Cases Of Inflammatory Arthritis Research Articles

Feasibility of Physiotherapist-Led Rheumatology Triage: A Randomized Study.

Given global shortages in the rheumatology workforce, the demand for rheumatology assessment often exceeds the capacity to provide timely access to care. Accurate triage of patient referrals is important to ensure appropriate utilization of finite resources. We assessed the feasibility of physiotherapist (PT)-led triage using a standardized protocol in identifying cases of inflammatory arthritis (IA), as compared to usual rheumatologist triage of referrals for joint pain, in a tertiary care rheumatology clinic. We performed a single-center, prospective, nonblinded, randomized, parallel-group feasibility study with referrals randomized in a 1:1 ratio to either PT-led vs usual rheumatologist triage. Standardized information was collected at referral receipt, triage, and clinic visit. Rheumatologist diagnosis was considered the gold standard for diagnosis of IA. One hundred two referrals were randomized to the PT-led triage arm and 101 to the rheumatologist arm. In the PT-led arm, 65% of referrals triaged as urgent were confirmed to have IA vs 60% in the rheumatologist arm (P = 0.57), suggesting similar accuracy in identifying IA. More referrals were declined in the PT-led triage arm (24 vs 8, P = 0.002), resulting in fewer referrals triaged as semiurgent (6 vs 23, P = 0.003). One case of IA (rheumatologist arm) was incorrectly triaged, resulting in significant delay in time to first assessment. PT-led triage was feasible, appeared as reliable as rheumatologist triage of referrals for joint pain, and led to significantly fewer patients requiring in-clinic visits. This has implications for waitlist management and optimal rheumatology resource utilization.

Shoulder arthroplasty for inflammatory arthritis is associated with higher rates of medical and surgical complications: a nationwide matched cohort analysis from 2016-2020

Inflammatory arthritis (IA) represents a less common indication for anatomic and reverse total shoulder arthroplasty (TSA) than osteoarthritis (OA). The safety and efficacy of anatomic and reverse TSA in this population has not been as well studied compared to OA. We analyzed the differences in outcomes between IA and OA patients undergoing TSA. Patients who underwent primary anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) from 2016-2020 were identified in the Premier Healthcare Database. Inflammatory arthritis (IA) patients were identified using International Classification of Diseases, Tenth Revision, diagnosis codes and compared to osteoarthritis controls. Patients were matched in a 1:8 fashion by age (±3 years), sex, race, and presence of pertinent comorbidities. Patient demographics, hospital factors, and patient comorbidities were compared. Multivariate regression was performed following matching to account for any residual confounding and 90-day complications were compared between the 2 cohorts. Descriptive statistics and regression analysis were employed with significance set at P<.05. Prior to matching, 5685 IA cases and 93,539 OA controls were identified. Patients with IA were more likely to be female, have prolonged length of stay and increased total costs (P<.0001). After matching and multivariate analysis, 4082 IA cases and 32,656 controls remained. IA patients were at increased risk of deep wound infection (OR 3.14, 95% CI 1.38-7.16, P=.006), implant loosening (OR 4.11, 95% CI 1.17-14.40, P=.027), and mechanical complications (OR 6.34, 95% CI 1.05-38.20, P=.044), as well as a decreased risk of postoperative stiffness (OR 0.36, 95% CI 0.16-0.83, P=.002). Medically, IA patients were at increased risk of PE (OR 2.97, 95% CI 1.52-5.77, P=.001) and acute blood loss anemia (OR 1.27, 95% CI 1.12-1.44, P<.0001). Inflammatory arthritis represents a distinctly morbid risk profile compared to osteoarthritis patients with multiple increased surgical and postoperative medical complications in patients undergoing aTSA and rTSA. Surgeons should consider these potential complications and employ a multidisciplinary approach in preoperative risk stratification of IA undergoing shoulder replacement.

Utilization of validated criteria for diagnostic assessment in nonsynchronous, allopatric populations: Role in archeologic diagnosis of rheumatoid arthritis and differentially distinguishing it from mimics

AbstractThe origin of rheumatoid arthritis (RA) has been controversial, with devouée committed to either New World or Old World origins. Support for the latter was predicated on observation of isolated Old World pre‐Columbian cases of inflammatory arthritis. The hypothesis is that spectral assessment of disease characteristics can determine the likelihood that pre‐Columbian Old World claims are validly attributed to RA. Do they represent spectrum outliers or do they have a different etiology (e.g., spondyloarthropathy)? The published literature was surveyed for reports alleging pre‐Columbian, Old World cases of RA. The disease characteristics in published reports claiming presence of pre‐Columbian RA were analyzed. Spectrum of disease (manifestations as population phenomenon) was utilized to assess likelihood diagnoses, when only isolated cases are recognized. None of the accessible 41 reported cases, with adequate information to allow assessment, described/illustrated individuals with the polyarticular, marginally distributed erosions in the absence of peri‐erosional sclerosis, reactive new bone formation, or ankyloses/fusion that is typical of RA. The findings in 90% of reports were actually classic for spondyloarthropathy. The probability of valid diagnosis of RA among individuals with subchondral erosions was less than 0.0001; individuals with joint fusion/ankyloses, &lt;0.0001; and individuals with axial joint disease, 0.0002. Observation only of outliers, without other individuals (in the same sample/population) representing the spectrum of disease that characterizes RA, provided a spectral pattern incompatible with that diagnosis. The role of spectral patterns was supported as an effective tool for generating confidence in paleopathological diagnoses. Additionally, confidently identified pre‐Columbian Old World RA removes the objection to its suggested New World Origin.

Analgesic prescribing in patients with inflammatory arthritis in England: an observational study using electronic healthcare record data.

ObjectivesInternational data suggest inflammatory arthritis (IA) pain management frequently involves opioid prescribing, despite little evidence of efficacy, and potential harms. We evaluated analgesic prescribing in English National Health Service-managed patients with IA.MethodsRepeated cross-sectional analyses in the Consultations in Primary Care Archive (primary care consultation and prescription data in nine general practices from 2000 to 2015) evaluated the annual prevalence of analgesic prescriptions in: (i) IA cases (RA, PsA or axial spondyloarthritis [SpA]), and (ii) up to five age-, sex- and practice-matched controls. Analgesic prescriptions were classified into basic, opioids, gabapentinoids and oral NSAIDs, and sub-classified into chronic and intermittent (≥3 and 1–2 prescriptions per calendar year, respectively).ResultsIn 2000, there were 594 cases and 2652 controls, rising to 1080 cases and 4703 controls in 2015. In all years, most (65.3–78.5%) cases received analgesics, compared with fewer (37.5–41.1%) controls. Opioid prescribing in cases fell between 2000 and 2015 but remained common with 45.4% (95% CI: 42.4%, 48.4%) and 32.9% (95% CI: 29.8%, 36.0%) receiving at least 1 and ≥3 opioid prescriptions, respectively, in 2015. Gabapentinoid prescription prevalence in cases increased from 0% in 2000 to 9.5% (95% CI: 7.9%, 11.4%) in 2015, and oral NSAID prescription prevalence fell from 53.7% (95% CI: 49.6%, 57.8%) in 2000 to 25.0% (95% CI: 22.4%, 27.7%) in 2015. Across years, analgesic prescribing was commoner in RA than PsA/axial SpA, and 1.7–2.0 times higher in cases than controls.ConclusionsAnalgesic prescribing in IA is common. This is at variance with existing evidence of analgesic efficacy and risks, and guidelines. Interventions are needed to improve analgesic prescribing in this population.

O06 Inflammatory arthritis triggered by COVID-19

Case report - IntroductionCOVID-19 is an infectious disease caused by a newly discovered β-coronavirus, named Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), resulted in a recent pandemic of COVID-19.As a novel pathogen, the nature and degree of risk of COVID-19 to individuals with rheumatic diseases were unknown, as was its ability to induce musculoskeletal and autoimmune disease. Concerns were related to the chronic autoimmune or inflammatory disease and immune suppressive medications to treat it. The consequences of this infection are currently not fully understood, including the autoimmune sequelae. Here we present two cases of inflammatory arthritis with a temporal link to COVID-19. Case report - Case description: Case 1A 37-year-old Caucasian male was referred to Rheumatology with severe joint pains. He developed flu-like symptoms in early April 2020, with myalgia, fever, sore throat, anosmia, and fatigue. SARS-CoV-2 PCR swab was positive. He recovered from these initial symptoms, however 4 weeks later, he developed pain and swelling in his hands, feet, ankles, and knee joints with early morning stiffness.On examination, there was marked synovitis of hands, wrists, knees, and ankle joints. Systemic examination was otherwise normal.Case 2A 70-year-old lady developed sore throat and cough started in late March 2020. 3 weeks later, she became generally unwell with lethargy and fatigue. Her cough gradually improved, but she continued to experience breathlessness on minimal exertion. In early May 2020, she developed excruciating pain in her hands, wrists, and right knee joints with morning stiffness. On examination she had synovitis in the wrists, small joints of the hands and right knee. Systemic examination otherwise was unremarkable.Given the severe inflammatory arthritis, both patients were commenced on oral prednisolone with remarkable improvement 4 weeks later.Case report - DiscussionWe present 2 cases of acute inflammatory arthritis, which were suspected to have been triggered by COVID-19 viral infection without any musculoskeletal complications with good prognosis. COVID-19 is a new disease and our understanding of it is continuing to grow.The initial concern was that COVID-19 -19 infection may lead to severe illness in immunocompromised patients, including those and with rheumatic conditions. However, this was not seen in large numbers. To our knowledge, COVID-19-related inflammatory arthritis has not previously been reported in the literature.Our current understanding of the COVID-19 pathogenic mechanisms is limited. However, it is likely that the disease may evolve in overlapping phases.Case report - Key learning pointsIn both cases, it was suggested that COVID-19 19 may be a triggering factor for inflammatory arthritis with good prognosis and settled with steroid therapy. It was suggested that arthritis may occur in patients with COVID-19, in previously fit and well patients without any underlying co-morbidities and autoimmune rheumatic disease and warrants urgent Rheumatology review. However, all COVID-19 suspected cases should be investigated on an individual basis to exclude other diagnosis to avoid missing other common reversible illnesses. O06 Table 1:Investigations at Baseline and 4 weeks Case 1 Case 2 Baseline4 weeks Baseline4 weeks CRP (<5) mg/L18227694ESR (2-28mm/hour)3 90 Hb (130-180 g/L)14315293114Wbc (4.0-11.0)109/L8.05.311.812.1Neutrophil (1.7-7.5)109/L5.793.289.2910.20Lymphocyte (1.0-4.5) 109/L1.391.381.241.14CK (<200) U/L90 22 ANANegative Negative ENA 0.2 0.3 ANCANegative ND RF (0-14) U/mL<10 428 CCP (0.4-6.9) U/mL0.8 51 ImmunoglobulinsNormal IgG,17.9 ComplementsND Normal CXR Bil Hilar enlargement Diffuse widespread air space opacities CT Chest Significant mediastinal Lymphadenopathy with no specific features Multifocal GGO, patchy consolidation, likely recovery stage of COVID-19

Treatment of immune checkpoint inhibitor-induced inflammatory arthritis.

This review summarizes the current evidence on treatment strategies for inflammatory arthritis because of cancer treatment with immune checkpoint inhibitors (ICI), prognosis of ICI-induced arthritis, and management of patients with preexisting inflammatory arthritis receiving ICI therapy. Inflammatory arthritis is the most common rheumatic immune-related adverse event observed in patients receiving ICI therapy. Most patients can successfully be treated with low doses of corticosteroids or conventional synthetic disease modifying anti-rheumatic drugs (DMARDs). A small minority will develop severe symptoms requiring biologic therapy including TNF inhibitors and IL-6 receptor inhibitors. Many cases of inflammatory arthritis will resolve with cessation of ICI therapy. Some patients will develop persistent arthritis despite discontinuation. Patients with preexisting inflammatory arthritis (e.g. rheumatoid arthritis) commonly flare on ICI therapy, but can usually be managed with corticosteroids. Inflammatory arthritis following ICI therapy for cancer is relatively common and the practicing rheumatologist should be able to recognize and manage it in conjunction with Oncology. The majority of patients respond to corticosteroids, but some will need treatment with conventional synthetic or biologic DMARDs. Additional studies should investigate the effects of immunosuppression on tumor response and the use of ICI therapy in patients with preexisting autoimmune disease.

Early Diagnosis Of Inflammatory Arthritis By Primary Care Physicians Following Training By A Rheumatologist.

BackgroundEarly diagnosis and therapeutic management of inflammatory arthritis (IA) is crucial for minimizing disease progression and improving outcomes. We recently developed the New Early Arthritis Referral Criteria to help improve the detection of suspected early IA via musculoskeletal (MSK) examination. The present study aimed to evaluate the agreement between rheumatologists and primary care physicians (PCPs) trained by rheumatologists in detecting IA when applying the standardized MSK examination techniques used to develop this criteria in a real-world setting in Jeddah, Saudi Arabia.MethodsThis quasi-experimental study was conducted in 4 primary health centers and involved 30 PCPs and 3 rheumatologists. All PCPs were trained by rheumatologists to apply the standardized MSK examination techniques used to develop the New Early Arthritis Referral Criteria. Patients were eligible if they were >18 years of age and presented with small-joint pain that persisted for >6 weeks. Patients were excluded if they had prior diagnosis of osteoarthritis, hand fractures, or rheumatic disease associated with IA. All patients were examined separately by a PCP and a rheumatologist, with the findings compared via kappa statistics and the rheumatologist’s findings considered the “gold standard”.ResultsData from 202 of the 203 enrolled patients were analyzed. There was fair-to-moderate agreement between PCPs and rheumatologists when assessing swelling of the small joints and wrist of the right side (range of kappa: 0.14–0.41) and low-to-moderate agreement in similar examinations of the left side (range of kappa: 0.04–0.42). Assessments of joint tenderness showed fair-to-moderate agreement for both the right side (range of kappa: 0.22–0.47) and left side (range of kappa: 0.24–0.45). P-values were significant for virtually all comparisons.ConclusionMSK examinations by PCPs showed a promising extent of agreement in detecting IA with those by rheumatologists following training. Refinement of the standardized training process could further improve accuracy and help PCPs to confidently identify cases of early IA, thus allowing earlier intervention than is typical in this setting.

Is There a Place for Hematopoietic Stem Cell Transplantation in Rheumatology?

In a time where new immunomodulatory therapies are widely available, it seems remarkable that the number of hematopoietic stem cell transplantations (HSCT) performed in rheumatic diseases is still increasing. However, in progressive systemic sclerosis, autologous HSCT is the only treatment with proven survival benefits. In refractory cases of inflammatory arthritis, systemic lupus erythematosus, and several other rare rheumatic conditions, HSCT contributed to better disease control as well. Nevertheless, HSCT is still associated with considerable risks, and a careful balancing of benefits and risks remains paramount.

An advanced clinician practitioner in arthritis care can improve access to rheumatology care in community-based practice.

ObjectiveTo facilitate access and improve wait times to a rheumatologist’s consultation, this study aimed to 1) determine the ability of an advanced clinician practitioner in arthritis care (ACPAC)-trained extended role practitioner (ERP) to triage patients with suspected inflammatory arthritis (IA) for priority assessment by a rheumatologist and 2) determine the impact of an ERP on access-to-care as measured by time-to-rheumatologist-assessment and time-to-treatment-decision.Materials and methodsA community-based ACPAC-trained ERP triaged new referrals for suspected IA. Patients with suspected IA were booked to see the rheumatologist on a priority basis. Diagnostic accuracy of the ERP to correctly identify priority patients; the level of agreement between ERP and rheumatologist (Kappa coefficient and percent agreement); and the time-to-treatment-decision for confirmed cases of IA were investigated. Retrospective chart review then compared time-to-rheumatologist-assessment and time-to-treatment-decision in the solo-rheumatologist versus the ERP-triage model.ResultsOne hundred twenty-one patients were triaged. The ERP designated 54 patients for priority assessment. The rheumatologist confirmed IA in 49/54 (90.7% positive predictive value [PPV]). Of the 121 patients, 67 patients were designated as nonpriority by the ERP, and none were determined to have IA by the rheumatologist (100% negative predictive value [NPV]). Excellent agreement was found between the ERP and the rheumatologist (Kappa coefficient 0.92, 95% CI: 0.84–0.99). In the ERP-triage model, time-from-referral-to-treatment-decision for patients with IA was 73.7 days (SD 40.4, range 12–183) compared with 124.6 days (SD 61.7, range 26–359) in the solo-rheumatologist model (40% reduction in time-to-treatment-decision).ConclusionA well-trained and experienced ERP can shorten the time-to-Rheumatologist-assessment and time-to-treatment-decision for patients with suspected IA.

The association between omega-3 fatty acid biomarkers and inflammatory arthritis in an anti-citrullinated protein antibody positive population.

Higher circulating omega-3 fatty acids (n-3 FAs) are associated with a lower prevalence of anti-CCP antibodies and RF in subjects without RA. We examined whether, in anti-CCP+ subjects, n-3 FAs also play a role in development of inflammatory arthritis (IA). At Colorado-based health fairs from 2008 to 2014, participants without a previous diagnosis of RA who were anti-CCP3+ (n = 47) were recruited into a follow-up study; symptom assessments and joint examinations were conducted every 6 months for the determination of IA. We measured n-3 FAs as a percentage of total lipids in red blood cell membranes (n-3 FA%) at each visit. We detected IA in 10 anti-CCP3+ subjects (21%) at the baseline visit. Increased total n-3 FA% in red blood cell membranes [odds ratio (OR) = 0.09, 95% CI: 0.01, 0.76], specifically docosapentaenoic acid (OR = 0.16, 95% CI: 0.03, 0.83) and docosahexaenoic acid (OR = 0.23, 95% CI: 0.06, 0.86), was associated with a lower odds of IA at the baseline visit, adjusting for n-3 FA supplement use, current smoking, RF+, elevated CRP+ and shared epitope. We followed 35 of the anti-CCP3+ subjects who were IA negative at baseline and detected 14 incident IA cases over an average of 2.56 years of follow-up. In a time-varying survival analysis, increasing docosapentaenoic acid significantly decreased risk of incident IA (hazard ratio = 0.52, 95% CI: 0.27, 0.98), adjusting for age at baseline, n-3 FA supplement use, RF+, CRP+ and shared epitope. n-3 FAs may potentially lower the risk of transition from anti-CCP positivity to IA, an observation that warrants further investigation.

SAT0478 Early inflammatory arthritis detection using a self-administered tool versus general practitioner diagnosis in primary care

BackgroundDelays to rheumatologic care represent addressable barriers to improved outcomes for inflammatory arthritis (IA)1. A self-administered tool has been developed for early IA detection in pre-rheumatology care settings. Psychometric properties...

Validation of a Self-administered Inflammatory Arthritis Detection Tool for Rheumatology Triage

The benefits of early intensive treatment of inflammatory arthritis (IA) are dependent on timely and accurate case identification. In our study, a scoring algorithm for a self-administered IA detection tool was developed and validated for the rheumatology triage clinical setting. A total of 143 consecutive consenting adults, newly referred to 2 outpatient rheumatology practices, completed the tool. A scoring algorithm was derived from the best-fit logistic regression model using age, sex, and responses to the 12 tool items as candidate predictors of the rheumatologists' blinded classification of IA. Bootstrapping was used to internally validate and refine the model. The 30 IA cases were younger than the 113 non-cases (p < 0.0001) and included clinical diagnoses of early IA (n = 10), rheumatoid arthritis (n = 9), and spondyloarthropathies (n = 11). Non-cases included osteoarthritis (n = 46), pain syndromes (n = 19), systemic lupus erythematosus (n = 5), and miscellaneous, noninflammatory musculoskeletal complaints (n = 43). The best-fit model included younger age, male sex, "trouble making a fist," "morning stiffness," "ever told you have RA," and "psoriasis diagnosis." The overall predictive performance (standard error, SE) of the derivation model was 0.91 (0.03). Internal validation of the derivation model across 200 bootstrap samples resulted in a mean predictive performance (SE) of 0.904 (0.002). The refined tool had a mean predictive performance (SE) of 0.915 (0.002), a sensitivity of 0.855 (0.005), and specificity of 0.873 (0.003). A simple, self-administered tool was developed and internally validated for the sensitive and specific detection of IA in a rheumatology waiting list sample. The tool may be used to triage IA from rheumatology referrals.

Periacetabular cement extrusion in the course of total hip replacement: Incidence and consequences. An analysis from 269 consecutive cemented total hips

Periacetabular cement extrusion during total hip arthroplasty is a frequent adverse event. This study sought to determine the contributing factors and any functional consequences of this type of extrusion, which has been insufficiently studied in the literature. We hypothesized that the occurrence of periacetabular cement extrusion could be the cause of an alteration in the functional result and/or intrapelvic complications. We retrospectively analyzed a series of 269 total hip prostheses consecutively implanted through a posterolateral approach using a second-generation technique with high-viscosity cement over a period of 1 year (186 standard cemented cups [69%] and 83 retentive cemented cups [31%]). The series comprised 110 males and 159 females aged a mean 69.3±16.8 years (range, 35-96 years). The indication for arthroplasty was primary osteoarthritis in 135 cases (50.4%), necrosis of the femoral head in 56 cases (20.8%), fracture of the femoral neck in 71 cases (26.5%), and seven cases of inflammatory arthritis. We radiographically assessed the frequency of periacetabular cement extrusion and then sought to determine the contributing factors as well as any eventual functional consequences based on the Modified Harris Hip Score, the existence of hip pain, and signs of pelvic dysfunction. Periacetabular cement extrusion was found in 68 patients (25%) and was more frequent in women. No other contributing factor was identified, notably the indication for arthroplasty, the operator's experience level, or the type of cemented cup. Extrusion was not accompanied by a change in the Harris function score nor an increased frequency of urinary or pelvic disorders. Periacetabular cement extrusion is frequent but its consequences are rare (mechanical, vascular, neurological, urological, or visceral). Preventing their occurrence with well-adapted technique is warranted (avoidance of perforating anchoring holes, control of cement penetration). Given the rarity of the consequences, ablation of any extrusion diagnosed intraoperatively should be cautiously pondered upon to prevent any potential iatrogenic incident for a doubtful gain. In cases of local pain persistence, the usual causes of hip pain should be ruled out before attributing the source of functional discomfort to extrusion and envisioning its removal.

Harlequin ichthyosis: a review of 50 cases and update of ABCA12 mutation analysis

Mutations in the ABCA12 gene underlie the most severe form of recessive congenital ichthyosis, Harlequin ichthyosis (HI). Due to the rarity of cases, there are no large series reporting the outcomes of babies born with HI. To improve the care of HI families, the authors have established a major referral centre for HI genetic screening and conducted an international study of 50 children born with this condition. The aim of this study is to assess the clinical outcomes of patients with HI referred to us for ABCA12 analysis and thereby report neonatal complications and long-term sequelae. Secondly, this study aims to identify novel mutations to facilitate prenatal diagnosis. Referring physicians were asked to review medical notes and retrospectively complete a clinical questionnaire. Adults and children over five were asked to complete a dermatology life quality index (DLQI) questionnaire. Mutation analysis was performed using PCR and sequencing but in one consanguineous case, reverse transcriptase-PCR (RT-PCR) on a parental skin biopsy was performed, followed by copy number analysis. Fifty responses were received. All infants had a typical appearance at birth and thereafter developed a persistent, diffuse scaly erythema with hair thinning and nail deformities. In most cases, acitretin was started shortly after birth. Approximately 54% of neonates survived into childhood and beyond. Mortality was associated with respiratory distress and sepsis. Early childhood skin infections with Staphylococcus, Streptococcus, Pseudomonas and MRSA were reported in one third. Problems maintaining weight necessitating nasogastric feeding in infancy and a high-calorie diet thereafter were seen in 58%. Older children experienced joint pain and there were two cases of inflammatory arthritis. While most children attended a mainstream school, 57% in the UK needed statementing. Despite the severity of the disease, the average children9s DLQI score was only 10/30. Eight novel ABCA12 mutations were identified and another three patients have been shown to harbour the common Pakistani mutation 7322delC. In the consanguineous case, a deletion of exons 12–15 was detected by RT-PCR and subsequently confirmed using copy number analysis. This is the first large-scale study of HI and provides important prognostic information for clinicians and affected families.

Interleukin-1 as a therapeutic target in systemic-onset juvenile idiopathic arthritis

Systemic-onset juvenile idiopathic arthritis (SoJIA) represents up to 20% of chronic inflammatory arthritis cases in childhood. The clinical manifestations of this disease are unique compared with other forms of juvenile idiopathic arthritis, and many SoJIA patients do not respond to available therapies, including antitumor necrosis factor agents. It has recently been demonstrated that the serum of SoJIA patients contains an interleukin (IL)-1-inducing factor, and an excess of IL-1β is secreted upon activation of SoJIA leukocytes in vitro, suggesting that IL-1 might represent a potential therapeutic target in this disease. Indeed, administration of an IL-1 receptor antagonist induced clinical remission and corrected the laboratory abnormalities in a group of patients who had been refractory to conventional therapies, supporting the idea that IL-1 is an important mediator of the disease.