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Published on: May 29, 2020

Acute hepatitis in three patients with systemic juvenile idiopathic arthritis taking interleukin-1 receptor

Scott Canna1, Jennifer Frankovich, Gloria Higgins

  • 1Division of Rheumatology, The Children's Hospital, 13123 E 16th Ave, Aurora, CO 80045, USA.

Pediatric Rheumatology Online Journal
|December 24, 2009
PubMed

Insights

Interleukin-1 receptor antagonist (IL1RA) treatment for systemic Juvenile Idiopathic Arthritis (sJIA) may cause acute hepatitis in children. Discontinuation of IL1RA led to hepatitis resolution, suggesting a link between IL1RA and liver injury.

Area of Science:

  • Pediatric Rheumatology
  • Hepatology
  • Immunology

Background:

  • Systemic Juvenile Idiopathic Arthritis (sJIA) is a severe autoimmune disease.
  • Interleukin-1 receptor antagonist (IL1RA) is a biologic therapy used for sJIA.
  • Acute hepatitis is a rare but serious potential complication of medical treatments.

Purpose of the Study:

  • To investigate the cause of acute hepatitis in three children with sJIA treated with IL1RA.
  • To determine if IL1RA contributed to the development of hepatitis in these patients.

Main Methods:

  • Retrospective review of laboratory and clinical data for three pediatric patients with sJIA.
  • Evaluation for sJIA flare, infection, macrophage activation syndrome (MAS), malignancy, and drug reactions.
  • Analysis of liver biopsies for signs of hepatocellular injury.

Main Results:

  • Hepatitis persisted in all patients despite withdrawal of other potentially hepatotoxic drugs and absence of infectious triggers.
  • Hepatitis resolved after discontinuation of IL1RA in all three patients.
  • Liver biopsies showed inflammatory infiltrates and hepatocellular injury, not characteristic of MAS.

Conclusions:

  • IL1RA may contribute to acute hepatitis in children with sJIA.
  • Hepatitis might result from an altered immune response to infection or represent an atypical MAS presentation.
  • Close monitoring for hepatic toxicity is recommended during IL1RA treatment for sJIA.
Abstract

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