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.


The Clinical Feature of 20092010 Influenza Virus Infection during Tocilizumab Treatment for Systemic Onset Juvenile Idiopathic Arthritis.

Uchimura1,  Toru, Imagawa1,  Tomoyuki, Hara1,  Takuma, Kikuchi1,  Masako, Hara2,  Ryoki, Miyamae1,  Takako, Mori1,  Masaaki

Department of Pediatrics Yokohama City University, Yokohama, Japan
Department of Pediatrics Yokohama City University
Department of Pediatrics Yokohama Minami Kyosai Hospital, Yokohama, Japan

Background:

We had reported that tocilizumab (a humanized anti-IL-6 receptor antibody, TCZ) had been proved to be highly effective in the clinical management of refractory systemic onset juvenile idiopathic arthritis (sJIA).TCZ inhibits interleukin-6 (IL-6) signal which relates to inflammation in sJIA by binding IL-6 receptor. It also affects the inflammatory reaction in infectious disease, such as pneumonia and gastroenteritis. Influenza virus infection has been known to make the disease activity of sJIA worse.

Objective:

We evaluated the impact of influenza virus infection during tocilizumab treatment for sJIA.

Method:

A total of 76 patients satisfying the WHO/ILAR criteria for sJIA were treated with TCZ, and received intravenous TCZ 8 mg/kg every 2 weeks. The patients who had the positive result of rapid chromatographic immunoassay for the detection of influenza A and B viral antigens from nasopharyngeal swabs were subject of this study from 2009 September to 2010 December. We examined the clinical manifestations and complications of the influenza virus infection, and the deterioration of sJIA.

Results:

Seven patients (4 boys and 3 girls) affected with influenza virus infection. The median age was 13.7 years and the median duration of TCZ treatment was 42 months. The disease activities including fever, arthritis, rheumatoid rash, and inflammatory examinations in all patients were well controlled by TCZ. All of seven patients showed the result of influenza virus A by rapid antigen test. Clinical symptoms at the time of the influenza infection were fever (> 38.0 degrees Celsius) in 6 patients (86%), cough in 7 patients (100%), nasal discharge in 5 patients (71%), vomiting in 1 patients (14%), diarrhea in 1 patients (14%) and fatigue in 3 patients (43%). The mean febrile period was 1.8 days (0 to 5 days). No complications including pneumonia, otitis media and influenza encephalopathy were observed. Six of 7 patients were treated with anti-influenzavirus medications; oseltamivir in 5 patinets, zanamivir in 3 patients. One patient switched from zanamivir to oseltamivir because of prolonged fever. One patient relapsed to sJIA after influenza. One patient presented with fever, arthritis and rheumatoid rash. Serum C-reactive protein and amyloid A were increased in 2 patients. None of patients developed macrophage activation syndrome (MAS).

Conclusion:

Neither influenza symptoms nor disease progression to MAS were observed in the patients affected with influenza virus infection during TCZ treatment. However, disease activities of sJIA might be aggravated by influenza in these patients. In addition, TCZ might mask inflammatory symptoms of influenza infection.

To cite this abstract, please use the following information:
Uchimura, Toru, Imagawa, Tomoyuki, Hara, Takuma, Kikuchi, Masako, Hara, Ryoki, Miyamae, Takako, et al; The Clinical Feature of 20092010 Influenza Virus Infection during Tocilizumab Treatment for Systemic Onset Juvenile Idiopathic Arthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :237
DOI: 10.1002/art.28006

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