The effect of green tea on simvastatin tolerability.

erythrocyte sedimentation rate was 68 mm/h, and C-reactive protein level was 73 mg/L; cultures of blood and sputum were negative. Azathioprine and colchicine therapies were stopped, prednisone therapy (5 mg/d) was continued, and subcutaneous anakinra therapy (100 mg/d) was started. Within 7 to 10 days, there was a dramatic remission in fever, marked improvement in oral and genital ulcers, no evidence of thrombophlebitis, and decreases in erythrocyte sedimentation rate (28%) and C-reactive protein level (86%) (Figure). When anakinra dosing was reduced to alternate days, oral ulcers and fever reappeared but remitted on return to daily dosing. After 20 months of daily anakinra (100 mg) and prednisone (5 mg) treatment, the patient remains disease-free. Discussion: The mechanisms underlying the pathogenesis of Behçet disease remain unknown, and the presence of clinical clusters indicates that there are several pathways (1). The amelioration of disease with anakinra in this patient is consistent with the concept that Behçet disease is an IL-1–mediated autoinflammatory disease (2). The ethnic component of Behçet disease links it to other autoinflammatory diseases, such as familial Mediterranean fever and the tumor necrosis factor receptor–associated periodic syndrome, which occur with increased frequency in patients with Behçet disease (3) and are also responsive to anakinra. The pathologic abnormality in autoinflammatory diseases is increased production of IL-1 . Blood monocytes from patients with these diseases release more active IL-1 than do cells from unaffected individuals. Reducing IL-1 activity reduces disease activity (4). Although anakinra is presently approved for reducing IL-1 activity, monoclonal anti–IL-1 antibodies and IL-1 Trap have also been used to successfully treat other autoinflammatory diseases (5). The near-complete resolution of clinical, biochemical, and hematologic abnormalities in our patient suggest that IL-1 is a primary mediator of inflammation in Behçet disease. Similar resolution of disease severity has been observed with anakinra in patients with adult-onset Still disease or neonatal-onset multisystem inflammatory disease that was resistant to conventional therapy as well as anti–tumor necrosis factortherapy (4). The half-life of anakinra is less than 6 hours, which explains disease flareups with dose reduction. Conclusion: Anakinra may be a treatment option for patients with Behçet disease that is resistant to conventional therapy.