Objective. To assess the efficacy of anakinra treatment in patients with adult-onset Still's disease (AOSD) that is refractory to corticosteroids, methotrexate (MTX), and etanercept.Methods. Four patients with AOSD were treated with prednisone and MTX and 2 patients were also treated with etanercept for worsening symptoms and indicators of systemic inflammation. White blood cells (WBCs), C-reactive protein (CRP) levels and/or erythrocyte sedimentation rate, and ferritin levels were measured and, in 1 patient, serum creatinine levels were determined. Treatment with anakinra at 100 mg/day was initiated.Results. The index patient's disease was refractory to treatment with prednisone (30 mg/day) and MTX, with spiking fevers, rash, synovitis, a serum ferritin level of 8,400 ng/ml (normal <200), and a CRP level of 86 mg/liter (normal <8). Levels of interleukin-1 (IL-1), IL-1␣, IL-6, IL-1 receptor antagonist, and IL-18 were elevated. Just prior to anakinra treatment, the WBC count was 14,600/mm 3 , the CRP level was 86 mg/liter, and the ferritin level was 573 ng/ml, with daily spiking fevers to 104°F, rash, and swollen joints. Within hours of the first injection, the patient was afebrile and asymptomatic; within days, the WBC count, ferritin level, and CRP level decreased into the normal range.On 2 occasions, anakinra was withheld. Within a few days, the WBC count rose to >20,000/mm 3 with prominent neutrophilia, the CRP level rose to >200 mg/liter, and the ferritin level rose to >3,000 ng/ml. Upon restarting anakinra, the patient became afebrile, the WBC count fell to 8,000/mm 3 , the CRP level fell to <3 mg/liter, and the ferritin level fell to <300 ng/ml. Three additional patients with refractory AOSD who experienced rapid reductions in fever, symptoms, and markers of inflammation when treated with anakinra are reported.Conclusion. Refractory AOSD appears to be IL-1-mediated since anakinra decreases hematologic, biochemical, and cytokine markers and also produces rapid reductions in systemic and local inflammation. Reported efficacy of tumor necrosis factor-blocking therapies in AOSD may be due to a reduction in IL-1.Adult-onset Still's disease (AOSD), a rheumatologic condition found worldwide, is characterized by a variety of clinical features, including intermittent fever, arthritis, evanescent rash, sore throat, leukocytosis, and hepatic dysfunction, polyserositis, lymphadenopathy, splenomegaly, and other systemic symptoms. Because of the diverse presentation (1), classifications have been developed to standardize the diagnosis of AOSD. The most widely accepted criteria set, as presented by Yamaguchi and colleagues (2), is a compilation of major and minor criteria with the exclusion of infections, malignancies, and other rheumatic or systemic diseases. More recently, Fautrel and associates have proposed classification criteria utilizing diagnostic markers of serum ferritin and glycosylated ferritin, thought to be more specific for AOSD (3). These criteria are said to provide a sensitivity of 80.6% and a specifi...
We study a 3d/2d dimensional degression which is a Kaluza-Klein type mechanism in AdS3 space foliated into AdS2 hypersurfaces. It is shown that an AdS3 massless particle of spin s = 1, 2, …, ∞ degresses into a couple of AdS2 particles of equal energies E = s. Note that the Kaluza-Klein spectra in higher dimensions are always infinite. To formulate the AdS3/AdS2 degression we consider branching rules for AdS3 isometry algebra o(2,2) representations decomposed with respect to AdS2 isometry algebra o(1,2). We find that a given o(2,2) higher-spin representation lying on the unitary bound (i.e. massless) decomposes into two equal o(1,2) modules. In the field-theoretical terms, this phenomenon is demonstrated for spin-2 and spin-3 free massless fields. The truncation to a finite spectrum can be seen by using particular mode expansions, (partial) diagonalizations, and identities specific to two dimensions.
We study a 3d/2d dimensional degression which is a Kaluza-Klein type mechanism in AdS 3 space foliated into AdS 2 hypersurfaces. It is shown that an AdS 3 massless particle of spin s = 1, 2, ..., ∞ degresses into a couple of AdS 2 particles of equal energies E = s. Note that the Kaluza-Klein spectra in higher dimensions are always infinite. To formulate the AdS 3 /AdS 2 degression we consider branching rules for AdS 3 isometry algebra o(2,2) representations decomposed with respect to AdS 2 isometry algebra o(1,2). We find that a given o(2,2) higher-spin representation lying on the unitary bound (i.e. massless) decomposes into two equal o(1,2) modules. In the field-theoretical terms, this phenomenon is demonstrated for spin-2 and spin-3 free massless fields. The truncation to a finite spectrum can be seen by using particular mode expansions, (partial) diagonalizations, and identities specific to two dimensions.
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