The pattern of response to anti–interleukin-1 treatment distinguishes two subsets of patients with systemic-onset juvenile idiopathic arthritis
Article first published online: 25 APR 2008
Copyright © 2008 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 58, Issue 5, pages 1505–1515, May 2008
How to Cite
Gattorno, M., Piccini, A., Lasigliè, D., Tassi, S., Brisca, G., Carta, S., Delfino, L., Ferlito, F., Pelagatti, M. A., Caroli, F., Buoncompagni, A., Viola, S., Loy, A., Sironi, M., Vecchi, A., Ravelli, A., Martini, A. and Rubartelli, A. (2008), The pattern of response to anti–interleukin-1 treatment distinguishes two subsets of patients with systemic-onset juvenile idiopathic arthritis. Arthritis & Rheumatism, 58: 1505–1515. doi: 10.1002/art.23437
- Issue published online: 25 APR 2008
- Article first published online: 25 APR 2008
- Manuscript Accepted: 18 JAN 2008
- Manuscript Received: 27 AUG 2007
- Ministero Salute
- Istituto Superiore Sanità
- Telethon Italy
- Associazione Italiana per la Ricerca sul Cancro
- Italfarmaco, Milan, Italy
To assess the clinical response to interleukin-1 (IL-1) blockade and in vitro IL-1β and IL-18 secretion in patients with systemic-onset juvenile idiopathic arthritis (JIA).
Twenty-two patients with systemic-onset JIA were treated with the IL-1 receptor antagonist (IL-1Ra) anakinra. Monocytes from 18 patients and 20 healthy donors were activated by different Toll-like receptor ligands. Intracellular and secreted IL-1β and IL-18 were analyzed by Western blotting and enzyme-linked immunosorbent assay.
Ten patients with systemic-onset JIA exhibited a dramatic response to anakinra and were classified as complete responders. Eleven patients had an incomplete response or no response, and 1 patient could not be classified in terms of response. Compared with patients who had an incomplete response or no response, complete responders had a lower number of active joints (P = 0.02) and an increased absolute neutrophil count (P = 0.02). In vitro IL-1β and IL-18 secretion in response to various stimuli was not increased and was independent of treatment efficacy. Likewise, secretion of IL-1Ra by monocytes from patients with systemic-onset JIA was not impaired. An overall low level of IL-1β secretion upon exposure to exogenous ATP was observed, unrelated to treatment responsiveness or disease activity.
Two subsets of systemic-onset JIA can be identified according to patient response to IL-1 blockade. The 2 subsets appear to be characterized by some distinct clinical features. In vitro secretion of IL-1β and IL-18 by monocytes from patients with systemic-onset JIA is not increased and is independent of both treatment outcome and disease activity.