It is check details also possible that even a modest response to anti-TNF-α in these patients is due to a reduction in IL-1 activity since TNF-α induces IL-1 50. Not all patients with TRAPS respond to anakinra, and neutralizing antibodies to IL-6 receptor have been effective in reducing disease activity, as reported in a single patient 51. Several trials have shown the benefit of anakinra in treating the signs and symptoms of rheumatoid arthritis. After one full year of treatment, the reduction in disease severity in patients with rheumatoid arthritis treated with anakinra

is comparable to other treatments 52, 53. IL-1 is a potent inhibitor of proteoglycan synthesis in cartilage 54, and joint space narrowing and erosions in patients with rheumatoid arthritis treated with anakinra are clearly improved 52, 55, 56. Moreover, unlike TNF-α blocking therapies, there have been no reports of opportunistic infections, particularly reactivation of Mycobacterium tuberculosis, in patients treated with IL-1β blocking agents. In an

analysis of anakinra use in rheumatoid arthritis, Mertens and Singh 57 reviewed five trials involving 2065 anakinra-treated patients compared with 781 patients treated with placebo and reported that there was significant improvement in various clinical and biochemical markers of disease activity as well as Selleckchem LDK378 in the Larsen Protein kinase N1 radiographic scores of the anakinra-treated patients. The authors concluded

that anakinra is a relatively safe and modestly efficacious therapy for rheumatoid arthritis. Given that anakinra is injected each day and because the first weeks of anakinra injections can cause painful injection site reactions, anakinra is not as popular with patients or with rheumatologists as anti-TNF-α. By comparison, there is widespread use of anti-TNF-α agents in treating rheumatoid arthritis, which is due to both the reduction in joint inflammation as well as the rapid (within a day) reduction in the depressive effects of TNF-α on the central nervous system. For example, with the use of functional magnetic resonance imaging, it can be observed that within 24 h of an intravenous infusion of infliximab, not only is nociceptive central nervous system activity both in the thalamus and somatosensoric cortex, but also activation of the limbic system, blocked 58. These results explain the rapid and sustained feeling of well-being reported by patients receiving anti-TNF-α treatment. The efficacy and safety of anakinra was evaluated in patients with active psoriatic arthritis; anakinra led to an improvement in signs and symptoms in nine out of 19 patients; two patients had an American College of Rheumatology (ACR) score of 70 59 (an American College of Rheumatology score of 70 indicates that the patient has experienced an overall improvement of 70% in disease activity).