Treatment of Juvenile Idiopathic Arthritis with Systemic Manifestations with Interleukin Inhibitors-1 (Clinical Case)

DOI: 10.47026/2413-4864-2023-1-118-128

UDC: 616.72-002-053.6
BBC: 57.334.181.2

Zhuravleva N.V., Aksionova A.V., Yakupova S.P., Smirnova T.L., Prokopyeva T.V., Arkhipova A.V., Guryanova E.A.

Treatment of Juvenile Idiopathic Arthritis with Systemic Manifestations with Interleukin Inhibitors-1 (Clinical Case)

Keywords: systemic juvenile idiopathic arthritis, IL-1 inhibitors, IL-6 inhibitors, canakinumab

The purpose of this study is to evaluate the effectiveness of the treatment of juvenile idiopathic arthritis with systemic manifestations with interleukin-1 (IL-1) inhibitors. Material and methods. A prospective analysis of the course of systemic juvenile idiopathic arthritis was performed in a 15-year-old patient; she was examined using laboratory and instrumental methods before and after therapy with the interleukin-1 (IL-1) inhibitor canakinumab. Laboratory examination included general and biochemical blood tests, determination of rheumatoid factor, C-reactive protein, lactate dehydrogenase, procalcitonin, antinuclear antibodies, anti-citrullinated peptide (ACCP) antibody titer, antistreptolysin-O titer. The patient underwent ECG, echocardiography (EchoCG), ultrasound examination of the pleural cavities, abdominal organs, kidneys, knee joints, radiography of the chest cavity organs and radiography of the hand, computed tomography of the chest and abdominal cavities. Results. Examination of the patient revealed: synovitis of the knee joints, bilateral pleurisy and pericarditis, positive markers of the inflammatory process, characteristic of juvenile idiopathic arthritis with systemic manifestations. The patient was diagnosed with leukocytosis up to 20.3×10⁹/l with a stab shift of leukocytes up to 18%, an increase in the erythrocyte sedimentation rate of 55 mm/h, an increase in C-reactive protein up to 288 mg/l, lactate dehydrogenase up to 500 units/l, in the analyzes urine revealed moderate hematuria and proteinuria. X-ray examination revealed structural changes in the knee and interphalangeal joints. We observed the effectiveness of canakinumab therapy. During therapy with canakinumab, after the second injection, positive dynamics was noted: leukocytes 5.1 × 10⁹/l, ESR 6 mm/h, CRP 12 mg/l, relief of symptoms of the disease. Conclusions. During therapy with canakinumab, the patient showed positive clinical and laboratory dynamics of the disease. The study demonstrated the effectiveness of interleukin-1 (IL-1) inhibitors, canakinumab, in achieving remission of the disease.

References

Petrova E.S., Zhuravleva N.V., Arkhipova A.V. Bolezn’ Stilla u vzroslykh: trudnosti diagnostiki. [Still’s disease in adults: diagnostic difficulties]. Klinitsist, 2021, no. 15(1-4), pp. 87–88.
Yuvenil’nyi artrit s sistemnym nachalom: klinicheskie rekomendatsii [Juvenile arthritis with systemic onset: Clinical guidelines]. Available at: http://disuria.ru/_ld/11/1107_kr21M08p2MZ.pdf.
Dinarello C.A. Interleukin-1 in the pathogenesis and treatment of inflammatory diseases. Blood, 2011, vol. 117, no. 14, pp. 3720–3732. DOI: 10.1182/blood-2010-07-273417.
Palomo J., Dietrch D., Martin P., Palmer G. et al. The interleukin (IL)-1 cytokine family-Balance between agonists and antagonists in inflammatory diseases. Cytokine, 2015, vol. 76, no. 1, pp. 25– DOI: 10.1016/j.cyto.2015.06.017.
Martini A., Ravelli A., Avcin T., Beresford M.W. et al. Toward New Classification Criteria for Juvenile Idiopathic Arthritis: First Steps, Pediatric Rheumatology International Trials Organization International Consensus. Rheumatol., 2019, vol. 46, no. 2, pp. 190–197. DOI: 10.3899/jrheum.180168.
Ravelli A., Minoia F., Davì S., Horne A. et al. Classification criteria for macrophage activation syndrome complicating systemic juvenile idiopathic arthritis: a European League Against Rheumatism/American College of Rheumatology/Paediatric Rheumatology International Trials Organisation collaborative initiative. Arthritis Rheumatol., 2016, no. 68, pp. 566–576. DOI: 10.1002/art.39332.
Świdrowska-Jaros J, Smolewska E. A fresh look at angiogenesis in juvenile idiopathic arthritis. Eur. J. Immunol., 2018. vol. 43, no. 3, pp.325–330. DOI: 10.5114/ceji.2018.80052.
Giancane G., Minoia F., Davì S., Bracciolini G. et al. IL-1 Inhibition in Systemic Juvenile Idiopathic Arthritis. Pharmaco.l, 2016, no. 7, p. 467. DOI: 10.3389/fphar.2016.00467.
Zhuravleva N., Smirnova T., Sharapova O., Gerasimova L. et al. Rheumatic masks of oncological diseases in children. The EULAR J., 2022, no. 81, p. 1728.
Swart J.F., de Roock S., Prakken B.J. Understanding inflammation in juvenile idiopathic arthritis: How immune biomarkers guide clinical strategies in the systemic onset subtype. J. Immunol., 2016, vol. 46, no. 9, pp. 2068–2077. DOI: 10.1002/eji.201546092.
Cimaz R. Systemic-onset juvenile idiopathic arthritis. Autoimmun Rev., 2016, vol. 15, no. 9, pp. 931–934. DOI: 10.1016/j.autrev.2016.07.004.
Shimizu M., Mizuta M., Yasumi T., Iwata N. et al. Validation of Classification Criteria of Macrophage Activation Syndrome in Japanese Patients With Systemic Juvenile Idiopathic Arthritis. Arthritis Care Res. (Hoboken), 2018, vol. 70, no. 9, pp. 1412–1415. DOI: 10.1002/acr.23482.
Lee P.Y., Schulert G.S., Canna S.W., Huang Y. et al. Adenosine deaminase 2 as a biomarker of macrophage activation syndrome in systemic juvenile idiopathic arthritis. Rheum. Dis., 2020, vol. 79, no. 2, pp. 225–231. DOI: 10.1136/annrheumdis-2019-216030.
De Silvestri A., Capittini C., Poddighe D., Marseglia G.L. et al. HLA-DRB1 alleles and juvenile idiopathic arthritis: Diagnostic clues emerging from a meta-analysis. Rev., 2017, vol. 16, no. 12, pp. 1230–1236. DOI: 10.1016/j.autrev.2017.10.007.
Ravelli A., Minoia F., Davi S., Horne A. et al. 2016 Classification criteria for macrophage activation syndrome complicating systemic juvenile idiopathic arthritis: a European league against rheumatism. Arthritis & rheumatology (Hoboken, N.J.), 2016, vol. 68, no. 3, pp. 566–
Minoia F., Consolaro A., Ravelli A. Filling the gap: Toward a disease activity tool for systemic juvenile idiopathic arthritis. Rheumatol., 2018, vol. 45, no. 1, pp. 3–5. DOI: 10.3899/jrheum.170703.
Blazina Š., Markelj G., Avramovič M.Z., Toplak N. et al. Management of Juvenile Idiopathic Arthritis: A Clinical Guide. Drugs, 2016, vol. 18, no. 6, pp. 397–412. DOI: 10.1007/s40272-016-0186-0.
Grevich S., Shenoi S. Update on the management of systemic juvenile idiopathic arthritis and role of IL-1 and IL-6 inhibition. Health Med. Ther., 2017, no. 8, pp. 125–135. DOI: 10.2147/AHMT.S109495.
Vanoni F, Minoia F, Malattia C. Biologics in juvenile idiopathic arthritis: a narrative review. J. Pediatr., 2017, vol. 176, no. 9, pp. 1147–1153. DOI: 10.1007/s00431-017-2960-6.
Vastert S.J., de Jager W., Noordman B.J., Holzinger D. et al. Effectiveness of first-line treatment with recombinant interleukin-1 receptor antagonist in steroid-naive patients with new-onset systemic juvenile idiopathic arthritis: results of a prospective cohort study. Arthritis Rheumatol., 2014, vol. 66, no. 4, pp. 1034–1043. DOI: 10.1002/art.38296.
Kessel C., Lippitz K., Weinhage T., Hinze C. et al. Proinflammatory Cytokine Environments Can Drive Interleukin-17 Overexpression by γ/δ T Cells in Systemic Juvenile Idiopathic Arthritis. Arthritis Rheumatol., 2017, vol. 69, no. 7, pp.1480– DOI: 10.1002/art.40099.
Ruperto N., Brunner H.I., Quartier P., Constantin T. et al. Canakinumab in patients with systemic juvenile idiopathic arthritis and active systemic features: results from the 5-year long-term extension of the phase III pivotal trials. Rheum. Dis., 2018, vol. 77, no. 12, pp. 1710–1719. DOI: 10.1136/annrheumdis-2018-213150.
Brachat A.H., Grom A.A., Wulffraat N., Brunner H.I. et al. Early changes in gene expression and inflammatory proteins in systemic juvenile idiopathic arthritis patients on canakinumab therapy. Arthritis Res. Ther., 2017, vol. 19, no. 1, p. 13. DOI: 10.1186/s13075-016-1212-x.
Canny S., Mellins E. New frontiers in the treatment of systemic juvenile idiopathic arthritis. , 2017, no. 6, p. 971. DOI: 10.12688/f1000research.11327.1.
Martini A., Ravelli A., Avcin T., Beresford M.W. et al. Toward New Classification Criteria for Juvenile Idiopathic Arthritis: First Steps, Pediatric Rheumatology International Trials Organization International Consensus. Rheumatol., 2019, vol. 46, no. 2, pp. 190–197. DOI: 10.3899/jrheum.180168.
Schulert G.S., Minoia F., Bohnsack J., Cron R.Q. et al. Effect of Biologic Therapy on Clinical and Laboratory Features of Macrophage Activation Syndrome Associated With Systemic Juvenile Idiopathic Arthritis. Arthritis Care Res. (Hoboken), 2018, vol. 70, no. 3, pp. 409– DOI: 10.1002/acr.23277.
Grom A.A., Ilowite N.T., Pascual V., Brunner H.I. et al. Rate and Clinical Presentation of Macrophage Activation Syndrome in Patients With Systemic Juvenile Idiopathic Arthritis Treated With Canakinumab. Arthritis Rheumatol., 2016, vol. 68, no. 1, pp. 218–228. DOI: 10.1002/art.39407.
Hoy S.M. Canakinumab: a review of its use in the management of systemic juvenile idiopathic arthritis. BioDrugs, 2015, vol. 29, no. 2, pp. 133–142. DOI: 10.1007/s40259-015-0123-8.

About authors

Zhuravleva Nadezhda V.: Candidate of Medical Sciences, Associate Professor, Department of Internal Diseases, Chuvash State University; Rheumatologist, Central City Hospital, Russia, Cheboksary (zhuravlevanv@mail.ru; ORCID: https://orcid.org/0000-0001-6470-7724)

Aksionova Angelina V.: Doctor of Medical Sciences, Professor, Department of Faculty Therapy named after Academician A.I. Nesterov, N.I. Pirogov Russian National Research Medical University, Russia, Moscow (aksyonova-av@mail.ru; ORCID: https://orcid.org/0000-0002-4259-3807)

Yakupova Svetlana P.: Candidate of Medical Sciences, Associate Professor, Department of Hospital Therapy, Kazan State Medical University; Chief Freelance Rheumatologist, Ministry of Health of the Republic of Tatarstan, Russia, Kazan (yakupovaSP@mail.ru; ORCID: https://orcid.org/0000-0002-8590-4839)

Smirnova Tatyana L.: Candidate of Medical Sciences, Associate Professor, Department of Obstetrics and Gynecology, Chuvash State University, Russia, Cheboksary (tlsmr@mail.ru; ORCID: https://orcid.org/0000-0002-8224-1515)

Prokopyeva Taisiya V.: Chief, Department of Rheumatology, Ministry of Health of the Chuvash Republic, Russia, Cheboksary (rkb@med.cap.ru; )

Arkhipova Anastasia V.: Rheumatologist, Republican Clinical Hospital, Russia, Cheboksary (nastya_arh83@mail.ru; ORCID: https://orcid.org/0000-0002-0553-3135)

Gurianova Evgenia A.: Doctor of Medical Sciences, Professor of the Department of Internal Medicine, Chuvash State University, Russia, Cheboksary (z-guryanova@bk.ru; ORCID: https://orcid.org/0000-0003-1519-2319)

Article link

Zhuravleva N.V., Aksionova A.V., Yakupova S.P., Smirnova T.L., Prokopyeva T.V., Arkhipova A.V., Guryanova E.A. Treatment of Juvenile Idiopathic Arthritis with Systemic Manifestations with Interleukin Inhibitors-1 (Clinical Case) [Electronic resource] // Acta medica Eurasica. – 2023. – №1. P. 118-128. – URL: https://acta-medica-eurasica.ru/en/single/2023/1/14/. DOI: 10.47026/2413-4864-2023-1-118-128.

Single article

Zhuravleva N.V., Aksionova A.V., Yakupova S.P., Smirnova T.L., Prokopyeva T.V., Arkhipova A.V., Guryanova E.A.