Volume 6 Supplement 1

15thPaediatric Rheumatology European Society (PreS) Congress

Open Access

Early effects of Anakinra in corticosteroid naïve SOJIA patients

  • NM Wulffraat1,
  • W de Jager1,
  • B Prakken1 and
  • W Kuis1
Pediatric Rheumatology20086(Suppl 1):P29

DOI: 10.1186/1546-0096-6-S1-P29

Published: 15 September 2008

Interleukin-1R antagonist (anakinra) induces disease remission in about 50% of corticosteroid (CS) resistant cases of systemic onset JIA (SOJIA) [1, 2]. Clinicians debate whether etanercept should still be tried first before giving anakinra to such patients. Another, more chalenging, issue is to start anakinra even in CS naïve SOJIA patients. We here report our first experiences of such an approach in 7 patients with SOJIA. Four patients had recent onset SOJIA (3 weeks to 3 months) with classical spiking fever, exanthema and arthritis, 3 had a recent flare. They were all treated with indomethacin for at least 2 weeks without effect. There were no signs of haemophagocytosis. Anakinra was started (2 mg/kg sc daily) as an in-patient procedure to monitor for disease progression. Disease activity was monitored at 0, 24, 72 hr and 3 weeks.

Fever and exanthema disappeared within 24 hours, arthritis within 3 days. One child had a recurrence of arthritis without fever or exanthema after 2 weeks. The mean values at t = 72 hrs: CRP decreased from 178 to 33, ESR from 120 to 94, ferritin from 1260 to 375. In 3 of 5 tested NK cell function restored within 72 hr.

Current follow up of 3 weeks anakinra showed persistent remission in 6/7 without the use of CS.

Based on these short term results we would like to propose a RCT (PRINTO?) to define the place of anakinra with a read-out of disease activity and prednisone use.

Authors’ Affiliations

(1)
Department Pediatric Immunology, University Medical Center Utrecht

References

  1. Gattorno M: The pattern of response to anti-interleukin-1 treatment distinguishes two subsets of patients with systemic-onset juvenile idiopathic arthritis. Arthritis Rheum. 58 (5): 1505-1515. 10.1002/art.23437. 2008 Apr 25;View ArticlePubMedGoogle Scholar
  2. Lequerré T: Interleukin-1 receptor antagonist (anakinra) treatment in patients with systemic-onset juvenile idiopathic arthritis or adult onset Still disease: preliminary experience in France. Ann Rheum Dis. 2008, 67 (3): 302-8. 10.1136/ard.2007.076034.View ArticlePubMedGoogle Scholar

Copyright

© Wulffraat et al; licensee BioMed Central Ltd. 2008

This article is published under license to BioMed Central Ltd.

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