Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

Anakinra as First-Line Disease Modifying Therapy in Systemic Juvenile Idiopathic ArthritisReport of 46 Patients from an International Multicenter Series.

Nigrovic4,  Peter A., Mannion14,  Melissa, Zeft15,  Andrew S., Rabinovich8,  Egla C., van Rossum9,  Marion A. J., Cortis2,  Elisabetta, Pardeo2,  Manuela

Alberta Childrens Hospital, Calgary, AB, Canada
Michigan State Univ, Grand Rapids, MI
Nationwide Children's Hospital, Columbus, OH
Nationwide Childrens Hosp, Columbus, OH
U of Iowa Children's Hosp, Iowa City, IA
Univ of Alabama at Birmingham, Birmingham, AL
University of Utah, Salt Lake City, UT
Bambino Gesù Hospital, Rome, Italy
Children's Hospital Boston, Cambridge, MA
Children's Hospital Boston, Boston, MA
Children's Hospital Montefiore, New York, NY
Children's Hospital of Alabama, Birmingham, AL
Children's Hospital Montefiore, Bronx, NY
Duke University Medical Center, Durham, NC
Emma Children's Hospital, Amsterdam, The Netherlands


Chronic active systemic juvenile idiopathic arthritis (sJIA) is one of the most devastating rheumatologic diseases of childhood. We hypothesized that early treatment with anakinra could favorably affect the course of this disease.


Medical records of children receiving anakinra as first-line therapy for sJIA were reviewed to characterize clinical course.


46 children from 11 centers in 4 countries received anakinra as part of initial disease-modifying anti-rheumatic drug (DMARD) therapy for sJIA, at a median dose of 1.5 mg/kg/day. Anakinra alone was employed as monotherapy in 10 patients (22%), while corticosteroids and additional DMARDs were employed in 67% and 33% respectively. Median follow-up was 14.5 months. Approximately 60% of patients, including 8 of 10 treated with anakinra monotherapy, attained clinical remission without further escalation of therapy. Fever and rash resolved within 1 month in over 95%, while C-reactive protein and ferritin normalized within this interval in over 80%. Active arthritis persisted at 1 month in 40%, at 3 months in 27%, and at >6 month follow-up in approximately 10%. Disease characteristics and treatment parameters were similar in partial and complete responders, but partial responders were markedly younger at onset (5.8 vs. 9.8 years, p=0.004). Associated adverse events included bacterial infection in 2 patients and hepatitis in 1 patient.


Anakinra is effective first-line therapy of sJIA, enabling rapid resolution of systemic symptoms while forestalling the development of refractory arthritis in 90% of patients. These results justify further study of IL-1 inhibition as first-line, rather than rescue, therapy in sJIA.

To cite this abstract, please use the following information:
Nigrovic, Peter A., Mannion, Melissa, Zeft, Andrew S., Rabinovich, Egla C., van Rossum, Marion A. J., Cortis, Elisabetta, et al; Anakinra as First-Line Disease Modifying Therapy in Systemic Juvenile Idiopathic ArthritisReport of 46 Patients from an International Multicenter Series. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :209
DOI: 10.1002/art.27978

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