Early effects of Anakinra in corticosteroid naïve SOJIA patients

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 inpatient procedure to monitor for disease progression. Disease activity was monitored at 0, 24, 72 hr and 3 weeks.