Tocilizumab masks the clinical symptoms of systemic juvenile idiopathic arthritis-associated macrophage activation syndrome: The diagnostic significance of interleukin-18 and interleukin-6

被引：99

作者：

Shimizu, Masaki ^{[1
]}

Nakagishi, Yasuo ^{[2
]}

Kasai, Kazuko ^{[2
]}

Yamasaki, Yuichi ^{[3
]}

Miyoshi, Mari ^{[2
]}

Takei, Syuji ^{[3
]}

Yachie, Akihiro ^{[1
]}

机构：

[1] Kanazawa Univ, Dept Pediat, Sch Med, Inst Med Pharmaceut & Hlth Sci, Kanazawa, Ishikawa 9208641, Japan

[2] Hyogo Prefectural Kobe Childrens Hosp, Dept Pediat Rheumatol, Kobe, Hyogo, Japan

[3] Kagoshima Univ, Dept Pediat, Sch Med, Fac Med, Kagoshima 890, Japan

来源：

CYTOKINE | 2012年 / 58卷 / 02期

关键词：

Systemic juvenile idiopathic arthritis (s-JIA); Interleukin-18 (IL-18); Tocilizumab; KILLER-CELL DYSFUNCTION; RHEUMATOID-ARTHRITIS; RECEPTOR ANTIBODY; GAMMA PRODUCTION; IL-6; RECEPTOR; DISEASE; CHILDREN; EFFICACY; PATHOGENESIS; ETANERCEPT;

D O I：

10.1016/j.cyto.2012.02.006

中图分类号：

Q5 [生物化学]; Q7 [分子生物学];

学科分类号：

071010 ; 081704 ;

摘要：

Macrophage-activation syndrome (MAS) is a potentially life-threatening complication of systemic juvenile idiopathic arthritis (s-JIA). Tocilizumab (TCZ), a humanized anti-IL-6 receptor monoclonal antibody, is an effective cytokine inhibitor for the treatment of s-JIA. We described the clinical courses of five cases of MAS during TCZ therapy and demonstrated the need for monitoring serum interleukin (IL)-18 and IL-6 concentrations. Clinical symptoms of patients with s-JIA receiving TCZ were apparently mild compared to those not receiving TCZ. Furthermore, serum CRP concentrations never increased during TCZ therapy, even in MAS. Serum IL-6 concentrations increased during s-JIA flare-up and with the complication of infection. Serum IL-18 concentrations increased persistently before the other measures of disease activity. The clinical symptoms of MAS and s-JIA could be masked during TCZ therapy; hence, monitoring serum concentrations of IL-18 and IL-6 is recommended for the evaluation of disease activity in s-JIA and to detect the complication of infection. (C) 2012 Elsevier Ltd. All rights reserved.

引用

页码：287 / 294

页数：8

共 45 条

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