Occurrence of Rheumatoid Arthritis in a Patient Treated with Anakinra for Schnitzler Syndrome: A Case Report

To the Editor: We report a 65-year-old patient with Schnitzler syndrome evolving over 18 years who developed rheumatoid arthritis (RA) while being successfully treated for 8 years with the interleukin 1 (IL-1) inhibitor anakinra. This observation raises the question of the potential link between persistent IL-1 inhibition and RA. A 65-year-old man had typical Schnitzler syndrome diagnosed 16 years ago on account of a 2-year history of urticarial rash, intermittent fever of up to 40°C, pain in both tibias, and a monoclonal immunoglobulin M (IgM) κ component. Prednisone, ibuprofen, and interferon-α proved ineffective to control his symptoms. In February 2007, treatment with anakinra (100 mg/day) was started. Efficiency was immediate and spectacular. … Address correspondence to Dr. D. Lipsker, 1 place de l’hopital, F-67091 Strasbourg Cedex, France. E-mail: dan.lipsker{at}chru-strasbourg.fr