Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan.
Cytokine. 2012 May;58(2):287-94. doi: 10.1016/j.cyto.2012.02.006. Epub 2012 Mar 6.
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.
巨噬细胞活化综合征（MAS）是全身型幼年特发性关节炎（s-JIA）潜在的危及生命的并发症。托珠单抗（TCZ），一种人源化抗白细胞介素-6 受体单克隆抗体，是一种有效的细胞因子抑制剂，用于治疗 s-JIA。我们描述了在 TCZ 治疗期间发生的五例 MAS 病例的临床过程，并证明需要监测血清白细胞介素（IL）-18 和 IL-6 浓度。与未接受 TCZ 治疗的患者相比，接受 TCZ 治疗的 s-JIA 患者的临床症状明显较轻。此外，即使在 MAS 期间，TCZ 治疗过程中血清 CRP 浓度也从未升高。血清 IL-6 浓度在 s-JIA 发作时和合并感染时升高。血清 IL-18 浓度在疾病活动的其他指标之前持续升高。MAS 和 s-JIA 的临床症状可能在 TCZ 治疗期间被掩盖；因此，建议监测血清 IL-18 和 IL-6 浓度以评估 s-JIA 的疾病活动，并检测感染的并发症。
