% in 12 patients. Two patients stopped anakinra due to severe skin-reaction and 2 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.

                                • adult onset Still's disease
                                • arthritis
                                • interleukin-1
                                • juvenile arthritis
                                • treatment

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