1. Gastrointestinal tract : Frequently, nausea (8%), diarrhea (7%), unspecific abdominal pain (5%).

2. Allergy : Rare cases of allergic reactions including severe anaphylaxis have been noticed. If necessary, the usual symptomatic therapy with corticosteroids, epinephrine, antihistamines and intravenous fluid correction should be initiated as soon as possible. Rare cases of allergic skin rash have also been seen.

3. Respiratory tract : Frequently, infections of upper respiratory tract (13%), sinusitis (7%), flu-like syndrome (6%), Infrequently, pneumonia and tuberculosis.

4. Skin : Frequently ecchymoses, infrequently skin mycosis, lupus erythematosus-like syndrome, urticaria, and isolated cases of melanoma 

5. Immune system : Frequently, infections (40%, severe in 2%). Infrequently, production of antibodies with neutralizing activity.

6. Blood and blood forming organs : Frequently, decrease in neutrophil counts (8% under anakinra, placebo 2%), infrequent significant neutropenia (0.4% under anakinra), moderate eosinophilia, moderately low platelet count, and malignant lymphomas (0.12 cases/patient year) 

7. Musculoskeletal system : Infrequently seen are arthritic symptoms, arthritic symptoms associated with inflammation, bony infections.

8. Pain, inflammation, and erythema at injection sites : Very frequently (70% of patients), usually during first 4 weeks of therapy, reversible within 1 to 2 weeks. These reactions are reasons why many patients discontinue therapy.

1- blood problem; neutropaenia, neutrophil is very important for fighting infection, so, blood test needed monthly in the first 3 months then every 3m up to one year

2- malignancies; the RA patients may be at high risk for lymphoma.

3- allergic reaction. rash, swollen face or difficulty breathing

the most commom side effect is injection site reaction.

4- infection espcialy chest infection

must do test for TB before use it

It is an IL-1 receptor antagonist, so immunosuppressive to some extent although usually well tolerated. The problem is that ankinra is a daily njection, and most patients prefer weekly, bi-weekly, or monthly injections of biologicals. It also acts slowly, not immediately; however, if the patient and treating physician persist, it can really be effective in treating RA a few months after initiation of therapy, 

The incidence of side effects of anankinra is as follows

More common

Diarrhea

fever or chills

headache

itching, pain, redness, swelling, tenderness or warmth on the skin

joint pain

muscle aches and pains

nausea or vomiting

runny nose or sneezing

sore throat

Less common or rare

Difficulty with swallowing

hives, itching, or rash

swelling of the face or lips

unusual bruising or bleeding

unusual tiredness or weakness

Incidence not known

Dizziness

fast heartbeat

hives or welts

large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs

puffiness or swelling of the eyelids or around the eyes, face, lips or tongue

We all need to realize that the above is a list of potential side effects. It does not mean that they are necessarily going to occur. In fact, the idea is that patients needing biologic therapy for RA or other autoimmune diseases will respond well to this type of treatmernt , without side effects, which is the case is the majority of patients. However, to be on the safe side, we monitor these patients on an ongoing basis with lab tests and clinical follow-ups, just in case something should develop. In addition, many of the side effects listed in the package insert are mandated by the FDA just because they were noticed during the drug trial regardless of whether they are in fact due to the drug in question,   

Why would you want to use anakinra in RA when it has very little efficacy? There are several more potent options. 

Well, yes, for RA, there are many other therapeutic options for sure. In fact, I cannot recall the last time I ordered anakinra for treating RA. However, I don't know why the author of this question is asking specifically about IL-1 inhibition particularly since he brought up Ilaris (canakinumab) in the same question,  

Maybe its JRA, by the tags attached? I pass on that.

the patient has a kind of dressler syndrome (pericarditis)

started with corticosteroid/methotrexate and now is trying to cut of them to go to other drugs cause of the CAPS syndrome

I am assuming you are referring to the cryopirin-associated periodic fever syndrome (CAPS), and not catastrophic antiphospholipid syndrome (the other CAPS in rheumatology). Can you give us more details about this patient? How old is she/he? The patient was originally diagnosed with Dressler syndrome, after open heart surgery? As you know, pericarditis has many etiologies, including autoimmune, e.g., lupus, infections, e.g., TB and viral, adult onset Still's disease, idiopathic, etc.  How was the diagnosis of CAPS made after an episode of pericarditis? Was colchicine tried? Thank you,

CAPS She is 34 years old

after open heart surgery (VSD) 

she had pericarditis 

colchicine was tried with corticosteroids but after the reduction of corticosteroid pericarditis stayed.

thensince March 2013 corticosteroids with methotrexate has been tried out- this did work but the patient wants after 2 years to cut of those meds. Anakinra has been tried for 3weeks with severe dermatitis at the injection.

any suggestions ?? 

Thank you for the information. It does look like she indeed had Dressler syndrome. If other causes have later been excluded, like infection, then I would try a second line agent such as azathioprine (Imuran), if the TPMT (thiopurine methyltransferase) screen is normal. The only detail that bothers me a bit is that Dressler syndrome usually does not last this long. Is she still on steroids, having chest pain, with a pericardial effusion by echocardiogram? Has she had a pericardiocentesis with cultures of the fluid?

infection is excluded MRI cardio has been clear and anosological(immune) examination negative.

this looks like a stress situation 

could it be a stress trigger from mast cells (see attached file)

thank you a lot 

except azathioprine?any other suggestions?

I don't know about stress triggers or the potential role of mast cells for a situation like this. That would be speculating on a possible pathophysiology. Rather, I would concentrate on treating the patient from a purely clinical standpoint. In other words, when you say the "the pericarditis stayed", what does that exactly mean? Did she improve initially, and then the pericarditis returned? Is it recurrent? Did she have one relapse? What is the basis for determining that she needs ongoing immunosuppression? Is she having chest pain? Are inflammatory markers, e.g., the CRP elevated? Is the echo showing pericardial fluid? You say the the MRI cardio is normal, so I am confused as to why you are saying that the pericarditis is still active,  

All the symptoms of the pericarditis return when she stops the corticosteroids- otherwise she is without any symptoms- when she stops taking the drugs CRP increases so does the pericarditis

The problem doesn't exist while she is on medication

I understand. What I would suggest then is: restart the colchicine, give her an oral boost of the prednisone for a few weeks, and when you start tapering the dose, introduce Imuran, beginning with a daily dose of 50 mg, as you continue the taper the steroids all the way done to zero, maintaining her later only on the colchicine and the Imuran,  

Thankyou for sharing this case. What is her ethnic origin? Has sustained Colchicine plus Aza allowed you to taper the steroids successfully?

I have found Anakinra to induce ISRs and other local skin reactions commonly. In the 3 weeks during which you used it, did you note any response or was it too difficult to tell? Use of alternate daily or thrice weekly Anakinra plus or minus concomitant antihistamines or potent topical corticosteroids may help attenuate the adverse skin response. Canakinumab might be better tolerated, but it is very expensive. Rilonacept development has unfortunately been discontinued.