From the Guidelines
Elevated levels of all interleukins (IL), except for interleukin-8 (IL-8), which is within normal limits, suggest a chronic inflammatory process that requires prompt evaluation by a rheumatologist or immunologist to determine the underlying cause and guide treatment. This pattern of interleukin elevation could indicate autoimmune disorders, certain cancers, or inflammatory conditions, as seen in studies such as 1, which highlights the role of various biomarkers, including ferritin and S100A8/A9 proteins, in diagnosing and managing conditions like systemic juvenile idiopathic arthritis and adult-onset Still's disease. The normal level of IL-8 in this context is unusual, as IL-8 typically rises during acute inflammation, suggesting that this may not be an acute infectious process but rather a chronic condition 1. Key considerations in the evaluation of such a patient include:
- Ordering additional tests such as complete blood count, C-reactive protein, erythrocyte sedimentation rate, and specific autoantibody panels to determine the underlying cause.
- Considering the potential for autoimmune disorders, severe infections, certain cancers, or inflammatory conditions based on the pattern of interleukin elevation.
- Avoiding the initiation of anti-inflammatory medications without medical guidance, as they might interfere with diagnostic testing.
- Tracking symptoms such as joint pain, fever, fatigue, or rashes while awaiting a medical appointment, as this information will be crucial for making an accurate diagnosis. Treatment will depend on the specific diagnosis but may include immunosuppressants, corticosteroids, or targeted biologic therapies, such as those discussed in 1 for the management of Still's disease and other inflammatory conditions.
From the Research
Significance of Elevated Interleukin Levels
Elevated levels of all interleukins (IL), except for interleukin-8 (IL-8) which is within normal limits, may indicate a complex immune response. The following points highlight the potential significance of this phenomenon:
- Elevated IL levels can be associated with a cytokine storm, a condition characterized by an overactive immune response, which can lead to increased mortality in patients with COVID-19 2.
- The use of corticosteroids, such as prednisone, can help mitigate the effects of a cytokine storm by reducing inflammation and suppressing the immune system 2, 3, 4.
- Interleukin-1 (IL-1) and interleukin-6 (IL-6) are key players in the inflammatory response, and targeting these cytokines with specific therapies, such as anakinra (an IL-1 receptor antagonist) or tocilizumab (an IL-6 receptor antagonist), may be beneficial in managing patients with severe COVID-19 pneumonia and moderate hyperinflammation 2, 4.
- The optimal treatment strategy for patients with elevated IL levels may involve a combination of corticosteroids and immunomodulatory therapies, such as anakinra or tocilizumab, to reduce inflammation and improve clinical outcomes 2, 4.
Potential Clinical Implications
The following points highlight the potential clinical implications of elevated IL levels:
- Patients with elevated IL levels may require close monitoring and aggressive treatment to prevent progression to severe disease or respiratory failure 2, 4.
- The use of corticosteroids and immunomodulatory therapies may need to be tailored to the individual patient's response and clinical condition, with careful consideration of potential side effects and interactions 3, 4.
- Further research is needed to fully understand the role of ILs in the pathogenesis of COVID-19 and other diseases, and to develop effective treatment strategies for patients with elevated IL levels.